Environmental Modifications for Parkinson’s Disease

What environmental changes will enhance your speech therapy sessions for patients with Parkinson’s disease?

In this article, you’ll find practical environmental modifications for Parkinson’s disease to help your patients get the most out of their time with you.

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Why Environmental Modifications?

Environmental modifications can help compensate for some of the speech, communication, cognitive, and motor challenges of Parkinson’s disease.

Speech-therapy-related challenges include:

• Decreased intelligibility
• Speaking too softly
• Speaking too quickly
• Breathiness when speaking
• Decreased non-verbal communication (gestures, facial expressions)
• Impaired cognition (attention, memory, problem-solving, etc.)
• Difficulty with writing, typing, self-feeding, and other fine motor skills

Voice & Speech Environmental Modifications for Parkinson’s Disease

Below are environmental modifications that help compensate for the voice and speech issues common in patients with Parkinson’s disease during your speech therapy sessions.

• Choose a quiet space (turn off the TV, radio, fans)
• Make sure you can see the patient’s face (turn on more lights, sit face-to-face, sit close enough)
• Use AAC (more below)
• Use an amplifier or other tech (more below)
• Keep your throat hydrated (keep water nearby to sip, use a humidifier if the air is dry)

(ASHA, n.d., Cleveland Clinic, 2020)

Cognitive Environmental Modifications for Parkinson’s Disease

Automatic behaviors are impaired in patients with Parkinson’s disease. They may also experience impaired memory, attention, and planning.

To improve success with cognitive tasks you can modify the environment by 1) increasing reminders and 2) decreasing distractions.

• Post the patient’s schedule
• Add labels (closets, pantry)
• Set reminders (alarms)
• Modify tasks to decrease the cognitive load (simplify, decrease multitasking)
• Organize the space to decrease distraction, time pressure, and fatigue (get rid of clutter, put things in the same place, keep high-use items on a wheeled cart)

Motor Environmental Modifications for Parkinson’s Disease

Collaborate with occupational therapy for help with environmental modifications that can compensate for the motor issues impacting your speech therapy sessions.

Example motor issues and compensations:

• Tremors: Weighted utensils for self-feeding or writing
• Fine motor difficulties: Built-up handles for cutlery, pens, stylus, etc.
• Fatigue and motor difficulties: Reorganize working environments (desk, dining table, kitchen counter, etc.) to minimize bending and reaching

AAC For Parkinson’s Disease

See the AAC Pack for pre-made AAC boards.

Adding the right AAC to the environment can help patients with Parkinson’s disease improve communication, reduce fatigue, and compensate for motor difficulties.

Have the AAC easily accessible to the patient at all times. For example, you might keep an alphabet board on a rolling cart. Or a cell phone with a text-to-speech app in the patient’s pocket.

The level of AAC will depend on the severity of the symptoms and on the patient’s preferences and budget. Below are AAC ideas that range from pen and paper to alternative access devices.

AAC Ideas:

• Felt-tip pen and notepad (or whiteboard and dry-erase marker) for patients to write on, if they can still write or draw
• Gestures
• Pointing
• Photos
• Alphabet board or needs board if writing is difficult
• Text-to-speech apps (especially for words and phrases)
  • Examples are LetMeTalk and Proloquo2go™ 

Alternative Access for High-Tech AAC:

For patients who have severe dysarthria and limited use of their hands:

• Stylus and joysticks to scan and select items on high-tech systems (AbleNet®, Smartnav™, Enabling Devices, School Health®)
• Trackballs and touch-pads to navigate high-tech systems (School Health, AbleNet)
• Head tracking and eye gaze to navigate high-tech systems (Tobii; PRC-Saltillo; Eyegaze, Inc.)

Tech for Parkinson’s Disease

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Below are technologies that can compensate for the quiet and/or unintelligible voices of people with Parkinson’s disease.

Portable Amplifiers

Portable amplifiers are pocket-size devices that come with 1) a microphone patients talk into and 2) a speaker to broadcast their voice at a louder volume.

Even if a patient has learned to speak louder with voice treatments such as LSVT LOUD or SPEAK OUT!, an amplifier may still be helpful in noisy environments.

There are many affordable options on amazon.com, and they may be covered by insurance and other funding sources.

Phone Tech: Telecommunication Relay Services

Telecommunication Relay Services (TRS) is a service that helps patients communicate effectively over the phone. It’s a free service funded by the U.S. government.

There are several types of TRS (learn more here), but we’ll cover three helpful systems for those with Parkinson’s disease:

• TTY Telephone Relay System. TTY includes both a special phone and an operator. The phone has a keyboard for the patient to type messages (or even single words) that their listener doesn’t understand. The operator then reads the message to the listener.
• Internet Relay System. Instead of typing their message into a phone, the patient types the message online. The operator then reads the message to the listener.
• Speech to Speech Relay (STS).  The patient calls their local STS number and relays their telephone message to a professional who is familiar with many different speech patterns. The professional then makes the call for the patient, using their exact words.

SpeechVive

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SpeechVive is a wearable device developed by an SLP that triggers the brain to speak louder, slower, and clearer.

How SpeechVive works (from speechvive.com):

1. The patient wears the device
2. SpeechVive tunes in to the patient’s voice
3. When the patient speaks, it plays a ‘babbling’ sound into their ear
4. This triggers the reflex to speak louder (in order to talk over the sound of the babbling)
5. The patient automatically speaks 50-75% louder
6. SpeechVive is silent when the patient isn’t speaking

The company advertises itself as an alternative to traditional voice treatment programs—but without the cognitive load or behavioral changes required to be successful with these programs. See their research page for more details.

SpeechVive is covered by U.S. Medicare, the Veteran’s Association, and some insurance companies.

More Speech Therapy Resources

References

• American Speech-Language-Hearing Association. (n.d.). Dysarthria in adults [Practice portal]. https://www.asha.org/Practice-Portal/Clinical-Topics/Dysarthria-in-Adults/ Retrieved Sep 12, 2023.
• Cleveland Clinic. (2020). Tips for Improving Communication in People with Parkinson’s Disease. Retrieved September 14, 2023, from https://my.clevelandclinic.org/health/diseases/9392-speech-therapy-for-parkinsons-disease
• Federal Communications Commission. (2022.)Telecommunication Relay Services (TRS). Retrieved September 20, 2023, from https://www.fcc.gov/trs
• Kalf, J. G. et al. (2011). Guidelines for Speech-Language Therapy in Parkinson’s Disease. ParkinsonNet. https://www.parkinsonnet.nl/app/uploads/sites/3/2019/11/dutch_slp_guidelines-final.pdf
• Sturkenboom, I. et al. (2011). Guidelines for Occupational Therapy in Parkinson’s Disease Rehabilitation. ParkinsonNet. https://www.parkinsonnet.nl/app/uploads/sites/3/2019/11/ot_guidelines_final-npf__3_.pdf
• Wu, T., Hallett, M., & Chan, P. (2015). Motor automaticity in Parkinson’s disease. Neurobiology of Disease, 82, 226. https://doi.org/10.1016/j.nbd.2015.06.014