Many individuals who have speech and voice problems in Parkinson's Disease can hugely benefit from intensive therapy. However such treatments are often best suited to individuals with mild to moderate difficulties. Some individuals with more moderate to severe difficulties may still make gains while others will benefit most from tools to compensate rather than therapy to remediate. Let's take a look at some of the available tools.
Portable Voice Amplifiers
A portable voice amplifier is a device a person can use to amplify their voice. It is of great benefit to many people with Parkinson's Disease who commonly have low volume. It can make their speech audible enabling family and friend to hear and understand. There are a range of available portable voice amplifiers of varying price.
Some people may be conscious of wearing a portable voice amplifier as they consider it not to be the norm. They may not initially realise that it is of benefit. Praise and encouragement is important. If the amplifying their speech does make it clearer, then be sure to tell the person. You could audio-record them so they can hear the difference for themselves.
Some individuals with Parkinson's Disease begin to speak very quickly. They may not be aware of how quickly they are speaking. They also often have difficulty controlling their rate.
Conversation Paceboard can help teach a slower rate of speech. Some will be able to learn a slower rate with practice while others will need to continue to use the app when speaking in order to speak more slowly and make themselves understood.
Delayed Auditory Feedback
Delayed Auditory Feedback may help some individuals with Parkinson's and a fast rate of speech to improve intelligibility. Research has shown mixed outcomes.
Delayed Auditory Feedback (DAF) works by enabling the person to hear their speech in an altered manner. This disruption to the normal auditory feedback loop causes the speaker to slow down which can make their speech clearer.
There are different available DAF apps. DAF Pro is one option. It requires headphones to work effectively and records the person's voice when they are using DAF which can be used for feedback.
Text to Speech Apps
Text to speech apps are suitable for individuals with Parkinson's who a severe speech and/or voice problem provided they are able to access the keyboard. Clients who have dyskinesias/involuntary movements will likely find it more difficult to use a keyboard. There are a wide range of text to speech apps. Some options include Clarocom, Speech Assistant, Assistive Express, Proloquo4Text, Predictable.
Free text to speech apps often have lower quality voices with better quality voices available with a paid upgrade. The more expensive text to speech apps generally tend to have more in-built options such as touch settings, switch access and the option to post on social media (Facebook, Twitter).
Ideally your clinic or speech therapy department will have tablets with a range of text to speech apps that can be trialled. However, if you have access to an iPad without any purchased text to speech apps, try the free in-built Notes app with the client. This will at least help you find out if they are able to type on a touch keyboard.
When we are in an environment that is noisy such as a nightclub, we automatically increase our vocal effort to make ourselves more easily understood. This is known as the Lombard Effect.
SpeechVive is a prosthetic device that is based on the Lombard Effect or the Lombard Reflex. It detects the speech of the person wearing it and plays a sound stimulus (multi-talker babble noise) in one of their ears when they speak. The sound triggers the Lombard reflex, causing the person to speak louder & more clearly.
Recent research into the use of SpeechVive has found improved communication: increased vocal intensity, reduced speech rate, and/or improved speech clarity. It has also found that patients show different patterns of improvement. Some patients demonstrated improvement even when they were not wearing the SpeechVive device. Other patients needed to wear the SpeechVive device continuously.
There is a free SpeechVive app which simulates the effect of the SpeechVive prosthetic device that improves speech loudness for people with Parkinson’s Disease. You will need earphones when using the app.
Please note that the SpeechVive device is currently available in the US but not yet in the European Union.
Watch this video to see how the gentleman got on when he tried SpeechVive for the first time.
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