By Lou Evans

What is Parkinson’s disease?

Parkinson’s disease is a progressive neurological condition. This means that the symptoms get worse over time. It is caused by a lack of the chemical dopamine in the brain, because some of the brain cells that make dopamine are no longer working. The exact cause of Parkinson’s is currently unknown but research suggests that it a combination of age, genetics and environmental reasons cause the dopamine-producing cells to die.

What are the Symptoms of Parkinson’s disease?

There are many different symptoms of Parkinson’s which start to appear when dopamine levels drop low enough to affect movement. The most common symptoms of Parkinson’s are:

    • Tremor

    • Stiffness (rigidity)

    • Slowness of movement

    • Memory and cognitive difficulties

    • Sleep disturbance

    • Changes to speech

    • Pain

    • Anxiety and depression

Changes in dopamine can cause movements to become smaller and less forceful.  This means speech can become quieter, handwriting becomes smaller and steps are shorter when walking.

Symptoms can vastly vary between people diagnosed with Parkinson’s and the severity of symptoms can vary from day to day and even depend upon the time of day. 

Although Parkinson’s is a degenerative condition, there are treatments that can stabilise, slow progression and even improve symptoms.  These include medication, therapy and remaining as active as possible.

What do we need to be aware of when working with people with Parkinson’s disease in the justice system?

    • Volume of speech

People with Parkinson’s may experience a gradually reducing volume of every day speech.  However, that doesn’t mean to say they can’t increase the volume of their speech (they can often shout when they need to!) but poor awareness of reduced muscle strength for speech means it is effortful for someone with Parkinson’s to maintain a good volume of speech.  Poor insight into reduced volume also means they don’t see the need to put extra effort in to improve the loudness of their speech and they may often accuse others of becoming deaf rather than realise issues with their own speech.  To make their own speech louder would feel like they are shouting as they are poorly calibrated to their own volume. 

    • Pace of speech

People with Parkinson’s disease may experience a change in the rate of their speech.  This can either be slower or faster. Sometimes speech can be so slow that it can sound slurred and be difficult to understand.  This is due to weakness in the muscles used for the articulation of speech, such as the tongue and lips. If speech becomes very fast it can appear to be a stammer and this may be due to a loss of power in the muscles used for breathing. 

    • A monotonous tone

Some people find their speech becomes flat in intonation.  This means they lose the melody in their speech as it becomes difficult to control how to make the voice rise and fall. 

    • A hoarse or unsteady voice

Caused by changes to the muscles controlling the vocal cords and breathing, a hoarse voice can be another symptom of Parkinson’s and often occurs alongside reduced volume.  This makes it even more difficult to hear and understand what somebody is trying to say, especially in environments that are noisy or with poor acoustics. 

    • Reduced facial expression

If the muscles of the face are affected a person with Parkinson’s can appear to have a “masked like face”.  This means that changes to facial expression, such as smiling or frowning may be limited or not possible at all.  This can cause someone to appear emotionless or disinterested.

    • Reduced body language

If muscles of the arms and hands are affected by Parkinson’s (tremor/rigidity), it can limit general movement and therefore limit gestures that accompany spoken language, adding to difficulties in expressing themselves non-verbally.

    • Small handwriting

Difficulty with fine motor movements can cause handwriting to become small and spidery and illegible at times.   This often removes handwriting as a method of communication if speech becomes difficult to understand. 

    Other symptoms to be aware of:

    1. A person with Parkinson’s may fatigue quickly, especially in stressful situations.  Fatigue can make all symptoms worse.

    1. Good and bad times of day are common and often coincide with medication wearing off. 

    1. Pain may limit a person’s ability to stay seated for long periods of time. 

    1. Difficulties with memory may affect how a person with Parkinson’s retains information shared with them.

How can an intermediary assist a person with Parkinson’s to enable effective participation?

An intermediary can complete a full communication assessment and advise on and implement strategies which would maximise a person’s ability to communicate and participate within the justice system. These can include:

    • Amplification techniques to encourage a louder voice when communicating verbally.

    • Pacing techniques to slow the pace of speech and improve articulation and clarity. 

    • Other methods of communication, such as communication aids, spelling charts.

    • Advise around fatigue and anxiety and minimising the effects of this and the need for breaks during conferences and meetings. 

    • Looking at how information is best presented and through which modality (eg. visually or spoken word).

    • Recommendations on the most effective language structures and vocabulary to enable effective participation. 

    • Propose special measures which may assist in court, for example the use of screens, a pre-court visit and a shorter court day. 

At the Intermediary Cooperative we can match a client with Parkinson’s disease to an intermediary with the right knowledge and skills.  The most effective way to see if a client would benefit from an intermediary is to refer for an assessment from one of our communication experts, who can then report recommendations on how to maximise communication for effective participation in the justice system. 
Go to www.theintermediarycooperative.co.uk and click the referral button to complete our referral process and we will soon be in touch.

2 Replies to “Working with clients with Parkinson’s disease”

  1. by Caroline McGaughey 4 weeks ago

    At the age of 66, my spouse was diagnosed with Parkinson’s disease. His symptoms included excruciating calf pain, muscular aches, tremors, slurred speech, frequent falls, loss of balance, and trouble standing up from a seated posture. After six months on Senemet, Siferol was given to him in place of the Senemet. It was also at this period that he was diagnosed with dementia. He began seeing hallucinations and became detached from reality. With the doctor’s approval, we stopped giving him Siferol and chose to try the Natural Herbs Center PD-5 program, which we had previously investigated. After three months of therapy, he has made significant progress. The illness has been completely contained. There are no symptoms of persistent twitching, weakness, tremors, hallucinations, or muscle soreness. The PD-5 Protocol was obtained from natural herbs centre. com. Though you still need to determine what works best for you, I thought I would share my husband’s story in case it could be helpful. Greetings and prayers

    1. Hi Caroline. Thank you so much for reading and sharing your story. I am pleased to hear your husband is doing well!

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