Speech Language
Pathology Toolbox
San Diego, November
2014
ATTP 2014 SLP Toolbox
Patient Quality-of-Life Surveys
Pt ID:
Date:
For the surveys below, there are no “right” or “wrong” answers. When answering, please consider both how severe the
problem is when you get it and how frequently it happens.
1. VHI-10 Instructions: These are statements that many people have used to describe their voices and the effects of their
voices on their lives. Circle the response that indicates how frequently you had the same experience in the last 4 weeks.
My voice makes it difficult for people to hear me.
0
1
2
3
4
People have difficulty understanding me in a noisy room.
0
1
2
3
4
My voice difficulties restrict personal and social life.
0
1
2
3
4
I feel left out of conversations because of my voice.
0
1
2
3
4
My voice problem causes me to lose income.
0
1
2
3
4
I feel as though I have to strain to produce voice.
0
1
2
3
4
The clarity of my voice is unpredictable.
0
1
2
3
4
My voice problem upsets me.
0
1
2
3
4
My voice makes me feel handicapped.
0
1
2
3
4
People ask, “What’s wrong with your voice?”
0
1
2
3
4
0 = Never
1 = Almost never
2 = Sometimes
3 = Almost always
4 = Always
Reference:; Rosen, C.A., Lee, A.S., Osborne, J., Zullo, T., & Murry, T., Development and validation of the Voice
Handicap Index-10, The Laryngoscope. 114, pp 1549-1556. (The validity and reliability of the VHI-10 has been
determined. The normal mean is 3.38; standard deviation is 5.65. Add up the points. A score of 10 or higher indicates
referral to SLP.
ATTP 2014 SLP Toolbox
2. RSI Instructions: These are statements that many people have used to describe their voices and the effects of their
voices on their lives. Circle the response that indicates how frequently you had the same experience in the last 4 weeks.
0 = No problem
5 = Severe problem
Hoarseness or a problem with your voice
0
1
2
3
4
5
Clearing your throat
0
1
2
3
4
5
Excess throat mucous
0
1
2
3
4
5
Difficulty swallowing food, liquids, or pills
0
1
2
3
4
5
Coughing after eating or after lying down
0
1
2
3
4
5
Breathing difficulties or choking episodes
0
1
2
3
4
5
Troublesome or annoying cough
0
1
2
3
4
5
Sensations of something sticking in your throat or a lump in your throat
0
1
2
3
4
5
Heartburn, chest pain, indigestion, or stomach acid coming up
0
1
2
3
4
5
Reference: Belafsky, P. C., Postma, G. N., & Koufman, J. A. (2002). Validity and reliability of the reflux
symptom index (RSI). J Voice, 16(2), 274-277, A score of 10 or high indicates a high suspicion of reflux disease and
medical referral.
3. CSI Instructions: These are statements that many people have used to describe their cough and the effects of coughing
on their lives. Please circle the response that indicates how frequently you had the same experience in the last 4 weeks. If
ATTP 2014 SLP Toolbox
you do not have a problem with coughing, please circle zero (0) in response to these statements.
My cough is worse when I lay down.
0
1
2
3
4
My coughing problem causes me to restrict my personal and social life.
0
1
2
3
4
I tend to avoid places because of my cough problem.
0
1
2
3
4
I feel embarrassed because of my coughing problem.
0
1
2
3
4
People ask, “What’s wrong?” because I cough a lot.
0
1
2
3
4
I run out of air when I cough.
0
1
2
3
4
My coughing problem affects my voice.
0
1
2
3
4
My coughing problem limits my physical activity.
0
1
2
3
4
My coughing problem upsets me.
0
1
2
3
4
People ask me if I am sick because I cough a lot.
0
1
2
3
4
0 = Never
1 = Almost never
2 = Sometimes
3 = Almost always
4 = Always
Gartner-Schmidt J, Shembel A, Rosen CA, Zullo TG. Development and Validation of the Cough Severity Index (CSI): A
Severity Index for Chronic Cough Related to the Upper-Airway. Accepted for publication in Laryngoscope.
ATTP 2014 SLP Toolbox
4. EAT-10: To what extent are the following scenarios problematic for you? Please circle the appropriate response.
0 = No problem
4 = Severe problem
My swallowing problem has caused me to lose weight.
0
1
2
3
4
My swallowing problem interferes with my ability to go out for meals.
0
1
2
3
4
Swallowing liquids takes extra effort.
0
1
2
3
4
Swallowing solids takes extra effort.
0
1
2
3
4
Swallowing pills takes extra effort.
0
1
2
3
4
Swallowing is painful.
0
1
2
3
4
The pleasure of eating is affected by my swallowing.
0
1
2
3
4
I cough when I eat.
0
1
2
3
4
Swallowing is stressful.
0
1
2
3
4
Please check that you have answered all of the questions.
Reference: The validity and reliability of EAT-10 has been determined. If the EAT-10 score is 3 or higher, you may have problems
swallowing efficiently and safely. We recommend discussing the EAT-10 results with a speech pathologist or
physician.
Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, Leonard RJ. Validity and Reliability of the Eating Assessment Tool (EAT-10). Annals
of Otology
Rhinology & Laryngology 2008;117(12):919-924.
Voice Handicap Index (VHI) – Jacobson et al., 1997
(AJSLP, Volume 6, pp. 66-70)
Name:______________________________
Date:________
Instructions: These are statements that many people have used to describe their
voices and the effects of their voices on their lives. Check the response that
indicates how frequently you have had the same experience within the past
month.
Statement
F1
My voice makes it
difficult for people to
hear me.
P2 I run out of air when I
talk.
F3
People have difficulty
understanding me in a
noisy room.
P4 The sound of my voice
varies throughout the
day.
F5
My family has difficulty
hearing me when I call
them throughout the
house.
F6
I use the phone less
often than I would like.
E7 I’m tense when talking
with others because of
my voice.
F8
I tend to avoid groups
of people because of
my voice.
E9 People seem irritated
with my voice.
P10 People ask, “What’s
wrong with your
voice?”
F11 I speak with friends,
neighbors, or relatives
less often because of
my voice.
Never Almost Sometimes Almost Always
Never
Always
Statement con’t.
F12 People ask me to
repeat myself when
speaking face-to-face.
P13 My voice sounds
creaky and dry.
P14 I feel as though I have
to strain to produce
voice.
E15 I find other people
don’t understand my
voice problem
F16 My voice difficulties
restrict my personal
and social life.
P17 The clarity of my voice
is unpredictable.
P18 I try to change my
voice to sound
different.
F19 I feel left out in
conversations
because of my voice.
P20 I use a great deal of
effort to speak.
P21 My voice is worse in
the evening.
F22 My voice problem
causes me to lose
income.
E23 My voice problem
upsets me.
E24 I am less outgoing
because of my voice
problem.
E25 My voice makes me
feel handicapped.
P26 My voice “gives out”
on me in the middle of
speaking.
E27 I feel annoyed when
people ask me to
repeat.
Never Almost Sometimes Almost Always
Never
Always
Statement con’t.
E28 I feel embarrassed
when people ask me
to repeat.
E29 My voice makes me
feel incompetent.
E30 I’m ashamed of my
voice.
Never Almost Sometimes Almost Always
Never
Always
Scoring the Voice Handicap Index
The items are divided into three subscales. Items in the functional (F) subscale
reflect statements that describe the impact of a person’s voice disorder on his or
her daily activities. The emotional (E) subscale consists of statements
representing a person’s affective (e.g. feeling) responses to a voice disorder.
Items comprising the physical subscale are statements representing selfperceptions of laryngeal discomfort and voice output characteristics.
To score the VHI, an Always response is scored 4 points, a Never response is
scored 0. The remaining options are scored between 1 and 3 points. Tally the
number of points for each of the subscales and also compute a total composite
score. Compare the patient’s values to published norms (Jacobson et al., 1997)
obtained from 65 adults patients seen in the Voice Clinic at Henry Ford Hospital,
grouped in the table below according to the severity of their voice disorder (e.g.
mild, moderate, severe).
Use these scores as pre- and post-treatment quality of life outcome measures.
An improved self-perception of the voice disorder following treatment reflects a
positive outcome.
Total the score for each subscale as well as total
Functional ______
Physical ______
Emotional ______
Total
______
Z-score for TOTAL VHI ____________________ INTERPRETATION: (mild,
moderate, severe) perceived voice disturbance that significantly impacts on
aspects of daily life.
Table 1. Normative mean and standard deviation (SD) values for VHI subscale
and total scale scores as a function of self-perceived voice severity obtained from
normal adults.
Normal Mean = 8.75
Standard Deviation is 14.97
Compute a Z-score for the pt’s Total Score so you can interpret the impact
of the patient’s voice disorder on QOL.
Pt Total Score – 8.75
14.97
Interpret the Patient’s z-score as follows: (negative values are WNL,
negative values mean no perception of handicap. Positive values indicate that
voice impairment has a negative impact on aspects of daily life).
Patient Z-score
0 to +1.00
+1.01 to +1.99
+2.00 to +2.99
Interpretation
No significant impact on aspects of daily life
Mild significant impact on aspects of daily life
Moderate significant impact on aspects of daily
life
+3.00 or greater
Severe significant impact on aspects of daily
life
If patient has a significant score, then also describe the physical, emotional, and
function contributions (from greatest impact to least). See report for Trish for an
example.
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Communication Effectiveness Survey
Ball, L., Beukelman, D., & Patee, G. (2004). Communication Effectiveness of
Persons with Amyotrophic Lateral Sclerosis. Journal of Communication
Disorders. 37(3), 197-215.
Please evaluate how effectively the speaker communicates in these
situations. Read the item describing each of the situations and decide how
successful the speaker communicates. If you think that communication is
very effective, circle the 7. If communication doesn't occur at all, circle
the 1. Circle any number on the scale that best describes communication in
that situation.(This can also be rated by the client).
1. Having a conversation with familiar persons in a quiet environment.
1
2
3
4
5
6
7
Not at all effective
Very effective
2. Having a conversation with strangers in a quiet environment.
1
2
3
4
5
6
7
Not at all effective
Very effective
3. Having a conversation with a familiar person over the phone.
1
2
3
4
5
6
7
Not at all effective
Very effective
4. Having a conversation with young children.
1
2
3
4
5
6
7
Not at all effective
Very effective
5. Having a conversation with a stranger over the phone.
1
2
3
4
5
6
7
Not at all effective
Very effective
6. Having a conversation while traveling in a car.
1
2
3
4
5
6
7
Not at all effective
Very effective
7. Having a conversation with someone at a distance.
1
2
3
4
5
6
7
Not at all effective
Very effective
8. Having a conversation with someone in a noisy environment.
1
2
3
Not at all effective
4
5
6
7
Very effective
9. Speaking or having a conversation before a group.
1
2
3
4
5
6
7
Not at all effective
Very effective
10. Having a long conversation with someone (over an hour).
1
2
3
4
5
6
7
Not at all effective
Very effective
Table 1. ALS Communication Effectiveness Ratings by ALS Speakers and
Listeners for 10 Social Situations
ALS SPEAKERS
LISTENERS
*Rank Situation
*Rank
Situation
1
Familiar persons, in a quiet place
1
Familiar persons, quiet place
2
Strangers, in a quiet place
2
Strangers, in a quiet place
3
Familiar person on the phone
3
Familiar person on phone
4
Speaking with young children
4
Speaking with young children
5.5
Strangers, on the phone
5
Strangers, on the phone
5.5
Speaking while traveling in car
traveling in car
6
Speaking while
7
Speaking at a distance
7
Speaking at a distance
8.6
In a noisy environment
8
In a noisy environment
8.6
Speaking before a group
9
Speaking before a group
8.6
Lengthy conversation (>1hr)
10
Lengthy conversation (>1hr)
*(Ranking of 1 is rated easiest)
References:
Ball, L., Beukelman, D., & Pattee, G. (Submitted) Communication
effectiveness of individuals with amyotrophic lateral sclerosis. Journal of
Communication Disorders.
Ball, L., Beukelman, D., & Pattee, G. (2001). A protocol for identification
of early bulbar signs in ALS. Journal of Neurological Sciences, 191: 43
Yorkston, K., Beukelman, D., Strand, E. & Bell, K. (1999). Clinical
management of speakers with motor speech disorders (2nd ed.). Austin, TX:
Pro-ed.
Carepartner Speech and Communication Survey
Margorie Johnson, (Parkinson Disease: Speech & Swallowing, NPF, 2nd Ed
If you are a carepartner, family member, or friend of a person who has PD,
complete this questionnaire. Circle the statements that are true for your friend or
family member.
•
•
•
•
•
•
•
•
•
I have difficulty hearing when s/he speaks.
I have difficulty understanding his or her speech.
S/he does not talk as much as in the past.
S/he does not attend social functions as frequently as in the past.
S/he often asks me to make phone calls or order from a menu for
him or her.
S/he clears his or her throat often.
S/he often sounds as if s/he is running out of breath when
speaking.
S/he suspects that I need a hearing aid.
S/he thinks I ignore what s/he has to say.
If you checked more than one item, your friend or family member probably has
problems with speech and communicating. Many of the problems revealed by
this survey can be improved with speech therapy. Talk to your doctor or health
care provided about referral to a speech language pathologist who specializes in
treatment with persons who have Parkinson Disease.
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1
Total Phonatory Range (TPR)
Bassich, ATTP 2013
Pt Name: _____________________ Date: _____________
Equipment: Korg Frequency Analyzer
GOAL: Measure (in Hertz) the highest (falsetto) and lowest fundamental frequency (but
not glottal fry) that pt can produce.
TASK: Various instructions can be used to probe maximum high and low. Pt must
sustain phonation for at least 3 seconds in order to measure with Korg Frequency
Analyzer.
Probes to obtain:
• Highest Fo (provide hand cueing during pt performance)
o Using the sound /i/, start at your mid-range and glide up to your highest note.
Hold that high note to the count of ‘5’ (DEMONSTRATE)
o Using the sound /i/, stair step up to your highest note. Hold that high note to
the count of ‘5’ (DEMONSTRATE)
o YAHOO
o Shriek, like you just saw a mouse or a snake in your house
o Pretend you are talking like Baby Bear (in Three Bears story) My porridge is
just riiiiiiiiight.
• Lowest Fo (provide hand cueing during pt performance)
o Using the sound “oo” (as in ‘who’) start at your mid-range and glide down to
your lowest not, pretending you are sitting down in a chair. Hold that low
note to the count of ‘5’ (DEMONSTRATE).
o Using the sound “oo” (as in ‘who’) start at your mid-range and stair-step
down to your lowest not, pretending you are sitting down in a chair. Hold
that low note to the count of ‘5’ (DEMONSTRATE).
o Imitate the sound of a fog horn.
o Pretend you are talking like Papa Bear (in Three Bears story) My porridge is
too cooooooold.
On the following page, place an “X” next to the lowest and highest note your patient achieves. Count the
number of semitones for his or her range (S column). Once you have the semitone range, use the
instructions to compute a z-score and then use normative table to interpret performance.
2
Note
C2
C2# / D2b
D2
D2# / E2b
E2
F2
F2# / G2b
G2
G2# / A2b
A2
A2# / B2b
B2
Semitones (S)
24
25
26
27
28
29
30
31
32
33
34
35
Frequencies (F)
65
69
73
77
82
87
92
98
103
110
116
123
C3
C3# / D3b
D3
D3#/ E3b
E3
F3
F3# / G3b
G3
G3# / A3b
A3
A3# / B3b
B3
36
37
38
39
40
41
42
43
44
45
46
47
130
138
146
155
164
174
185
196
207
220
233
246
C4
C4# / D4b
D4
D4# / E4b
E4
48
49
50
51
52
261
277
293
311
329
3
F4
F4# / G4b
G4
G4# / A4b
A4
A4# / B4b
B4
53
54
55
56
57
58
59
349
370
392
415
440
466
493
C5
C5# / D5b
D5
D5# / E5b
E5
F5
F5# / G5b
G5
G5# / A5b
A5
A5# / B5b
B5
C6
60
61
62
63
64
65
66
67
68
69
70
71
72
523
554
587
622
659
698
739
783
830
880
932
987
1046
highest note was ______ What is Fo? __________ What is semitone? ________
lowest note was ______ What is Fo? __________ What is semitone? __________
What is semitone range?
Compute pt z-score: [ Pt semitone range – norm Mean (ST)]
[Norm SD (ST)]
Authors
Ramig & Ringel, 1983
Linville, 1987
No. of
Subjects
8
8
8
24
20
23
Gender
Age
Mean (ST)
SD (ST)
M
M
M
F
F
F
26-35
46-56
62-75
25-35
45-55
70-80
32.2
28.3
31.4
33.1
34.0
29.0
8.77
8.74
4.38
3.43
3.22
4.13
4
Values falling:
Between -1 sd and +1 sd
Between -1.1 and -1.99
Interpretation
Total Phonatory Range is within normal limits
(WNL)for sex and age
Total Phonatory Range is mildly restricted
Between -2.0 and -2.99
Total Phonatory Range is moderately restricted
-3.0 or beyond
Total Phonatory Range is severely restricted
Between +1.1 and +1.99
Total Phonatory Range is greater than the normal
range (mild)
Between +2.0 and +2.99
Total Phonatory Range is greater than normal range
(moderately, probably a trained singer)
+3.0 or beyond
May observe this in a highly trained opera singer (e.g.
vocal athlete).
Interpretation:
Sample write-up in a report: Maximum total phonational range was assessed by stimulating Ms. Patient to
produce phonation using her lowest and highest voice. Fundamental frequency (Fo) was measured using a Korg
Frequency Analyzer. Her lowest Fo was measured at 207 Hz and her highest Fo was measured at 415 Hz. This
indicates a total phonatory range of 12 semitones (z-score = > -3.0), which indicates a total phonatory range
that is severely restricted . Fo values were restricted for both high and low voice productions.
 What is typical value of lowest Fo
o
Males –
o
Females - 170 Hz (E3)
we expect to see for
100 Hz (G2# / A2b)
 What is typical value of highest Fo we expect to see for
o Males - 500 Hz (B4)
o Females – 900 Hz (A5)
5
Using the Figure below, plot the patient’s z-score for TPR
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Functional Sentences
1. How are you?
26. Are you hungry?
2. I'm fine.
27. No, I'm not.
3. Where are you going?
28. We'll eat later.
4. I'm going home.
29. When are we going?
5. Who was that on the phone?
30. I'll ask him.
6. It was for you.
31. Who was at the door?
7. I'm in a hurry.
32. I've had it.
8. It was time for dinner.
33. I'm okay.
9. What are we having?
34. He gave it to me.
10. Is that clear?
35. I'll think about it.
11. Do you understand me?
36. Where's the doctor?
12. I don't know.
37. I don't believe you.
13. What do you want?
38. How are you doing?
14. I want a drink.
39. Please give it to me.
15. What's new?
40. I want some more.
16. I've had it.
41. What's your name?
17. I'm trying.
42. It's too late.
18. Excuse me.
43. Are you coming?
19. I need your help.
44. I know what I'm doing.
20. Oh, come on.
45. How old are you?
21. Are you ready?
46. What did you say?
22. I said so.
47. I said, "Let's go."
23. Who knows?
48. Nevermind.
24. I don't care.
49. What time is it?
25. I need you.
50. I get it.
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Resonant Words, Phrases, and Sentence Stimuli (#7)
WORDS
Mine
Me
Moon
Men
Mom
Mail
May
Mall
One
Nine
Many
Mow
Newer
Meaner
Nanny
Normal
Marine
Mommy
Yummy
Yellow
PHRASES
Many men
Nine-one-one
Mow the lawn
My home
My mom
My room
My name
My son
One-one-one
My phone
No one
Never mind
Meet me
Lend me
No news
On the moon
Yummy yams
No nerve
Nelly knits
Roomy rambler
SENTENCES
Mary made me mad.
Maybe I can meet you at the mall at noon.
My mom made lemonade
No one found the money
No news is good news
Mom is a morning woman
Make many trips to town
Meet me at the mall
Meet me at the zoo
Meet me at the movies
Mary knits with yellow yarn
Raise the roof at the mall
My mom made lemon muffins
Laurie loves lunch at noon
Lennie met me at the mall
The news was nice to know
Norman made me lemonade
Lend me the money on Monday
Lauren and mom went to the mall
Make me more yummy muffins.
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Spacious Speech (#8)
Start with an open-throat breath (like a sniff of a freshly baked pie or
the beginning of a yawn_. Let the breath do the work. Be light, fluid,
legato, and spacious. Exaggerate inflection! Glide over your entire
pitch range. These phrases should feel effortless. This is like a massage
for your vocal folds, stretching and contracting the muscles, while
vibrating in a spacious throat.
Hi there
Heeeeeeeeeeeeee
How are you?
Haaaaaaaaaaaaay
Who are you?
Hooooooooooooo
Who is she?
Huuuuuuuuuuuuu
Hey there
Haaaaaaaaaaaaaa
Hey Joe
Hmmmmmmmmm
Who there, hey there, hi there
Hi there, how are you?
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Resonant Answers for Open-ended Questions (#9)
M
Another word for angry is _____________
A male is a butler, a female is a ________
The month after April is _______________
A female horse is called a ______________
The opposite of woman is _____________
The opposite of less is ________________
Breakfast, lunch, and dinner are three ___
A marathon is approximately 26 ________
If you are polite your mind your ________
Not the beginning, not the end, but the _______
To see yourself you look in the ____________
Ketchup, relish and _____________________
N
The opposite of yes is ___________________
The coin worth 5 cents is a _______________
The opposite of far is ___________________
Y
The opposite of no is ___________________
Another word for delicious is _____________
People knit with needles and _____________
The color of the sun is ___________________
The opposite of old is ___________________
The yellow part of the egg is the ___________
L
The opposite of short is __________________
When life gives you lemons, make ___________
When you wash your clothes, you do the ______
Communicating with
Parkinson’s Disease
Tips for Individuals with Parkinson’s
Disease and their Communication
Partners
Jessica Tellis B.A.& Kate Holden B.S.
Under the direction of Dr. Celia Bassich
Towson University
Department of Speech Language Pathology
2009
Table of Contents
I.
Title Page-Communicating with Parkinson’s Disease
II.
Communication Strategies for People with Parkinson’s Disease
III.
Communication Strategies for Caregiver’s of People with
Parkinson’s Disease
IV.
Communication Checklist for PWP
V.
Communication Checklist for Caregiver
VI.
Speech Tutorial
VII.
Examples of Common Communication Difficulties
VIII. Techniques for Improving Comprehensibility
IX.
Resources and Support Groups
Acknowledgements and References
Appendix B; Techniques for improving Comprehensibility: For the Dysarthic Speaker.
Adapted from Vogel and Miller, 1996.
Conversational Strategies for the Communication Partner by Monique Kaye.  by
Thinking Publications, 2000.
Tips for Understanding Dysarthic Speech.  by Park Nicollet Institute, 2004.
Communications Strategies for People with
Parkinson’s Disease
1. Gain eye-contact with communication partner before speaking
- Make sure to get the attention of your communication partner
before speaking to assure they will focus on listening.
2. Use body language to convey meaning
- For example, point to an object you are referring to further
clarify your needs.
3. Be open to new methods of communication.
- For example, use hand signals or simple signs to convey your
message. A thumbs up sign can signal ‘I understand’ versus a
thumbs down which can signal ‘I do not understand’.
4. Let communication partners know if you need more time.
- It may take you longer to speak so make sure to let your
communication partner know if you are not finished speaking.
It may be helpful to develop a sign to signify this. For example,
holding up your hand to show you need more time if they try to
interrupt.
5. Educate family and friends about how your speech has changed.
- Your speech may become slower, more slurred, and quieter.
The more informed your family is about these changes, the
better they will be able to adjust to your needs.
6. Join a support group.
-Support groups can be very helpful by getting you in touch
with others experiencing similar needs and difficulties. Please
see attached sheet or ask your SLP for local support groups.
7. Be patient with yourself.
- Although frustration is common when struggling to
communicate, it is important to remain calm as frustration
blocks thoughts.
8. Take your time when speaking- PUNCH IT OUT.
- Often, people with Parkinson’s disease speak at a faster rate
than average. It is important to concentrate on speaking slower,
louder, and with more emphasis than you think is normal.
9.
Exaggerate articulatory movements to make speak clearer.
- Words may sound slurred or mumbled so it is important to
concentrate on overstressing mouth movements.
10. Speak in short phrases or sentences.
- This may increase your intelligibility and make it easier for
you to communicate.
11. Try to speak in quiet environments.
- Reduce background noise before speaking. Make sure to turn
off any extraneous noises (i.e. a television or radio) before
attempting to communicate.
12. Use vocal communicators.
- These are words that are easy to say but convey meaning
clearly. For example, “uh huh” for yes, “uh uh” for no, “mmm”
for good, and “ahh” for pain.
13. Talk about your feelings.
-Often, your face may not convey your true emotions and
feelings. It is important to tell people how you are feeling since
your facial expressions may not reflect your mood.
14. State the topic context.
-For example, “I want to talk about my medications.”
15. Rephrase rather than repeat a misunderstood message.
-Listeners then to get anxious when they cannot understand a
message being repeated over and over. Re-wording will
decrease listener anxiety.
16. Keep a small notepad handy to write if listener is having
particular difficulty.
Communication Strategies for Caregivers
Early Stages
1. Ask questions by giving PWP multiple choices: EX: “Would you like
chicken, fish, or hotdogs?” rather than “What do you want to eat?”
2. Reduce background noise when speaking. Turn off all radios,
televisions, and noisy appliances.
3. Gain attention and eye-contact before speaking.
4. Give PWP sufficient time to speak and respond to your questions.
5. Be an active listener by looking for hints from eye-gaze and gestures.
6. Be honest-If you do not understand the message ask for specific
clarification. For example, repeat the part of the statement you
understand before asking for more information so the PWP knows
what part of the message was lost.
7. Maintain a normal level of voice volume. Resist the urge to talk
loudly.
8. Provide emotional support.
9. Use specific feedback. For example, repeat the part of the message
that is understood and ask for clarification on the part that you are
unsure about.
10. Ignore errors if you understand the message.
11. Use short, simple sentences when communicating.
12. Provide encouragement to the PWP. Let them know you understand
they are frustrated speaking and not being understood.
13. Identify if the message has been understood. This may include a
signal such as a nod or thumbs up.
Communication Strategies for Caregivers
Later Stages
1. Ask “yes” or “no” questions rather than leaving the questions openended. For example, ask “Do you want juice?” as opposed to “Do you
want juice, coffee, or tea?”
2. Be open to new methods of communication-EX: establish simple
signals or gestures to convey a message
3. Be respectful of your loved one and encourage their efforts. For
example, give them time to get their message across and remain
patient if it takes longer than expected. Remember- it is frustrating for
them as well!
4. Some people find the use of a simple communication board useful. A
communication board includes simple pictures that a PWP can point
to. A speech-language pathologist can assist you with the
development of a communication board if desired.
SPEECH Tutorial for Frequent
Communication Partners
 S – Spotlight your face-keep it visible
 P– Pause between content in sentences
 E – Empathize and be patient
 E – Ease their listening
 C – Control the circumstances
 H – Have a plan
SPEECH Tutorial for Frequent
Communication Partners
S – Spotlight your face-keep it visible. Use good visual
cues. Keep a good distance, Face the speaker, etc.
P – Pause slightly between content in sentences. Use
“Clear speech”—don’t ramble on and on, slight pauses
between phrases are good for allowing the PWP time to
“catch up”.
E – Empathize and be patient. Try to keep your cool and
be patient.
E – Ease their listening. Get the listener’s attention
before speaking. Generally try to be helpful. Ask for
specific ways to increase understanding.
C – Control the circumstances. Try to make sure the
environment is controlled. Pay specific attention to noise
sources.
H – Have a plan. Try to anticipate difficulties and
identify strategies that may work in advance.
Examples of Communication Difficulties
Communication
Difficulty
Caregiver does not
understand the
message
Effective Response
Ineffective Response
“I’m not sure if I
caught all of that.
Did you say…?”
“What?” and “huh?”
or
Caregiver pretends to
understand what was
communicated
PWP is taking a long
time to communicate
their message
Caregiver gives a
“thumbs up” louder
cue
Caregiver gives PWP
ample time to finish
thought
Caregiver yells at
PWP or speaks very
loudly
Caregiver interrupts
PWP before he is
finished his thought
Caregiver interrupts
PWP or attempts to
finish their thought
PWP signals that he
needs more time to
finish his thought
PWP looks
uninterested or bored
due to reduced facial
expression
PWP explains the
situation and how
they are actually
feeling
PWP gets frustrated
or
Gives up on
attempting to
communicate
Caregiver assumes
PWP is uninterested
or rude and PWP
does not attempt
explain their true
emotions
PWP is speaking
too quietly
Conversation Checklist for Person with
Parkinson’s
 Gain eye-contact before speaking
 Reduce background noise before
conversation
 Speak in shorter sentences
 Take your time while speaking
 Let communication partner know you
need more time

Be patient with yourself
Conversation Checklist for Caregiver
 Gain eye-contact before speaking
 Reduce background noise before
conversation
 Speak in shorter sentences
 Be honest if you do not understand PWP.
Ask for clarification
 Encourage partner’s efforts
 Be respectful
 Do not rush PWP when they are speaking
 Give PWP choices when asking questions
Techniques for Improving Comprehensibility
Provide context for what you are saying to your communication partner.
Knowing the topic up front will allow your communication partner to better
follow the conversation. You may want to provide context by writing or
spelling the topic of your message.
Let your communication partner know when you are changing the topic of
conversation and do not do so abruptly. If you change the topic of
conversation without first clueing in your partner, they are likely to lose
important details of the message.
Develop and use turn-taking signals in conversation. Develop a sign with
your communication partners, such as a hand gesture, body movement, or
verbal interjection to signal that you have something you would like to say.
Before you begin speaking, make sure to gain the attention of your
communication partner so they know to focus on your message.
If your communication partner is unable to understand your message the first
or second time you say it, try rephrasing it in a simpler form as opposed to
repeating it.
Use simple hand gestures during conversation when appropriate to
supplement speech. For example, pointing to an object in the room and then
to yourself may symbolize “Please being that to me”. This may be an easier
and quicker way for your communication partner to understand your
message.
Make your speaking environment as “friendly” as possible. Try to avoid
having important conversations in noisy places and always attempt to
minimize background noise before beginning to speak.
Avoid attempting to communicate over large distances. Attempting to speak
with someone who is across the room can be very difficult.
When having a conversation that is ‘emotionally loaded’, make sure you are
not tired and have plenty of time for discussion so there is no pressure to
rush.
Support Groups and Resources
Support Groups:
Civista Medical Center
LaPlata, MD
888-332-4847
Johns Hopkins University
Baltimore, MD
410-955-8795
Sibley Memorial Hospital
Washington, DC
202-537-4000
Union Memorial Hospital
Baltimore, MD
410-554-2000
Washington Hospital Center
Washington, DC
202-877-6213
Find a Support Group:
http://www.parkinson.org/Page.aspx?pid=302
Resources:
http://www.parkinsons.org.nz/books/parkinsonsandspeech.pdf
Ask the Doctor:
http://www.parkinson.org/Page.aspx?pid=255
Ask the Nutritionist:
http://www.parkinson.org/Page.aspx?pid=257
Ask the Speech-Language Pathologist:
http://www.parkinson.org/Page.aspx?pid=256