For those individuals who will eventually be diagnosed with Parkinson’s disease (PD), the symptoms they first notice tend to be difficulty performing regular daily movements, such as getting up from the couch or reaching for their morning coffee. In addition to the more obvious motor signs associated with PD, such as tremors and muscle rigidity, patients face challenges from the damaging effects of the disease on other functions of the central nervous system. Flat affect, slurred speech, decreased voice volume production, difficulty writing, and poor balance can significantly detract from a person’s ability to communicate with their loved ones and engage with their surroundings. Due to the progressive degenerative nature of PD, these early symptoms can become life-altering impediments that may prevent the patient from fully participating in activities that bring joy and meaning to their lives. Often, rehabilitation therapy for patients with PD is a creative exercise between patient and therapist with the ultimate goal of increasing the patient’s ability to do those things that are most important to them. There are therapeutic programs for patients with PD focusing on daily walking regiments, yoga, tai chi, or dance and some that incorporate music as a medium to improve volume of voice. For one patient-therapist team at Emory Rehabilitation Hospital, poetry became a meaningful way to enhance the therapy experience, provide emotional motivation, and ultimately helped one patient reclaim her voice.
When retired science teacher Maria Birdseye came for speech therapy with Rita Lor, SLP, she spoke in a low, hoarse voice, and had some difficulty articulating words through an entire conversation. Ms. Birdseye is a lovely 72 year old with a 5-year history of Parkinson’s disease who explained that her voice no longer sounded “like her.” Her physician had referred her to work with Mrs. Lor to help strengthen her voice and learn strategies that could help her cope with vocal changes due to PD. Ms. Birdseye explained to Mrs. Lor on their first meeting that her friends told her that she sounded tired on the phone at night, almost as though she had laryngitis. Their treatment sessions emphasized vocal loudness by exercising the respiratory system in conjunction with the phonatory muscles of the larynx for 4 weeks. She and Mrs. Lor worked on developing appropriate vocal volume, improving speech intelligibility, and using vocal intonation to impart feeling and sentiment. Since many of the activities they would do as part of their speech therapy sessions involved oral readings and conversation, Mrs. Lor encouraged Ms. Birdseye to bring material to read that would keep her interested and engaged while they worked.
“Anybody who is willing to share how they feel, enriches us.”
— Maria Birdseye
Therapy session activities included vocal strengthening exercises, conversational tasks, and reading sentences and texts aloud with an emphasis on self-monitoring volume, tone, and clarity. Mrs. Lor worked with Ms. Birdseye over a course of four 60-minute treatment sessions for 4 weeks. The focus of their time together was on trying to “think loudly” and speak using a loud voice. Outside of these formal sessions, Ms. Birdseye was expected to complete daily “homework” activities. These tasks helped to improve carry over from therapy and encouraged her to use those vocal strategies in her home environment. She practiced reading and conversing with friends and family.
She found that the classic poetry of Robert Frost allowed her to get lost in the beauty of the words, while improving the strength of her own.
His poems, with prominent themes drawn from nature and hometown landscapes, were quickly integrated into her regular therapy sessions.
As was the case with Ms. Birdseye, PD patients frequently do not realize the softness of their voice. Recent research studies have shown that treatment that emphasized vocal loudness without strain could help improve articulation, facial expression, and swallowing; all of which can be impaired in patients in different stages of Parkinson’s.1 By stimulating the muscular-skeletal components involved in speech and incorporating sensory awareness training, speech therapy can enhance the patient’s ability to self-monitor voice volume control and articulation. Her therapy sessions encouraged Ms. Birdseye to think and to speak more loudly, and helped to illustrate that her new louder voice was the best way to express herself. Ultimately, this helped increase her confidence and comfort when speaking to others.
Mrs. Lor explained that poetry can be an excellent vehicle for many speech therapy activities, and was thrilled that Ms. Birdseye showed interest in utilizing poems that held personal meaning for her. Using poetry in their therapy sessions provided flexibility of choosing shorter, longer, simpler or more complex passages as Ms. Birdseye progressed and strengthened her voice. The poems that Ms. Birdseye chose also provided an opportunity to show emotion when reading aloud through variations in intonation, inflection, and emphasis. Reading selected poems out loud helped to improve her loudness for the duration of component sentences, and eventually for the entirety of the poem. Mrs. Lor was able to provide her with immediate feedback, and a sound level meter used during therapy sessions helped teach Ms. Birdseye to monitor and control volume on her own. As she improved in loudness, pitch, and vocal quality, she was able to increase the length of the poems she was reading. She also made significant improvement in the use of inflection in her voice that allowed her to incorporate feeling and emotions while reading the poems. Working with poetry provided Ms. Birdseye with the means to communicate feelings, and gave her the confidence to know she was being understood.
“The written word, whether it is a poem or a play or a book or a short story, it captures another person’s life for you to share….and in that respect, I think literature is wonderful.”
— Maria Birdseye
Completing her treatment with Mrs. Lor gave Ms. Birdseye the tools and confidence she needed to use her improved vocal strength and quality in her everyday life. This idea of being able to generalize using a loud voice in everyday speech was an important consideration of their treatment sessions. In verbally interpreting Robert Frost’s poems, Ms. Birdseye trained to formulate and express her thoughts at an appropriate tone and volume. She noticed progress as she read and re-read the same poems each session with increased loudness and clarity. The words that had once appealed to her for their beauty and description had taken on a deeper meaning. They gave her a means to control how she spoke and the confidence to trust her ability to communicate with others. Discussing poems grounded in nature and extolling the gift of life gave Ms. Birdseye a perch to reclaim her voice and to live her life in full volume.