Communication Challenges in Multiple System Atrophy (MSA)
• Bonnie Bereskin, M. Ed.• Speech-Language Pathologist (reg. CASLPO)• [email protected]• (416) 633-2146
Agenda for evening
• What is MSA??• Communication challenges• Speech and voice exercises• Communication Circle – organization,
schedule and questions• Practice of speech and voice exercises
What is MSA?
• Progressive, neurodegenerative disease marked by a combination of symptoms affecting movement, blood pressure and other bodily functions
• Unpredictable course over time
• Usually 5-10 years in duration
Parkinsonson-like symptoms - Rigidity
• “Lead pipe” stiffness
• Trunk is more affected than limbs
• May cause pain and discomfort
Slowness of movement
• bradykinesia
• “hard to get going”
• slow movements in getting out of a chair, walking, writing etc.
Other problems
• Visual changes – blurred vision
• Swallow changes
• Postural instability
• Early changes in speech
Treatment
• Parkinson meds may help
• Non-drug treatments are of benefit:o Speech Therapyo Social Worko Physiotherapyo Occupational Therapyo Caregiver support
Quality of Life
• Illness affects all areas of lifeo Caregivero Socialo Financial
• Families sometimes become isolated with a chronic illness
Communication Difficulties in MSA
• Voice - quiet voice with little intonation• Speech – slurred, unclear sounds• Fluency – “stuttering-like” speech• Gesture - less movement because of
stiffness• Facial expression - less expression in the
face because of muscle stiffness
Importance of maintaining communication
• Despite the changes brought about by MSA, it is essential to work on maintaining good communication
Brain – attention skills
• Requires sustained attention for “good speech”
• MSA interferes with the automatic aspect of speech
• This is the most difficult task in improving speech
Good news
• Speech therapy
• Regular practising can help to maintain communication
• Regular social interaction decreases risk of isolation and gives needed support to the family
Bad news [skull and cross bones below strikes me as “too much”
• There is no magic pill
• Without regular practice, it becomes more difficult to communicate
Lee Silverman Voice Treatment (LSVT) for Parkinson’s Disease (not much in literature for MSA)
• Intensive program of regular exercise• Helps to improve individual’s perception
of his or her voice• Strengthens vocal cords, breath control
and voice
How do these exercises work and why?
• Individuals with MSA have reduced loudness, making speech hard to understand
• Focus is only on loudness – THINK LOUD
• The exercises are simple – they focus only on voice – not breathing, posture, articulation, etc.
Intensive treatment
• Program (LSVT) works well because of the intensive treatment
• Therapy and practice allow person to get a stronger voice
• It allows individual to “recalibrate” the amount of effort and loudness required
Voice Exercise – Exercise 1
• Ask __________ to sustain the “ah” sound for as long as possible
• This sound should be as loud as __________ can produce
• This simple exercise strengthens the vocal cords and improves breath control
• “THINK LOUD” – Try for as loud as possible
How Often ???
• This exercise is to be done at the beginning of each session
• 10 times each practice• Give ______ feedback about
each effort• Encourage a louder and
longer effort• Record your times
Exercise 2 for Rapid Rate
• Many people with MSA have trouble in controlling the rate of their speech
• It is as if the speedometer is broken and they cannot slow down
• Speech becomes increasingly difficult to understand
Pacing – Slower Rate of Speech
• Pacing slows down the speech and makes it more understandable because:o It gives more time for the
articulators to moveo Allows the individual time to
take a breatho Allows the listener time to
process the message
Downside of Pacing
• Not natural/robot like• Takes a great deal of
attention• Listener needs to remind
__________ frequently
Positive of Pacing
• Speech is much easier to understand
• Easy to learn• Can be used even with
quite severe speech problems
Divided attention – need for support
• Some people with MSA have difficulty doing a few things at the same time
• Speech is challenging as one has to concentrate on many things at the same time (message, listener, finding words, listening to the response, speaking clearly)
Need for support with speech
• One is more likely to use skills, to speak clearly, with support and reminding from friends and family. Many individuals forget to use skills without some reminding and coaxing
• When family and friends help with practicing it takes the responsibility off of spouse
What Can You Do???
• Practice diligently• Make sure that you do the
exercises as they are taught• Remind ____ to use “loud
voice” and “slow speech” in other situations
• Don’t be afraid to ask ____ to repeat something if you didn’t “get it” the first time
Gentle reminding/coaching
• Kindly remind _____ to use a slow rate of speech
• Frequent reminding can be annoying and so use humor and gentleness
Practice! Practice! Practice!
• The most effective exercises (like medications) need to be used regularly
• Speech exercises are only effective if practiced frequently
Take home message
• Start to improve your speech now
• Practice specific exercises – like meds, they do not work if not used
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