|dc.description.abstract||Parkinson’s disease is a degenerative neurological condition which affects motor control, in almost all cases involving speech, and is frequently of many years duration. Much is known about speech production but less of the psychosocial consequences of the speech impairment (dysarthria). Accounts of people with dysarthria have shown that its impact on quality of social participation can be varied and profound. However, level of participation has not been investigated. Reduction in social activity and social networks has been found following onset of other neurogenic communication disorders. In Parkinson’s disease there is some evidence of social activity reduction but this has not been studied in relation to severity of dysarthria. Social anxiety has been found to be raised in speakers with other speech production impairments and this may be a contributor to reduction in social engagement. Investigation of social variables is of importance in understanding relationships within a biopsychosocial model of health which underpins intervention for therapies for communication disorders.
The study aimed to investigate the impact of dysarthria on social participation and whether presence of dysarthria in Parkinson’s disease (PD) resulted in changes to social anxiety, social networks and social activity. It further sought to investigate whether severity of dysarthria resulted in changes to the same variables.
A group of 43 mild-moderately dysarthric speakers with PD were recruited. Exclusion criteria were applied to control for cognitive impairment, depression, apathy, movement disability and co-occurring neurological and communication impairment. A group of 30 non-neurologically impaired participants were recruited matched for age, sex, socioeconomic status and educational attainment. Participants with PD were further grouped using measures of sentence intelligibility and motor speech impairment into higher and lower functioning groups. All participants completed a social anxiety questionnaire, a social activity checklist and detailed their social network. Group data were compared to address the research questions. Semi-structured interviews were carried out with all participants to explore change to social life and perceptions of causes of change.
Participants reported a range of changes to interaction and social engagement arising from speech and other impairments and also from intra and interpersonal contextual factors. Quantitative data showed that presence of dysarthria was associated with social anxiety and avoidance but not changes to social activity level or social network size. Greater severity of dysarthria was associated with deterioration in social activities and social network. There was wide individual variation on these variables.
Impact of dysarthria may be significant and unrelated to severity of impairment and satisfaction with level of activity is low in dysarthric speakers. Mild - moderately dysarthric speakers with PD may experience social anxiety in particular types of social situation. Moderately dysarthric speakers may experience loss of social capital in terms of quantitative changes in social networks and social activities. Motor speech impairment was a better predictor of social functioning than intelligibility in this sample. It is possible that a threshold for change lies at a more severe level of speech involvement. How speakers with PD perceive and experience their social interactions is discussed and limitations to the research are considered. The implications of the findings are discussed in relation to the ICF framework and the concept of social capital||en