Q: People living with Parkinson's disease sometimes find their voice capacity deteriorating. I have seen some programs by speech therapists to address this condition. Do you or Baxter have any suggestions how this specific problem can be addressed with assisted asanas?A: The ability to speak is vital to just about every aspect of our daily lives, including effectively communicating with our family, co-workers, friends, and communities and being able to maintain and make new relationships. In turns out that for some people who have the disease, Parkinson’s Disease can have a deteriorating effect on the voice. (For those of you who have not read our previous posts on PD, please take a minute to check Yoga for Parkinson's Disease, Part 1. and Interview with Vickie Russell Bell). For all PD symptoms, the intensity and frequency of changes can vary dramatically from person to person, and will change over time. This is true of changes to the voice as well.
Parkinson’s can affect the voice and communication is several ways. According to the Parkinson’s Disease Foundation, the following areas are affected:
“Language and Memory: Some people with PD experience changes in cognition and language, which make it difficult to think quickly, to manage multiple tasks, to find words or to understand complex sentences. A related problem can be the time it takes to formulate ideas. Although this does not directly relate to the voice, you can imagine how challenging it would be to try to hold a normal conversation!
Emotions and Gestures: People with PD can have difficulty recognizing both words and facial expressions that convey emotions. At the same time, they may speak with a ‘flatter’ voice and make fewer expressive facial expressions, meaning that their faces communicate less meaning to their listeners. The same goes for physical gestures.
Speech and Voice: About 90 percent of people with PD will experience changes in their voices or their ability to make speech sounds at some stage of their lives. Most commonly, the voice becomes quieter. It can also develop a breathy or hoarse quality. These changes may make a person’s speech less precise and more difficult to understand, especially when speaking to partners who have hearing loss. In addition, about 90 % of these folks will slow down the speed of talking, whereas 10% will actually speed their speech up. Either situation can contribute to difficulty being understood.
Walking and Talking: People with PD may find it difficult to communicate while walking or doing other tasks. Speech may become softer, and less clear when moving around.”
As for the underlying cause of the voice and speech changes, researchers believe that these symptoms are due to brain changes that make it difficult to follow internal cues, telling us how loud the voice should be or how much effort is required to produce clear speech.
The foundation recommends that anyone whose voice is affected should work with a speech language pathologist (SLP). They also recommend a voice-training program called Lee Silverman Voice Treatment (LSVT®), which is a well-studied technique to help improve voice volume. So, readers out there may want to look into that. See lsvtglobal.com to view a short video on their website that shows before and after voice effects. I love the “mantra” the patient has from her training: “Think Loud”. It also turns out that there is a device worn in the ear like a hearing aid that can provide sound feedback to the brain that simulates the background noise of a crowded room. For people who have difficulty making their voices louder, these devices optimize the natural tendency we all have to raise our voices above background noise. This natural tendency is called the Lombard effect.
With all the above as background, for some thoughts on how yoga practices might help in addressing the unwanted changes to the voice from PD, let’s look at some ideas I have and that some others have as well. Keep in mind, there is no good research yet as to the effect of yoga on PD voice changes. (However, there is one 2012 study that shows yoga helps with improving motor function in PD Effect of Yoga on Motor Function in People with Parkinson’s Disease: A Randomized, Controlled Pilot Study.)
First off, I couldn’t help but immediately think of the Vedic vowel chanting practice that Ann Dyer, a local Bay area yoga teacher and vocalist, shared with some of her teachers last year. Each major vowel sound, except for “i” and “y”, is chanted and related to an energetic part of the body. “ah” is connected to the heart area, “aye” ( ad in “hey”) is connected to the throat, “eee” is connected tothe forehead, “oh” is connected to the upper belly, and “u” (as the vowel sound in “you”) is connected to the lower belly. People with PD could do these practices on a regular basis, adding volume to the sounds to foster overall improvement in volume. To give you a taste of Ann’s take on sound, check out her Ted talk Why sing? Why now?.
I asked nationally renowned yoga teacher and writer Richard Rosen for his personal insights on the topic. He said:
“I have now been living with PD for 13 years, and according to my doctor, who I've been with all that time, I'm still essentially at level 1 (he also says I should be much farther along and taking 3 times the mess I am). People ask me if I think yoga is the reason for this, and I always answer it's hard to say. There are however two things I am sure of: yoga has helped my breathing and my awareness of the many symptoms of the condition. That awareness helps me consciously counteract some of the symptoms. For example, when my right foot shakes, I can if I'm aware of it, calm it purposefully down. The same goes for low talking. If I'm aware I'm doing it I can again purposefully increase the volume. This is something I believe a regular yoga practice can do for you, help you deal with the consequences of the condition without resorting to more increasingly expensive medications. So I highly recommend a REGULAR asana/breathing practice to anyone with PD.”
Another source directed me to some practices that are skillfully outlined in the wonderful yoga book Yoga: Awakening the Inner Body by Donald Moyer.
- With Parkinson’s, the thoracic spine gets very rigid, which pulls the head and neck forward and closes the throat. To counter this, try practicing supported chest openers, such as Supta Baddha Konasana.
- To relieve tension at the base of the throat and difficulty swallowing, try Setu Bandhasana with a Roll Under C7. (For a description, see page 27 of Yoga: Awakening the Inner Body.)
- To improve circulation at the base of the throat, include Viparita Karani. (See page 28.)
- To relax tension at the base of the skull and give gentle traction to the neck, conclude the practice with Savasana with a Neck Roll. (See page 25.)
—Baxter
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