Erica Tilley, Speech Pathologist
What type of neurodegenerative conditions might require involvement from a speech therapist?
Neurodegenerative disorders are conditions where the cells in the brain are affected. In many conditions, the parts of the brain responsible for swallowing (eating and drinking), finding the right words (aphasia), coordinating muscle movements to make sound (voice) and speech can be affected. These conditions can include Huntington’s Disease, Motor Neuron Disease (MND), Primary Progressive Aphasia (PPA), Parkinson’s disease and more severe forms of parkinsonism such as Multiple System Atrophy (MSA), Progressive Supranuclear Palsy (PSP) and Corticobasal Degeneration (CBD). There are other neurological conditions which may or may not deteriorate over time including Multiple Sclerosis (MS), Spinocerebellar Ataxia (SCA), Myasthenia Gravis and Guillain Barre Syndrome.
Some examples of symptoms may include:
- rough or soft voice (dysphonia)
- slurred speech (dysarthria)
- difficulty swallowing meat or bread or coughing when drinking (dysphagia)
- word-finding difficulties
- an uncomfortable feeling of a catch in the throat or a feeling that the throat is closing over (in some cases with appropriate investigation it can be found to be inducible laryngeal obstruction)
How can a speech pathologist help with these conditions?
Receiving a new diagnosis can come as a shock to you and important people in your life. For neurologists it can also be a challenge as often medication options are limited for these types of disorders. Whilst researchers are working on finding a cure, it is simplistic to say that nothing can be done, rather there are many practical strategies or ‘life-hacks’ that can be put in place.
A speech pathologist can work with you to identify triggers (such as poor sleep, background noise) and implement strategies such as:
- Safe swallowing strategies
- Food and fluid modification
- Mealtime Management Plans
- Clear speech strategies
- Lee Silverman Voice Technique (for Parkinson’s disease)
- Vocal hygiene strategies
- Management of excess salivary secretions
- Methods of relaxing your airway
A good starting point for strategies to manage symptoms is to review resources and handbooks available from neurodegenerative condition associations for example MND Australia, Parkinson’s Australia, and PSP Australia (also has MSA and CBD). Here at Umbo, a Speech Pathologist can work with you to tailor the strategies to your own symptoms and everyday life activities. We can also work as a team with our Umbo Occupational Therapists to address other difficulties in activities of daily living you may be having. Depending on your age if you are under 65 years, we can also work with you to complete the initial assessments and reports to help you apply for a NDIS plan.
Can therapy for these conditions be done online?
A key part of assessment includes talking with you or significant people in your life about your individual situation and symptoms. After the case history has been obtained, we will then talk with you about further assessment which might involve having a conversation with you (looking at your communication) or seeing how you go having something to eat and drink (swallowing).
Based on your individual symptoms and goals, we can then tailor a communication or swallowing management plan. Depending on where you are at, you may be able to do this online on your own, or you may need to have someone with you to help facilitate the session. If you have a communication therapy plan you may feel comfortable practicing independently. Alternatively, we also have allied health assistants at Umbo who can help you with your therapy program.
If you are suspected to have possible inducible laryngeal obstruction, we can with your consent contact your GP and discuss suitable referrals such as assessment by a respiratory physician, gastroenterologist or ENT.
Is online therapy as effective as face-to-face?
Generally, online speech therapy can be as effective as traditional face-to-face therapy. The benefit of online therapy includes reduced wait times, sensory demands (associated with travel, wait-room environment) and opportunities to be assessed in your natural environment. For example, the type of chair you sit on at home (and the support it provides) may result in swallowing difficulties that would not be apparent if your swallowing was assessed in a clinic setting.
There are many ways in which therapy can be adapted to the online setting, for example handouts and therapy programs can be emailed through to you rather than given to you in person. Additional information can be provided to you and key people in your life about types of swallowing difficulties, how to identify them yourselves and to access first aid training for choking. This means you and your significant others can play a greater role in understanding your condition and how it affects you in everyday life.
Are there any things that can’t be done online?
In some cases you will benefit from what is known as objective assessment of swallowing. This is where it is unclear whether or not food or drink may be going down the wrong way and you will benefit from having either a camera (FEES) or an x-ray (Videofluroscopy study or Modified Barium Swallow) to assess you whilst swallowing. We will work with you to identify the closest option and provide a referral for these services often available in the outpatient hospital setting.
At Umbo we have Speech Pathologists who can provide therapy for neurodegenerative conditions online, via videolink. Book a free consultation to talk with one of our therapists about your needs.