My speech


#1

My Speech

A couple of years ago at my neurology appointment they decided to do those short assessments for cognition. One of the tasks was to repeat back a sentence. I could tell they were shocked how my speech came out and so was I. It was completely unintelligible although I think I managed the correct number of syllables.

Something started to happen to my speech in 2002 after my GP - having misdiagnosed my blepharospasm as a stress –related symptom – gave me a couple of antidepressants.

Then it got worse after a specialist told me I had a tic and gave me a neuroleptic. I remember going to the pub with friends and when I tried to speak my face and neck were covered in sweat. It was exhausting.

I was referred to a speech therapist at the National in 2003 but it wasn’t till the following year at Kings that I was told I had hyperkinetic dysarthria.

My speech started getting worse again in 2009 but this time it was different . There seemed to be a pause sometimes when I wanted to speak, sometimes I stuttered and sometimes nothing came out at all
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It was getting really bad on the phone. I remember ending up in tears once trying to sort out a simple request to the GP’s receptionist about a letter. Some people seem to be very patient and try to guess what you are saying. Others just switch off.

Sometimes it came out very quiet. The speech therapist did some exercises on loudness with me.

I had begun researching Parkinson’s and thought that I now had hypokinetic dysarthria. I discovered the word for my stutter - palilalia .

These days I don’t talk much. I stopped going to my Parkinson’s group as not much fun having to sit (I’ve got akathisia too) and not speaking.

I went out for lunch with one of the children recently and hardly spoke . Too busy concentrating on eating my food. (I had put my false teeth in for the occasion – wish I haDN’T BOTHERED - they give me a sore mouth.)

I hardly use the phone. I think I managed to order a cab a couple of years ago. Then I learnt how to order them online. I write the address on a card for the driver.

The speech therapist helped me apply for an ipad. It take it with me to the dentist and type out what I want to say while I am waiting. Predictive text is actually a pain. I’m looking at the keyboard trying to hit the right keys – I’ve got pins and needles in my fingers, tremor in right arm, terrible head tremor and blepharospasm. Sometimes when I look up at what I’ve written it looks like gibberish – laborious corrections…

The ipad was fun for taking photos though because it has a casing incorporating a keyboard so I can put it on a flaT SURFACE AND TAKE SHAke-free picures. My Mum had dementia so instead of talking I could show her photos .

Chapter 7 Duffy Hypokinetic dysarthria (in Motor Speech Disorders - E-Book: Substrates, Differential Diagnosis, and Management J.R. Duffy) 1995, 2005, 2013 Elsevier

The identification of hypokinetic dysarthria can aid neurologic diagnosis and localisation. Its presence is strongly associated with basal ganglia pathology and is often tied to a depletion or relative insufficiency of the neurotransmitter dopamine.

It may be manifest in any or all of the respiratory, phonatory, resonatory, and articulatory levels of speech, but its characteristics are most evident in voice, articulation and prosody.

The disorder reflects the effects of rigidity, reduced force and range of movement, and slow individualist but sometimes fast repetitive movements on speech.

PD is almost certainly the most frequent cause of hypokinetic dysarthria. Also, in the absence of other influences (eg. medication effects) hypokinetic dysarthria is the dysarthria of PD.

In addition, patients with PD may have more than hypokinetic dysarthria. For example medication used to treat PD sometimes causes involuntary movements that result in hyperkinetic dysarthria.