LOUD for Life is a weekly speech exercise group for people with Parkinson’s disease (PD) that meets throughout the academic year and the first summer session. Participants also learn about healthy eating in collaboration with Nutrition and Food Sciences faculty and students. The group meets at the University of Rhode Island’s Speech and Hearing Clinic under the direction of Dr. Leslie Mahler, Associate Professor in the Department of Communicative Disorders (CMD), and has been active at URI for 11 years. Students from CMD, Nutrition and Food Sciences, and Biology collaborate by planning weekly activities focusing on nutrition and speech activities for people with PD.In 2014 the program partnered with Dr. Ingrid Lofgren, Associate Professor in the Department of Nutrition and Food Sciences (NFS) to incorporate weekly nutrition education and food tastings. As a result of this partnership, students from CMD, INP collaborate to provide weekly life enrichment activities for people with Parkinson’s disease and practice as an interprofessional team.
“It was very thoughtful about why we partnered,” reflects Mahler, “It is because speech language pathologists and dietitians overlap in our disciplines and we value that. Out in hospital settings I do rely on the dietitian and the dietitian relies on me. When it comes to Parkinson’s disease, we know that aspiration pneumonia is the number one cause of death, so it makes sense to talk about swallowing problems which includes a diet component. It is important for people to think about ‘when I can’t eat as much, how do I eat well to sustain my health?’’ Weekly sessions include speech and cognitive exercises, and nutrition education to help manage changes as a result of Parkinson’s Disease. Students across disciplines work together to design lessons that are appropriate for varying disease stages. Many living with Parkinson’s disease speak very softly and it is difficult to hear them, even though they feel they are speaking at a normal level of loudness. Speech activities include practicing common phrases they use daily speaking with a level 10 effort of loudness. Some activities incorporate speech and memory exercises such as bringing an old photograph in and discussing it with the group using normal loudness. Nutrition activities often incorporate a cognitive-linguistic component, and include identifying “Go, Slow, & Woah” foods, bone health jeopardy, and fiber price is right. The nutrition portion of LOUD for Life includes a food tasting for participants that helps promote optimal nutrition. The texture of the snack is also an appropriate consistency for people with swallowing issues, a common side-effect of Parkinson’s disease.
The program teaches students, roles and responsibilities, as well as teamwork and communication. Students meet before and after each session to plan and debrief. In between sessions students must coordinate activities and assure activities and snack for the following week are planned out and included in a written lesson plan. During sessions students across discipline are helping and participating in each activity. Students are also required to keep a journal related to their experience, interaction with participants and participant performance, as well as reflecting upon what went well, what could have gone better and how they are achieving personal goals. Students also submit reflection mid-semester and at the end of the semester to Dr. Mahler.
Lofgren points out LOUD for Life is an opportunity for future speech language pathologists and registered dietitians (RDs) to work together early on and understand how each can be a leader on the healthcare team, “For a tube feed patient, there may be sometimes where the dietitian is the leader because this would be a time where the RD is needed to focus on the issue… but they still need the feedback from everyone else. No matter who the leader is, the focus is what is best for the patient. Everyone is needed to support because you can’t just focus on the meds, the diet, or the speech.”
In the future Lofgren and Mahler hope to incorporate RDs practicing in the community that have an interest in nutrition for Parkinson’s disease. Lofgren states this will help extend reach into the clinical field and help promote interdisciplinary collaboration in clinical settings. Both faculty hope to provide opportunities to involve bench scientists and medical students to help translate bench research to bedside.