In honor of Parkinson’s Awareness Month, we are highlighting some of the outstanding clinicians who work with us in the Klein Family Parkinson’s Rehabilitation Center at Jefferson Moss-Magee Rehabilitation. Pippa Siguenza is a Speech Language Pathologist (SLP) who helped design and create the center in 2019, and her expertise is an important component to the center’s multidisciplinary clinic. A major strength of our clinic is that it brings together a team of clinicians to help patients with Parkinson’s disease (PD) achieve functional goals specific to their individual needs. Ms. Siguenza shares more about her role at the Klein Family Parkinson’s Rehabilitation Center, and the importance of speech, voice, swallowing, and cognitive therapy in rehabilitation for this population.
What are your roles and responsibilities within the Klein Family Parkinson’s Rehabilitation Center?
Being a team member of the Klein Family Parkinson's Rehabilitation Center Clinic is an incredibly rewarding experience. My colleagues and I provide valuable information to patients, their families, and caregivers. Patients often arrive with little to no information regarding their diagnosis or what the next steps are. It's a recurring theme.
This is the opportunity to provide them with education about Parkinson’s disease and give them tools and resources to maximize the functional skills necessary for improving their quality of life.
Can you describe how speech therapy can benefit people with Parkinson's disease?
As the SLP on the team, I put emphasis on educating patients and their caregivers about swallowing safety. Swallowing disorders are among the first signs of PD, and they can impact safety with eating and drinking, as well as overall quality of life. Many people don’t realize they have issues with swallowing until they are asked the right questions.
I educate them on the effects of Parkinson’s disease on normal age-related swallowing issues. We discuss general safe swallow strategies to use at home and in social situations. Education regarding swallowing studies is also provided. Family members and caregivers are encouraged to be trained in the Heimlich Maneuver to maximize safety during eating.
Persons with PD frequently present with diminished vocal intensity. Many report that people can no longer hear them when they speak, which can then lead to social isolation. When asked to talk louder, they feel like they are shouting. We talk about "recalibrating" the brain, so they are able to identify when they are speaking with optimal volume. They learn about the basic principles of LSVT-LOUD, an evidence-based, speech therapy program that is designed to improve vocal loudness and functional communication.
Cognitive changes can be experienced as well. For example, some patients note difficulty maintaining their train of thought, recalling a word or a person's name, or where they put things. We identify functional strategies to address these issues, and many of the spouses and caregivers smile and say they'll put them to use as well.
What has it been like for you to work with individuals with Parkinson's disease and their families and caregivers?
The reward is immeasurable. Patients and families leave the clinic with a better understanding of PD, an individualized list of recommendations, and specific referrals and community-based activities geared for persons with PD.
Following up on the recommendations provided during their clinic assessment, many of the patients are later seen as outpatients, and the majority rave about the clinic experience. The most frequent comment I hear is that they were given hope.
Treating patients in the outpatient setting is also extremely rewarding. Their optimal speech/voice goal is to actively participate in a conversation and be heard. Their swallowing goal is to eat safely without coughing and choking. Cognitively, they'd like to be as independent as possible.
Is there something you would like people to know about Parkinson's research or care during Parkinson's Awareness Month?
It is well documented that the incidence of PD is rising at an alarming rate. This is also reflected in my outpatient caseload. The frequent comments I hear from numerous patients and their families is that after the initial diagnosis, they are not provided with the next steps.
Within the same doctor visit when a patient is given the diagnosis of Parkinson's disease, identifying next steps is imperative. It's important to create a patient-centered, comprehensive rehabilitation team that consists of a specially-trained occupational therapist, speech-language pathologist, physical therapist, and a social worker who is well versed in PD and the resources available, as well as a nutritionist, a psychologist, and a neurologist who is a movement specialist.
It is critical to provide comprehensive education, resources, and strategies salient to a patient’s specific needs to help preserve, enhance, and optimize their current level of function and quality of life. The Klein Family Parkinson’s Rehabilitation Center Clinic was designed with these exact goals at the heart of their mission.