Graduate Student Clinician Rush University Medical Center Norridge, Illinois, United States
Disclosure(s):
Nicol C. Musielak, n/a: No financial or non-financial relationships to disclose
Abstract: A case to improve speech function in a patient with Parkinson’s disease (PD) and bilateral subthalamic nucleus deep brain stimulation (STN DBS) was reported. The patient had PD and active bilateral STN DBS which interfered with his speech production. Data collected pre- and post-treatment of 14 weekly sessions. The treatment used exercise and strategy to improve speech comprehensibility, targeting hypokinetic dysarthria and palilalia.
Summary of Presentation : The focus of the presentation was on improving speech function in a patient with Parkinson’s Disease (PD) and subthalamic deep brain stimulation (STN DBS) and severe speech impairment. Parkinson’s disease is a progressive, neurodegenerative disorder. It affects people over the age of 65 and has an estimated prevalence in the U.S. of 1 million and 10 million people worldwide. It is a result from degeneration of dopaminergic neurons in the substantia nigra located in the midbrain and the basal ganglia control circuit is affected. STN DBS is implantation of electrodes in areas of the brain to regulate abnormal impulses. Speech disturbances are common adverse effects in PD patients treated with bilateral STN DBS.
Patient A is a 68 year old male with Parkinson’s Disease (PD) and underwent subthalamic deep brain stimulation (STN DBS) and has a severe speech impairment. The patient was diagnosed with PD 11 years ago. He underwent left-sided STN DBS 6 years later and right-sided STN DBS two years subsequently. Patient presented with speech issues attributed to PD (hypokinetic dysarthria) and STN DBS (palilalia). At the initial evaluation, the patient demonstrated accelerated speaking rate and significantly decreased articulatory accuracy. This resulted in significantly reduced speech intelligibility, which was rated as “3-4” on the Speech Intelligibility Rating (SIR) Scale (0-5). Although the patient was initially treated with Lee Silverman Voice Treatment with some success, after chronic bilateral subthalamic nucleus deep brain stimulation (STN DBS), his speech function significantly deteriorated with new onset of severe palilalia which no longer responded to LSVT exercise. The long-term treatment goal was to improve and maximize speech function and oral speech comprehensibility. Respiration, respiration-phonation coordination, and prosody were targeted. A pacing board was used as a compensatory strategy to train the patient to forcefully separate words in production and effectively slow down speaking rate. The reassessment was carried out to measure the improvement in the patient’s functional speech in comparison to that from his pre-treatment evaluation. Patient received a score of “2” on the SIR Scale while using the learned compensatory strategies independently during functional phrases exercises and during topic conversations/running speech, which indicated a 2 point gain on the rating scale, resulting a change in severity from severe to a mild-moderate dysarthria.
STN DBS in PD may affect intelligibility negatively and speech therapy may help. High frequency practice individually with a pacing board may be a good strategy to target fast speaking rate (e.g., palilalia) in PD. Patient’s motivation and compliance are key to success.
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Learning Objectives:
At the completion of this activity, participants should be able to:
Upon completion, participant will be able to understand the basics of Parkinson’s Disease.
Upon completion, participant will be able to identify common speech characteristics in patients with PD and STN DBS.
Upon completion, participant will be able to utilize the Pacing Board and compensatory strategies in patients with PD and palilalia and hypokinetic dysarthria.