May 2010

Matthew McKeon, Speech/Language Pathologist

Matt’s contact info:
Matt McKeon – Speech/Language Therapist
phone: 703.385.0555 x5392
email:   speechtherapy@thevirginian.org
address: The Virginian,  9229 Arlington Boulevard,  Fairfax, VA 22031-2504
website: www.thevirginian.org

A speech/language pathologist treats language, voice (LSVT – voice treatment), cognition (memory, problem solving cognition), swallowing

About Matt
Matt is 28 years old, grew up in Philly and now works with adults as opposed to earlier in his career working with children. He practices the Lee Silverman Voice Treatment (LSVT). He works closely with Ear Nose and Throat (ENT) doctors as well as otolaryngologists. He has done research on the aging voice with the VA hospitals and has worked with voice disorders. He works with all levels of patients at the Virginian from the continuing care unit, assistive living and skilled nursing departments. He also works with outpatients. However, he is only able to work with Medicare insurance. He welcomes calls and questions and will recommend other speech therapists in the area including those that take insurance other than Medicare.

In order to be treated by Matt, Parkinson’s patients must first be evaluated by an ENT or otolaryngologist such as Dr. Patty Lee. from   Otolaryngology Associates. (Dr. Lee spoke to our group in April 2008.) You must bring a referral. The reason he volunteers to speak to various groups is to educate the PD population.

Signs
Weak voice – voice that is quiet – breathy, airy, doesn’t carry far
When people start leaning in to you, asking you to repeat what you’re   saying
Patients can’t be heard and will say that their spouse needs hearing aids.
People avoid doing things like calling people on the phone, answering the   phone.
Difficulty with speaking reduces independence.
A clinical symptom of PD is a monotone voice, no rise and fall in speech.
Some patients have festinating speech when sometimes speed will pick up and voice will go quieter. With LSVT this will cease.

LSVT
LSVT is a voice treatment designed for people living with PD
who have a weak voice and low volume. A weak voice is a voice that does not have resonance and no volume. Poor perception of how loud a person is speaking is the problem. After working with hundreds of patients, Matt perceives that often people feel that they are putting in the same effort as they always have to speak, so why change.

94% of Parkinson’s patients have speech disorders. Parkinson’s patients don’t realize that they are speaking quietly and would speak louder if they realized they were speaking so quietly. As the disease progresses they’ll put in the same effort of speech they always have, but the volume isn’t the same it was. They need to feel like shouting in order to produce a normal volume but people don’t like to shout.

When putting effort into your voice when you speak he uses a rating of 10 as normal. If you have been speaking at an effort of 10 for 40 years and then are diagnosed with PD and your muscles are weakening, now you may be putting in an effort of 5 but getting the volume of 4. PD affects muscles. Just like your legs may not move the way you want them to, your voice muscles, or vocal cords, aren’t working the way you want them to and must be exercised for strength and flexibility just like all your other muscles. Muscles have the ability to relearn a new task. He trains patients to speak at a level 8 to get a normal volume. He gives you permission to yell at your therapist! Use of biofeedback is implemented in this technique via a tape recorder.

LSVT is a commitment of 4 weeks, 4 days a week totaling 16 sessions.
Each session is one hour. If you miss 2 weeks you will be discharged because the therapy must start over. You cannot take any breaks within these 16 sessions in order for this therapy to be successful. After the 16 sessions, you must practice 10 minutes every day for the rest of your life. You need to recalibrate the amount of effort you need to put into speaking in order to be heard. An expert can motivate you and give you biofeedback and get you to speak louder. The goal is to re-teach your muscle and you need a coach to do this. He believes that you cannot do this therapy alone because the biofeedback is so important. When speaking, 70-74 decibels is considered normal. 50 decibels is silent and 90 decibels is yelling. Most people living with Parkinson’s usually have a level of 62-63. The goal for Medicare is “normal”. All of Matt’s patients have   improved.

It takes about 2 weeks for PD patients to understand the perception of  heir volume of speech. You can expect to double your volume after LSVT. It is important to be able to speak at a normal volume because it is an expression of yourself. LSVT slows speech down. If you think about it, when you yell it is really prolonged vowels (Hiiiiii or Looook Ooout). If you talk fast you get quieter.

The key is remembering to practice and use the technique. Your muscle range of motion in speech affects pitch. If you don’t use it you will lose it. You will be tired after the session and it takes effort but you will build up your endurance as with any muscle. It is easier to fix this speech problem if done early. You should be proactive and start working these muscles sooner rather than later. If you have a supporting spouse or caregiver to assist you with practice it is beneficial. Aging in itself makes the vocal folds (cords) weaker.

If your voice is getting weaker, it’s likely it will get weaker and it will be harder to correct. Try to treat it early because LSVT does work   and it’s better to deal with it before it becomes an issue that affects your life. You can expect to double the volume of your voice.

Example of treatment – speaking loud. Breathe in – repeating words. It’s how you say words not just saying them. not all speech therapists are voice therapists.

How long the treatment lasts depends on the patient and the motivation received from his/her support system. Caregiver should sit in with patient so they can learn the cues and practice using them with the patient for consistency. You will need to keep doing it 10 minutes every day for the rest of your life but it’s much like as eating and sleeping. Not that big of a deal.

Think LOUD!

Question about what helps with drooling. He has no therapeutic treatment for this. Suggests you consult a doctor for medication to reduce excess salvia production.

Medicare Therapy Cap

Medicare pays $1860 for outpatient speech and physical therapy in one year. LSVT absorbs all of that in the 16 required sessions. Occupational therapy has its own cap of $1860. The cap was eliminated for 2010 but write to your congressman and ask that the elimination stays in effect. A diagnosis of Parkinson’s disease allows you to exceed the cap as does a diagnosis of voice disorder. Call Medicare to confirm and for a list of services available for PD patients. A therapist can not treat you without a prescription.

Swallowing

When you swallow if things go down the wrong way you cough. Vocal cords protect your airway and keep things out of your lungs. They sit on top of the trachea and are open when you breathe. When you hold your breath they’re shut.

Impaired swallowing leads to aspirating. Aspirating has to do with inhalation. Choking means you are unable to breathe. Often with PD   patients timing is an issue and food or liquid goes down the throat before you actually swallow while the airway is wide open although it should be blocked when swallowing.

A treatment available is VitalStim, neuro electrical stimulation. A neuromuscular stimulating device emits small electrical current to   stimulate the muscles responsible for swallowing.

Talk to your doctor if you have trouble swallowing. Only a speech therapist can treat swallowing – there’s no pill. Matt can also treat   people with this therapy.

Sometime ears and eyes making tears can also indicate swallowing issues (they can also indicate many other conditions).

Silent aspiration is when things go down the throat into the lungs without you realizing. Examples would be thin liquids like tea, water, coke, etc. The result may be pneumonia. Often people are treated for pneumonia but not the cause, so they are treated, released from   hospital, and then pneumonia reoccurs, etc. The result is repeated pneumonia. You can get a swallow study done in a hospital. The speech therapist will work with the radiology to determine why you are aspirating.

A swallow study is an outpatient procedure. They give you food and drink and take x-rays of your throat so they can see exactly what’s   going on. A speech therapist and radiologist do the test but it’s the speech therapist that will tell you why you’re aspirating.

Matt hasn’t heard of any medication helping swallowing. With Medicare you have to show constant improvement. A weak voice can affect the ability to clear your throat. With swallowing treatment, voice seems to improve, too.

A handy tip for Caregivers
Instead of saying “Speak louder”, or “Can’t hear you”, and other phrases that could be perceived as nagging, try a hand signal like raising your thumb. (Thanks, Liz!)

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