Journal of Neurology, Neurosurgery, and Psychiatry 1983;46:140-144 Speech therapy for Parkinson's disease

SUMMARY Twenty-six patients with the speech disorder of Parkinson's disease received daily speech therapy (prosodic exercises) at home for 2 to 3 weeks. There were significant improvements in speech as assessed by scores for prosodic abnormality and intelligibility ' and these were maintained in part for up to 3 months. The degree of improvement was clinically and psychologically important, and relatives commented on the social benefits. The use of a visual reinforcement device produced limited benefit over and above that from prosodic exercises alone, except to patients with severe speech disorder. About one half of all patients with Parkinson's disease show disorder of speech, its severity being generally but by no means universally related to the severity of physical disability.1-3 The main features are reduced intensity of voice, a tendency to increased and unvarying pitch, monotony of speech, and an abnormal rate of speaking. " It contributes substantially to disability, and patients and their relatives regard speech difficulties as responsible for much embarrassment and social isolation.3 The speech disorder of Parkinson's disease responds to levodopa,4 and indeed improvement in speech is often the first objective evidence of response. Though obvious abnormality of speech frequently persists in patients on otherwise optimal drug therapy,4 formal speech therapy is usually considered as of limited value.7 8 A small uncontrolled trial previously reported9 demonstrated that improvement in communication following speech therapy was possible and might last at least in part for up to 6 months. The present study attempts to provide controlled observations on a larger group of patients, and to assess the value of a visual reinforcement device. Patients and methods Forty-six patients with Parkinsonian speech disorder were referred by hospital consultants, general practitioners, an