Communication circles – a guide for people with Parkinson’s and families
By Bonnie Bereskin, M. Ed., Speech-Language Pathologist at Baycrest Geriatric Health Care System in Toronto.

The challenge of maintaining clear speech can cause many people with Parkinson’s to withdraw from friends and social activities. However, with intensive practice, communication losses can be delayed and minimized. A cost-effective way to provide intensive speech therapy is by tapping into your social network to create a circle of people who can help you practise speaking in person or by telephone.

Communication changes in Parkinson’s

Voice. The voice becomes quiet and monotonous in intonation.

Articulation. Speech sometimes sounds slurred. Consonant sounds are weakly produced.

Rate of speech. Some people speak too quickly so their speech becomes difficult to understand.

Facial expression is reduced.

Cognition. Complicating the speech changes of Parkinson’s are changes in one’s ability to think. Individuals find it hard to pay attention to a task. Some people become impulsive and begin speaking without planning for a loud voice and slow speech.

Advantages of communication circles

Communication circles provide intensive, on-going and cost-effective speech therapy. Why are all three features essential to maintaining speech with Parkinson’s? Intensive practice, four times per week, has been shown in the scientific literature as the minimum amount required in order to improve and maintain functioning. Ongoing treatment is important for Parkinson’s as it is a chronic illness. The benefits of cost-effective therapy are obvious. Few of us have extra dollars crowding our wallets.

Since Parkinson medications have little effect on speech, therapies have been developed to improve the loudness and strength of the voice and to slow the rate of speech. Before creating a communication circle, it is best to have an assessment with a Speech Language Pathologist who can develop a specific speech and voice therapy program for the person with Parkinson’s and train the volunteers.

Six steps for creating a communication circle

1. Recruit volunteers. They are not only good for the voice practice; they also bring fun, laughter, companionship and interest.

2. Hold an education session about PD, its symptoms, and the course of the illness. Few volunteers will have prior experience or knowledge of Parkinson’s.

3. Invite a Speech-Language Pathologist to discuss communication changes in Parkinson’s, the Lee Silverman Voice Treatment for Parkinson’s, communication exercises and other relevant treatment approaches.

4. Ask one of the volunteers (with organizational skills) to be the group facilitator whose duties will include sending out a monthly schedule of practice times.

5. Have volunteers arrange for someone to replace them when they are unable to attend.

6. Hold an administrative meeting once every four months, to share information, Speech-Language Pathologist input, new learning and fine-tune the communication circle program.

Circles that work

George Copeland’s inspiring story describes the process and success of a communication circle.

Here’s how communication circles have helped other clients keep up their favourite activities

• One person recruited members of his community theatre group who encouraged him to participate in musicals.
•  Another person chose fellow members of his local Kiwanis Club who encouraged him to introduce speakers at their meetings then gave him feedback on the effectiveness of his communication.
• Yet another circle takes place mainly over the telephone. The volunteers, recruited from family and associates of a friend, practise the speech exercises on the telephone and sing songs with the person with Parkinson’s who is a retired singer.
   

Bonnie Bereskin, M. Ed., Baycrest Centre, Toronto