Reduced motor dysarthria is the main speech disorder in Parkinson’s disease. Hoarseness is the main speech feature. Most patients exhibit laryngeal dysfunctions. Rough sounds, breath sounds, vocal tremors, single tone and single volume can also occur in some patients. Speech disorders are characterized by low voice, slow speech, low pitch, short speech, lack of rhythm, diminished stress, inaccurate consonants, and occasional harsh sounds.
Training:
1.Relaxation training
Head and neck training: head rotation to the left and right, lateral tilt, head, jaw, neck first simultaneously retraction and then forward extension, can be carried out according to the rhythm of the trunk, upper and lower limbs relaxation training intentional relaxation method.
2.Breathing training
Deep breathing method — abdominal breathing, deep inhalation and fine exhalation.
Deep breathing, emphasizing the expansion of the chest and abdomen when inhaling, when exhaling, both hands press both sides of the thorax, deflated abdomen with breathing movement, requiring patients to experience the feeling of torso straightness in breathing.
3.Facial movement training
The face should be trained with swallowing and expressions, such as smiling, frowning, blinking, pouting, cheek puffing, showing teeth and whistling in the mirror, and the therapist should massage and pull the facial muscles.
4.Language training
Alternating lip and tongue movements
Soft palate elevation exercise
Pronunciation initiation training
Continuous vocalization training
Volume control training
Phonetic control training
5.Treatment for the improvement of phonation
The principle is to train to pronounce vowels first, then consonants. Consonants start with bilabial sounds such as b, p, m, etc. After being able to pronounce consonants, we should combine the consonants we have mastered with vowels for training, and finally transition to training of words and sentences.
6.Slowing down speech speed training
Metronome use
7.Sound recognition training
8.Training to overcome nasalization
Palm pushing therapy, guided airflow method
Difficulty in swallowing: difficulty in starting the swallowing action, slow chewing and swallowing action, saliva accumulation in the mouth resulting in a lot of salivation.
Assessment of swallowing function
1.Repeated saliva swallowing test (RSST)
2.Wakita drinking test
The patient sits upright, drinks 30ml of warm water, and observes the required time to drink and cough. grade 1 (excellent) can swallow the water smoothly in one go.
Grade 2 (good) can swallow without choking and coughing in 2 or more times
Grade 3 (moderate) can swallow in 1 time but with choking and coughing
Grade 4 (OK) swallows in 2 or more times, but with choking
Grade 5 (poor) frequent choking and coughing, unable to swallow all
Normal: grade 1, within 5 seconds; suspicious: grade 1, more than 5 seconds or grade 2; abnormal: grade 3 to 5
Swallowing function training.
1, active and passive movements of the lips, cheeks and tongue to enhance the strength of the muscles involved in swallowing and improve the flexibility and coordination of the pharyngeal muscles
2.Respiratory and phonatory training can promote the contraction of swallowing muscles and improve the blood circulation of swallowing and phonatory organs;
3.Ice sticks stimulate the posterior pharyngeal wall to make the pharyngeal muscles contract, which can prevent pharyngeal muscle atrophy and promote the recovery of sensory function and reduction of glandular secretion in the oral cavity and posterior pharyngeal wall;
4, low-frequency electrotherapy can promote the contraction of pharyngeal muscles, improve local blood circulation and regulate autonomic function;
5, psychological support therapy is the basis and guarantee of successful swallowing training.
6, the use of appropriate eating aids and food nutrition.