George Scofield will celebrate 60 years of marriage to his wife Patricia in August. He says this will happen despite his suggestion she get a hearing aid.

“Some women probably prefer to not hear their husbands after all those years,” says the 80-year-old Scofield. “There was a point last year that every time I talked to her she kept asking me, ‘What did you say?’ I told her she needed a hearing aid. But it was me who was having the problem, not her.”

Scofield, a 1955 graduate from the UAB medical school, was diagnosed with Parkinson’s Disease seven years ago and was beginning to lose the strength in his voice. What he believed was a normal, conversational tone actually had faded into nothing more than a mumbled whisper. This phenomenon, known as disordered communication, occurs in 89 percent of the nearly 8 million individuals worldwide with Idiopathic Parkinson Disease (IPD).

Only 3 to 4 percent of those affected seek treatment, according to LSVT Global, a group specializing in the development of innovative and effective treatments for therapeutic needs of individuals with Parkinson’s Disease and other neurological conditions.

At his neurologist’s suggestion, Scofield sought treatment at Spain Rehabilitation Center as part of the LSVT speech-therapy course. Scofield met with Jamie Wade, clinical coordinator of speech and hearing at Spain Rehab, four times a week for four weeks in summer 2008. The training gave him back his voice.

“Everyone I’ve had has been able to note marked improvements in their daily function,” Wade says. “This is probably the most efficacious program in speech research to come along. I think the component that makes it so valid is that it’s intensive, and you really use force.” 

Exercise is medicine
UAB is one of only five places in Alabama to provide LSVT speech therapy and is the only location with more than one therapist trained to administer the therapy. Suzanne Brown, speech language pathologist, also sees patients for treatment.

Soft, monotone, breathy and hoarse voice quality and imprecise articulation — together with lessened facial expressions — contribute to limitations in communication in the vast majority of people with IPD. Most have significant speech deficits that adversely impact quality of life, despite optimal medical management.

Wade says Parkinson’s research and therapy are beginning to show that exercise is medicine, and that’s the basis for LSVT therapy.

Therapy sessions are broken down into daily variables, which include sustained phonation and pitch sweeps up and down of the sound “Ah.” Wade measures the volume of the patients with a sound-pressure meter and sets goals for the number of decibels they want to achieve in four weeks.

“The whole premise is ‘think loud,’” Wade says. “The reason why we choose that one phrase is it decreases demand of the brain. If you think about your daily life, and you, let’s say, scream at your children, you naturally over-articulate and take a deeper breath. IPD patients don’t articulate completely and they talk low. That one cue to think loud tells the brain to do everything else.”

Therapy also consists of repeating 10 functional phrases like — Did you get the mail? Is the coffee ready? Who’s on the phone? — all while thinking loud. The patients must follow the program at home and are required to commit to 30 additional minutes of work on their own after the hour of therapy with Wade.

“It is a commitment to people to be here, participate and follow up with homework,” Wade says. “There’s a two-fold commitment: I do my part, and the patient does their part. That leads to success.”

Drastic improvement
Now seven months removed from the program, Scofield admits keeping up the practice is not always easy for him. Still, his voice sounds strong while he speaks. “Right now, I feel like I’m shouting at you,” he says, though his voice is at a normal, conversational level.

Scofield, a former pathologist, says when he entered the speech therapy program he would have rated the strength of his voice at a one on a scale of 10.

“Today, I would say I’m a seven, and that’s pretty good. That’s drastic improvement,” he says. “I owe a lot of that to Jamie’s help.” 

Scofield also has been involved in studies through UAB’s Physical Therapy department to improve his mobility and weight-lifting. It’s not easy. He describes Parkinson’s as a disease that’s progressive and unrelenting.

“You know you’re not going to get better, but these therapies give you something to do, and you see some improvement,” he says. “It gives you some goals in life. That’s encouraging.”

Wade says she asks each patient the area in which they want to be most effective in communicating when the therapy is complete. For one man, it was to be heard when he greeted his customers as they walked in his store. For another gentleman it was to be able to order his wife’s food again when they went out to eat.

Scofield’s goal was to be able to say grace at Christmas dinner for his family. His wife, four children and six grandsons were all present. “And I was able to do that,” Scofield says. “I can’t tell you how special that was.”

If you think you might be a candidate for LSVT therapy, ask for a prescription for an evaluation from your physician and call Wade at 975-4922.