De Coördinatietherapie en de ziekte van Parkinson

Demmink-Geertman, E.G. (1995). De Coördinatietherapie en de ziekte van Parkinson. Logopedie en Foniatrie, nr 12, p. 302-311.
(Artikel in niederländischer Sprache)

Introduction
Parkinson’s disease is a slowly progressive motor system disorder, affecting mostly elderly people. This disorder is the result of the loss of dopamine-producing brain cells. Dopamine is a chemical messenger responsible for transmitting signals within the brain. Loss of dopamine affects the parts of the brain which control movement, and leaves patients unable to direct or control their movement in a normal way. Muscles become stiff and sluggish, movement becomes clumsy, difficult and uncontrollable; rhythmic twitching of groups of muscles produces the characteristic tremor, which may be widespread or limited to one group of muscles.

Posture, movement and breathing
Symptoms here are rigidity or stiffness of the limbs and the trunk, slowness of movement, and postural instability and coordination. We see bent shoulders, too much flexion of the head, spasmodic bent arms and legs, and a shuffling walk.
These problems with posture and mobility restrict diaphragmatic respiration movement: breathing becomes shallow.
Hanging of the head affects the dynamics of the pharynx and the upper oesophageal sphincter and next swallowing, articulation, phonation (inhibition of the resonating caves), and affects also the respiration in a negative way.

Feeding function
In general facial action is limited; the patient shows a poker-face. Often the patient cannot control the facial muscles, this leads to problems of chewing, swallowing and articulation. Rigidity and lack of control of the chewing muscles cause problems with biting off food, and slacken the swallow motion. The frequency of swallowing is also diminished; this causes an abundance of saliva and drooling.
The muscles of the tongue are too tensed. The patient often presses a large part of his tongue to the hard palate; this leads to tension of the throat muscles and a too high rest position of larynx and hyoid. These muscles are involved in the functions of respiration (depth and rate), chewing and swallowing, articulation and phonation.
.It is obvious that an imbalance in this area also stimulate such disorders as globus sensation, aspiration, reflux, heartburn and temporomandibular joint dysfunction.
Of course the problems with swallowing are mostly due to neurological disorders, but part of them is caused by the overhead described problems.

Articulation
Articulation is hampered by rigidity and hypo kinaesthesia of the orofacial muscles. In this scope it is also important to realise that the way of producing a vowel or a consonant influences the respiration patterns in speaking. (See the general article about the coordination therapy).

Phonation
As mentioned above inhibition of the resonating caves can arise as the result of wrong posture of neck and shoulders or / and a too uplifted larynx. The quality of the voice diminishes, we see a decrease of volume and of resonance; Dysphonia is possible.

Psyche
As with several other diseases involving the brain, depression is an often signalized symptom in Parkinson’s disease. This can be worsened by the chronically uplifting of the larynx, which causes a feeling of a lump in the throat, a phenomenon that normally only appears in times of grieve and sorrow.

Communication
Decrease of mimic (poker face), gesture and further bodily expression hampers communication processes. This applies also for the above mentioned problems with articulation, decrease of volume, and decreased use of accents; the latter leads to a monotonous, low way of speaking.
Normally accents influence vivacity of human speech and emotional expression. They have impact on articulation- and phonation functions. Rhythmic accents influence speech respiration by regulating the pattern of inspiration and expiration during speaking. Dynamic accents affect respiration by evoking alterations in subglottic pressure and expiration air flow and emotional accents bring the emotions into the human voice.

Treatment with the coordination therapy
For the elimination of forcing mechanisms and the correction of posture, movement and breathing pattern, CTh. provides several possibilities.
In order to improve posture, alternating movement of the extremities (extension and flexion) is executed by the therapist, while the patient is lying in supine position. These exercises are very comforting to the patient. The correction of posture in sitting and standing is also important, particularly the correction of head posture.
Next massage of sternum and diaphragm is applied and breathing exercises are executed.
Massage of tensed hyoid- and extrinsic larynx muscles is done as relaxation of the throat muscles will not only stimulate an optimal mobility of the larynx, but also facilitate a good low rest position of larynx, hyoid and tongue. Next we apply relaxing massage for all the facial muscles, in order to activate facial action.
Then exercises are done to correct the functions of drinking, chewing, swallowing, articulation and phonation.

Special attention is given to practicing melodic, rhythmic and dynamic accents. Melodic accents improve vivacity of speech, rhythmic accents the regulation of breathing, and dynamic accents increase the power of the phonation.

Results
Application of the coordination therapy with Parkinson’s disease insures good results. Of course the treatment is symptomatic, meaning that our current means do not cure or stop the progression of Parkinson’s disease, but ease the symptoms.