Communication Challenges in Multiple System Atrophy (MSA)

• Bonnie Bereskin, M. Ed.• Speech-Language Pathologist (reg. CASLPO)• bbereskin@hotmail.com• (416) 633-2146

Agenda for evening

• What is MSA??• Communication challenges• Speech and voice exercises• Communication Circle – organization,

schedule and questions• Practice of speech and voice exercises

What is MSA?

• Progressive, neurodegenerative disease marked by a combination of symptoms affecting movement, blood pressure and other bodily functions

• Unpredictable course over time

• Usually 5-10 years in duration

Parkinsonson-like symptoms - Rigidity

• “Lead pipe” stiffness

• Trunk is more affected than limbs

• May cause pain and discomfort

Slowness of movement

• bradykinesia

• “hard to get going”

• slow movements in getting out of a chair, walking, writing etc.

Other problems

• Visual changes – blurred vision

• Swallow changes

• Postural instability

• Early changes in speech

Treatment

• Parkinson meds may help

• Non-drug treatments are of benefit:o Speech Therapyo Social Worko Physiotherapyo Occupational Therapyo Caregiver support

Quality of Life

• Illness affects all areas of lifeo Caregivero Socialo Financial

• Families sometimes become isolated with a chronic illness

Communication Difficulties in MSA

• Voice - quiet voice with little intonation• Speech – slurred, unclear sounds• Fluency – “stuttering-like” speech• Gesture - less movement because of

stiffness• Facial expression - less expression in the

face because of muscle stiffness

Importance of maintaining communication

• Despite the changes brought about by MSA, it is essential to work on maintaining good communication

Brain – attention skills

• Requires sustained attention for “good speech”

• MSA interferes with the automatic aspect of speech

• This is the most difficult task in improving speech

Good news

• Speech therapy

• Regular practising can help to maintain communication

• Regular social interaction decreases risk of isolation and gives needed support to the family

Bad news [skull and cross bones below strikes me as “too much”

• There is no magic pill

• Without regular practice, it becomes more difficult to communicate

Lee Silverman Voice Treatment (LSVT) for Parkinson’s Disease (not much in literature for MSA)

• Intensive program of regular exercise• Helps to improve individual’s perception

of his or her voice• Strengthens vocal cords, breath control

and voice

How do these exercises work and why?

• Individuals with MSA have reduced loudness, making speech hard to understand

• Focus is only on loudness – THINK LOUD

• The exercises are simple – they focus only on voice – not breathing, posture, articulation, etc.

Intensive treatment

• Program (LSVT) works well because of the intensive treatment

• Therapy and practice allow person to get a stronger voice

• It allows individual to “recalibrate” the amount of effort and loudness required

Voice Exercise – Exercise 1

• Ask __________ to sustain the “ah” sound for as long as possible

• This sound should be as loud as __________ can produce

• This simple exercise strengthens the vocal cords and improves breath control

• “THINK LOUD” – Try for as loud as possible

How Often ???

• This exercise is to be done at the beginning of each session

• 10 times each practice• Give ______ feedback about

each effort• Encourage a louder and

longer effort• Record your times

Exercise 2 for Rapid Rate

• Many people with MSA have trouble in controlling the rate of their speech

• It is as if the speedometer is broken and they cannot slow down

• Speech becomes increasingly difficult to understand

Pacing – Slower Rate of Speech

• Pacing slows down the speech and makes it more understandable because:o It gives more time for the

articulators to moveo Allows the individual time to

take a breatho Allows the listener time to

process the message

Downside of Pacing

• Not natural/robot like• Takes a great deal of

attention• Listener needs to remind

__________ frequently

Positive of Pacing

• Speech is much easier to understand

• Easy to learn• Can be used even with

quite severe speech problems

Divided attention – need for support

• Some people with MSA have difficulty doing a few things at the same time

• Speech is challenging as one has to concentrate on many things at the same time (message, listener, finding words, listening to the response, speaking clearly)

Need for support with speech

• One is more likely to use skills, to speak clearly, with support and reminding from friends and family. Many individuals forget to use skills without some reminding and coaxing

• When family and friends help with practicing it takes the responsibility off of spouse

What Can You Do???

• Practice diligently• Make sure that you do the

exercises as they are taught• Remind ____ to use “loud

voice” and “slow speech” in other situations

• Don’t be afraid to ask ____ to repeat something if you didn’t “get it” the first time

Gentle reminding/coaching

• Kindly remind _____ to use a slow rate of speech

• Frequent reminding can be annoying and so use humor and gentleness

Practice! Practice! Practice!

• The most effective exercises (like medications) need to be used regularly

• Speech exercises are only effective if practiced frequently

Take home message

• Start to improve your speech now

• Practice specific exercises – like meds, they do not work if not used