Today’s blog topic is important and very serious, particularly for people with Parkinson’s Disease. It is a bit long, and the words I write will not be humorous or inspirational. Some of you will not like what I have to say. I apologize for that in advance, but I sincerely hope you will understand that I write with your best interests in mind.
What has me so uncharacteristically somber? Advice on the Internet. It is abundant. It is awesome in so many ways. You can go to YouTube and learn to do just about anything. But… just because you can, does that mean you should? I don’t mind if you want to learn about origami or horticulture. It disturbs me when unqualified people post exercises and strategies that fall under the scope of practice of an educated, trained, licensed, and competent Speech-Language Pathologist.
Would you hire a plumber to fix your electrical system?
Would you hire a chiropractor’s front office assistant to manipulate your spine?
Would you hire a surgical nurse to perform deep brain stimulator implantation?
No to all of the above? Then why would you entrust the care of your ability to communicate and to swallow safely to someone who lacks credentials to address them?
I have said it before and it bears repeating: Speech-Language Pathologists are extensively educated in the anatomy and physiology of the head, neck, and aerodigestive tract. We must complete a two-year Master’s level course of study, pass a national praxis examination, fulfill a post-graduate school Clinical Fellowship Year, receive a Certificate of Clinical Competence from the American Speech-Language Hearing Association (ASHA), and maintain licensure status at the state and national levels by completing a daunting number of Continuing Education Units (CEUs) each certification cycle. We have a broad but well-defined Scope of Practice, and our Code of Ethics is quite stringent and actively enforced by ASHA.
My objections have nothing to do with the economics of the thing. The fact that the advice is “free” does not bother me overly much. I understand that progressive disorders place financial hardship on the families affected by them. The problem is that the people posting this advice may have some peripheral training and experience but do not fully understand speech, voice, and aerodigestive anatomy and physiology. It is false economy to utilize “free” services that end up exacerbating the problem. Exercises being promoted recently are similar to some of the more intensive ones I train, but as presented they would be minimally effective at best; downright harmful at worst. One voice exercise I saw was of particular concern!
According to research, up to 89% of people with Parkinson’s will develop voice/speech problems (Hartelius & Svensson 1994). Aside from the obvious impact on communication, disorders of voice (dysphonia) and speech (dysarthria) also place you at increased risk for swallowing problems (dysphagia). Some exercises posted on the Internet may provide temporary relief but aren’t particularly effective treatments for dysphonia or dysphagia. What I’ve seen promoted would be like putting a bandaid on an arterial bleed. It may stem the flow a bit but is unlikely to have much impact and could even aggravate or at the least delay treatment of the underlying problem. One exercise, if executed as described, could create undue tension in the throat and laryngeal musculature. This can exacerbate existing voice and swallowing problems or create new ones. How is that going to affect your quality of life in the long run?
So, my closing advice is this: please pay attention to the credentials of the person promoting exercises for speech, voice, and especially swallowing problems. If the person is not a licensed Speech-Language Pathologist, s/he may cause more harm than the intended good. Proceed with extreme caution!
Hartelius, L., & Svensson, P. (1994). Speech and swallowing symptoms associated with Parkinson’s disease and multiple sclerosis: A survey. Folia Phoniatrica Logopedia, 46, 9–17.
Cynthia Williams Bowen, MS, CCC-SLP owns Bowen Speech-Language Therapy, LLC in Clearwater, FL. Cyndee provides quality, creative, collaborative treatment to adults and adolescents with communication, swallowing, Parkinson’s, and related disorders.