SLHS student leading a group with Parkinson's disease in vocal exercises.

Gwen Nolan, Assistant Clinical Professor in Speech, Language and Hearing Sciences, was recently awarded a Phase III grant from the Parkinson Voice Project to continue administering clinical services through the Parkinson Speech Program in the Department of Speech, Language and Hearing Sciences.

The Parkinson Voice Project is a nonprofit organization that developed evidence-based treatment protocols designed to help those with Parkinson’s improve their speech called SPEAK OUT!®and The LOUD Crowd®. This two-part therapy approach has been proven to increase the strength of the voices of individuals with idiopathic Parkinson’s disease, and emphasizes the maintenance of improved voicing over time.

Since August 2018, Nolan has supervised SLHS graduate students as they work with Parkinson’s patients through the protocol’s curriculums after she became involved with the local Parkinson’s support group.

“Idiopathic Parkinson’s Disease (PD) is a progressive neurodegenerative disorder that causes movement- and non-movement related symptoms, Nolan said,  “When most people think of PD, they think of tremor, but PD also impacts the muscles that control voice, swallowing, breathing, and articulation.”

As a result, PD patients often speak in quick “rushes” with their voices trailing at the end of a sentence, which can make them hard to understand.

“Interestingly, most people with PD do not notice they are harder to understand,” Nolan said, “And because the disease process affects motivation, people often do not reach out for help until loved ones push them.”

The first six weeks of the program is the SPEAK OUT!® portion, where patients come into the clinic individually twice per week to work with Nolan and a speech-language pathology graduate student. Under supervision, patients are trained by the students to speak with intent and deliberation from sound level to conversation.

“Intent is the focus across every activity from warm-ups through cognitive tasks,” Nolan said. “The concept of intent helps bypass the weakening autonomic system that would normally automatically calibrate vocal loudness, and moves it to one that a patient can control. When patients speak with intent not only can you hear them, they can be understood because their articulation is clearer and their voices sound stronger in addition to sounding louder.”

After the six weeks are completed, the patient moves on to the second component of the program, The LOUD Crowd®. This component allows the patients to put what they learned in the first portion, speaking with intent, into practice in a group setting.

SLHS graduate students are also present at these weekly meetings, leading the group in vocal warm ups and other conversational exercises. Both Nolan and the graduate students constantly encourage the group members after they take turns speaking. Attend one of their sessions, and you’ll be sure to hear praise from them such as “Great intent!” and “Great job speaking slowly!”

“These patients form a tight bond and they hold each other accountable because if someone doesn’t practice, the other people in the group notice and call them out,” Nolan said. “Because people see the benefits of speaking with intent, they rarely miss group.”

Nolan reports that as a group, vocal intensity has been maintained for everyone, including those who were discharged to the group last October. Group members report that in addition to being heard more easily, they say they feel they are swallowing better.

“This program is a win-win because it combines two things I feel passionately about: helping people communicate and educating students,” Nolan said. “People in our own community, and their families, are profoundly impacted by PD, and I am lucky to work with people who have so much hope and put forth so much effort. This program has been so effective for the patients we have treated, and in teaching students to provide an evidence-based treatment protocol they can take with them to treat their own patients after graduation.”

The success of this project – from helping Parkinson’s patients increase their vocal confidence to empowering future speech-language pathologists with clinical skills and knowledge – is a large reason why Nolan won the SHP Excellence in Clinical Service Award earlier this month.

Her nominator, SLHS Clinical Professor Dana Fritz, wrote that her “entire department supported this nomination, not just because of her clinical excellence, but because of her passion for helping others and her dedicated mentorship of students.” “In her six years at SHP, Nolan has at least tripled the number of adults served by graduate student clinicians each year.

Nolan is also President Elect for the Missouri Speech-Language Hearing Association.

There is no cost to participate in this program. Do you or does someone you know have Parkinson’s Disease? Find more information on how to get involved with this program here.

Contact:
Alex Ethridge
ethridgea@health.missouri.edu