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Published on April 13, 2018

Finding his voice after Parkinson’s diagnosis Finding his voice after a Parkinson's diagnosis

Walter Stringer started to lose his voice gradually over a 10-year period. He went to several specialists for evaluations and had his vocal chords checked for impairments. All of his assessments and testing were normal.

Over time, his voice lost tone and audibility, and it became more difficult for him to carry on conversations.

“My wife, Carol, thought she was getting hard of hearing so she had it checked and her hearing was fine,” said Stringer, 74, of Falmouth.

His PCP, Natalie Chambers, MD, a Cape Cod Healthcare internist, referred him to Elizabeth Sharp, MS, CCC-SLP, a speech language pathologist at Falmouth Hospital, for a swallow and speech evaluation.

Sharp explained the hoarse or soft voice is sometimes an early symptom of Parkinson ’s disease. It can also be related to aging of the vocal chords. A consultation with a neurologist confirmed the diagnosis of Parkinson’s. While his voice was changing, Stringer didn’t realize there were other subtle signs of the disease, including lack of energy, difficulty sleeping, losing his train of thought and an occasional tremor.

An avid bicyclist, he rode 20 miles a day until a fall ended his riding days. He turned to walking and fell on the bike path and broke a tooth. He said he didn’t connect the falls and imbalance as signs of a problem.

The Speech Treatment Plan

Stringer was determined to learn how to speak louder and more clearly. He started working with Sharp in the Lee Silverman Voice Treatment Loud (LSVT-LOUD) program, one of only two LSVT programs offered on the Cape. Sharp is certified to provide the therapy, which is an intensive schedule of 16 one-hour sessions within four weeks.

“LSVT-LOUD improves both the voice and speech of individuals with Parkinson’s Disease by treating the underlying physical cause associated with the disordered voice,” said Sharp.

Patients aren’t always aware that their voice is soft or hoarse and it takes a great deal of concentration to think about using a high-energy, loud voice.

“They have one concept to focus on and that is to think loud,” said Sharp. “If I ask them to speak loud, they naturally have to take a breath, open their mouth and articulate their words. If instead, I specifically ask them to sit up straight, take a breath, open their mouth, over exaggerate, and talk loud, that’s too much to remember.”

The goal is to teach patients to recognize the amount of effort it takes to speak so they are heard and understood by their spouse, children, friends and people in the community, Sharp said. It has a great deal to do with internal cues, how much effort and how much energy they use to feel the loudness. She uses a computer program to constantly measure how loud their voice is during their session. Patients warm up much like singers warm up to sing a song. They learn to say phrases they often use at home, such as ‘good morning,’ ‘how are you,’ ‘what is the plan for today? ‘

“When they say it outside of this therapy room, they’ll remember that’s their phrase and remember to say it loud,” said Sharp.She builds on these exercises over the one-hour session, requesting them to say their name, their date of birth, read familiar phrases, sentences and paragraphs, and then, finally, answer personal questions giving one or two-word responses, then sentences and gradually increasing to conversational speech over the month of therapy.

There is homework that progresses from saying ‘hello’ and ‘goodbye’ to other people and being conscious of the amount of vocal effort needed to produce a loud, strong voice. They move on to having a one- to two-minute conversation with a familiar person and later asking a question or making a comment to the clerk in the store and, finally, having a conversation of at least five minutes with a family member or friend.

“They need to become comfortable doing this because in their head, they are shouting when, in reality, they really aren’t,” said Sharp.

The program has shown that 80 percent of participants are able to maintain their loudness of 80 decibels up to two years, and may then drop to 70 decibels.

“Their voice and speech are better than if they hadn’t done the therapy,” said Sharp.

Stringer, who credits his wife with helping him with the exercises, said he would recommend the program to others “in a heartbeat.”

“Since I’ve completed the program, my voice is better and it solved the problem that had been bothering me for years,” he said.