Order of Events

Order of Events: 

1) Access evaluation and treatment materials located within the shared folder. You can also use CE's login to eLibrary at parkinsonvoiceproject.org (login information located in your shared folder) or use the hard copy of the SPEAK OUT!® Workbook (located in Secure Lab or CE's office)

2) Complete evaluation 

• • • Access and print the SPEAK OUT! Initial Eval Protocol (Under Initial Evaluation folder) in the folder that your CE shared with you. 

    • You will need all documents within this folder for your evaluation. Print the Rainbow Passage, the Grandfather Passage,  the VHI-10, and the SPEAK OUT! Stimulability Phrases. There are also copies of these documents in the SPEAK OUT! binder in the secure lab (cabinet to the left of the iPads).

    • To prepare - schedule a visit with an online Parkinson's Advocate. Email a Parkinson's Advocate at Advocates@ParkinsonVoiceProject.org to complete a mock session. Email them with a few days/times that you’re available.

    • SLP students should also record their voices to practice speaking with intent.

    • For the Eval: 

      • Prepare to video and audio record your evaluation (Video recording includes: 1-2 minute conversational sample, pre-treatment interview, spontaneous conversation, Grandfather passage)

      • Stimulability Testing

        • • Sustained phonation /a/ x 2 without cuing – document intensity range (e.g., 60-68dB)

          • Sustained phonation /a/ at max loudness - cue client to achieve 75-85db – may take a few trials

          • Can the client follow commands? Can they increase their volume with modeling and cueing, sit up straighter, take bigger breath? Just model, don't tell them to do these things.

      • Repeat short phrases while speaking out (ideally 75-80 dB)

        • • Model intentional voice you want - “Say it with intent.”

          • Are they achieving increased intelligibility, intensity, articulation, prosody, facial expression?

      • Audio record reading short phrases while reading with intent to increase feedback 

        • • Cue them to “Say it with intent.”

          • Audio record - Then ask how does it feel to use a stronger voice? Pt’s will revert back to normal voice and say, “It sounds like I’m yelling” – listen to audio recording. Educate on sounding loud vs feeling loud. Individuals with Parkinson's have sensory deficits. 

      • Listen to recording together

      • Fill out SPEAK OUT! Initial Evaluation in ClinicNote. 

3) If patient qualifies for therapy:

A) Order client a workbook using CE's Parkinson Voice Project login on https://parkinsonvoiceproject.org/account/dashboard/. When you log in, go to My Dashboard, then click the Patient Workbook and eLibrary icon. You will need their email address for eLibrary Access and their shipping address to receive a workbook. 

•  While waiting for your client's workbook or eLibrary access, you may use your workbook or eLibrary access for materials, but DO NOT photocopy the workbook pages for your client.  Be sure to discuss establishing a routine, setting up a home practice station, and addressing motivation issues during these early sessions. Use real-life activities, such as practicing intent with reading names, addresses, ads, greeting cards, greetings, etc. During this time, you can also identify the most effective cues for the client and involve their family in the training, making this time productive even without the workbook. 

B) Educate them on the Circle of Intent 

Be sure to educate them on the need to complete their home exercises 2x/day during treatment and 1x/day following treatment

C) Assign them to watch the What is Parkinson’s webinar on the Parkinson Voice Project website by your next therapy session 

D) Refer them to the online Parkinson’s Speech Exercises – LIVE Monday-Friday at 10am (20 minute time commitment)

*If patient doesn't quality for treatment, speak with you Clinical Educator about other treatment options or referrals. 

4) Begin treatment - 2x/wk for 4 weeks

• Graduation day = when 8 sessions are completed. You will complete a SPEAK OUT! Progress Note on graduation day. 

  • • Conduct final recording (post-treatment script) – ask family members to leave the room if present

    • We have Speak with Intent shirts to provide to your clients on graduation day - See Mrs. Hinrichs to get a shirt

• Schedule a follow up session in 4-6 weeks. 

5) Schedule one follow up session (9th visit) 4-6 weeks following treatment 

• Purpose of visit: Determines whether clients are continuing with home exercise program and establishing a daily routine

• 4-6 weeks after finishing the treatment protocol, clients will realize that they’re not “cured” during the honeymoon period and realize that they’re always going to have to practice and think about speaking with intent.

During follow-up session:

• Remind them to select one lesson to complete each day – doesn’t matter which lesson it is. Practice should be 15 minutes/once a day. 

• Ask the following questions: 

  • • Has client continued the home exercise program 1x/week?

    • Can client explain what it means to speak with INTENT?

    • Can client accurately perform 6 SPEAK OUT! exercises? (should only take 15 minutes)

    • Is client consistently attending assigned weekly SPEAK OUT! Group?

    • If yes, client is discharged and scheduled for refresher in 3-6 months. If no, pt needs additional tx

• Have the client independently or with caregiver support complete all 6 exercises - Do 5 glides and 5 ahs

• Time how long it takes to complete HEP to reiterate it only takes 15 minutes

• If client is independent with exercises (with or without caregiver support) and voice is consistent with final recording, move to step six and fill out a SPEAK OUT! Progress Note. Change heading within note to SPEAK OUT! Discharge Summary. 

• If client is not independently (with or without caregiver support) completing exercises and voice is not consistent with final recording, pick up for a few additional visits. Fill out SOAP notes for all visits until last visit when you will fill out a SPEAK OUT! Progress Note. Change heading within note to SPEAK OUT! Discharge Summary. 

6) Schedule Refresher Re-evaluation every 6 months

• Pt’s seen typically every 3-6 months, but can schedule at any time

  • • Depends on: Dx, cog, access to group, and whether or not they're following home exercise program

• Performance during refresher is compared to their graduatation day

• 1 tx session to make comparisons, 1 tx session to go through exercises independently

• Takes 6 mo-2 years to make it completion of exercises a routine.

*This content is from the SPEAK OUT!® Therapy for Parkinson's: SLP Licensing Course