In the spirit of Dystonia Awareness Month I thought I would share this story…

This year I worked with Tom*. Tom lives in another state, Tom has a rare form of Parkinson’s disease, Tom has laryngeal dystonia or spasmodic dysphonia (spasm of muscles that impacts the voice and swallowing) and muscle tension dysphonia (muscle tension in his throat making voicing difficult). Tom’s Ear Nose and Throat specialist (ENT) is a very dynamic doctor and suggested that Tom try LSVT before considering vocal fold augmentation (this is where a filler is injected into the vocal fold). That’s where I came in!

I enjoyed working with Tom immensely as I was combining three of my passions; Telehealth, Lee-Silverman Voice Treatment (LSVT) and clinical voice therapy to support him to reach his goal of improving his voice quality. Tom was very dedicated to improving his voice, he worked full time and he mentioned that his voice impacted “everything” so was very motivated to make a change. He was diligent in following an extended LSVT program with me (20 sessions over 5 weeks!!!).

Telehealth was a great platform for him as it gave him the autonomy to log on to the session after his working day – no travel to clinic was needed! It also enabled him to see a clinician certified to provide the treatment recommended (in another state!). Tom, his wife, and I formed a great relationship (home-to-home) which made the sessions fun and enjoyable for all of us!

After LSVT treatment, Tom went back to the ENT for a scope (camera view of the larynx). The ENT noted that there was less of a gap when his vocal folds came together. Tom’s voice was notably stronger, and he was able to produce voice consistently and for longer. Happy days!

HOWEVER…. lots of muscle tension was still noted and his voice had a strained quality. We needed to continue working! Tom kept up his LSVT practice, but I added in some exercises to optimize vocal fold movement (semi occluded vocal tract exercises) and some training to use his breathing to support his voice.

One afternoon I got a call from Tom’s wife as she has just received a late notice cancellation appointment for another ENT review. I remember her asking me – “is he ready?” I said, “just go for it!”

The day Tom went in for his scope was one of the proudest in my career so far! I instantly heard from his wife afterwards who was super excited about the changes she had seen. She sent me a video of the ENT consultant running through the “before” and “after” footage at the appointment and I was pleased to see marked change in Tom’s larynx. I was humbled when the ENT commended my treatment and very happy for Tom when he was told he no longer needed an augmentation!

Working with Tom has taught me so much! The power of evidence-based practice, working in a team with an ENT and, of course, supporting your client to reach their goals. I saw tangible evidence that SPEECH PATHOLOGY CAN MAKE LASTING PHYSICAL CHANGE!
I am lucky that I still get to see Tom for maintenance therapy, but I will be grateful to him and his wife for this experience for many years to come! Thank you both!

Katie Milton
Speech Pathologist

*name changed for privacy reasons