Dear Mrs. Renee White,

I am sending you this letter as a follow-up from the appointment you, your mother, and I had on Tuesday. I was very pleased with the meeting and was delighted to be able to talk with you both. I have a positive outlook about your mother's situation. She and you are such optimistic people, which is so important in this situation. I cannot stress enough that support and positive attitudes are some key factors to helping your mother, and you guys seem to be having no trouble with that!

After talking with your mother, I became aware of some of the speech problems you mentioned to me prior to the appointment. These seem to be natural symptoms of Parkinson's disease. I know some techniques, as well as some precautions, that can help her in daily activities. As a speech-language pathologist, it is my job to inform you about your mother's condition so that you can understand what is going on and know techniques that will be helpful to your mother (Schwab, Doshay, 2002). As long as everyone is willing, we can work together to assure that your mom has the healthiest lifestyle possible.

Some symptoms that you had mentioned to me were that her voice is very quiet & that she mumbles a lot. After speaking with her, I noticed these problems; there are valid reasons for the speech problems. Parkinson's disease influences muscle movement, motor planning, and muscle control (just to name a few). These shortfalls in turn affect respiration, phonation (producing sound/voice), articulation (moving parts of your oral cavity in the correct position so that you can produce a certain sound), and resonation (Ferrand, Bloom, 1997). During therapy, I will be working with your mother to help improve her articulation so that she when she wants to talk, her speech will not sound so "mumbled". Research also shows that Parkinson's disease affects that shape of the vocal folds. In order to create a clear sound, the vocal folds must be parallel, symmetric, and be able to close totally; however, PD can cause the vocal folds to be bowed shaped and not parallel then they will not be able to completely close. There are exercises that I can teach to help build the muscles so that they can close. Note that these exercises must be done regularly for them to work, so you may need to remind her just to make sure she gets the exercises done on a regular basis (Parkinson's Disease Foundation, 2002).

These are just some areas we will be covering the next time we meet in therapy. Please let me know if there are any specific things that you think should be brought to my attention. It is my goal to make your mother as comfortable in her environment as possible and to increase your and other family member's understanding of this disease (Schwab, Doshay, 2002).

Sincerely,

Julie Compton

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