Tips For Managing Drooling In Parkinsons
Sailorrhea, or drooling, refers to pooling of saliva in the mouth. ;It occurs in around 50-80% of all Parkinsons patients, particularly men. ;This blog post explains the cause, risk of aspiration, anxiety, and social embarrassment, with 10 helpful tips & treatment options to help with this pesky problem.
What Are The Common Reasons That Someone With Pd May See A Speech
Often people with PD are referred to an SLP by their physician when they begin to have difficulty communicating or swallowing. Unfortunately, by the time people receive an evaluation from a SLP they have likely been experiencing subtle symptoms for quite a while. People with PD as well as their family members and friends often start being aware of communication issues when the person with PDs voice becomes too soft to communicate effectively. The communication symptoms begin very gradually, so they may first experience difficulty projecting their voice in a noisy environment, or when ordering at a drive-thru window. Over time they begin to experience more and more issues being heard and understood by others. Some people may gradually develop some imprecise/slurred speech and/or a hoarse or breathy voice quality. Communication can also be negatively impacted by changes in nonverbal communication, such as reduced facial expression and speaking with a monotone inflection.
Swallowing issues are often not detected until the person with PD is coughing significantly during meals or struggling to chew and swallow food safely and efficiently. The changes in swallowing can also happen so gradually that people assume symptoms are just related to aging or some other external factor, when in reality, these changes are directly related to the sensory and motor issues associated with PD.
V Management Of Dysphagia
Because lack of awareness of swallowing difficulty as well as silent aspiration are not uncommon in PD, it is critical to monitor weight and provide counseling regarding signs and symptoms of swallowing difficulty even to individuals who report no swallowing difficulties. For patients with documented swallowing difficulty, regular evaluation should help to anticipate problems and put strategies in place to reduce the likelihood of malnutrition, dehydration, and pulmonary problems.
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Lets Talk About Talking With Parkinsons Disease
Communication issues can become a problem for people living with Parkinsons disease . Recently APDA published a new booklet entitled Make Your Voice Heard! Healthy Communication and Parkinsons Disease which can be downloaded from our website for free or ordered by mail at no cost to you. Lisa Sommers, MA, CCC-SLP Clinic Director and Clinical Assistant Professor, in the Department of Communication Disorders at University of Massachusetts Amherst, is a Speech-Language Pathologist and an expert in speech and communication issues for people with PD and was one of the authors of this extremely informative publication. She is also an advisor to our APDA Massachusetts Chapter. Recently, I was able to talk with Ms. Sommers about the value of speech therapy for people with PD at all stages of the condition and what someone with PD might expect from a visit with an SLP.
If I Have Parkinsons Disease What Kind Of Speech And Voice Problems May I Experience
If you have Parkinsons disease, some of the voice and speech difficulties seen include:
- Softened voice. Reduced volume to your voice.
- Speaking in an unchanging pitch .
- Having a hoarse or strained quality to your voice.
- Having a breathiness to your voice. Breathiness in the quality of your voice that is easily heard by your listeners. It takes more effort and energy to speak. You run out of gas as you speak.
- Trouble clearly and easily pronouncing letters and words.
- Tremor in your voice.
- Using short rushes of speech.
- Loss of your facial expression.
If you have Parkinsons disease, you may not be aware of the problems with your spoken communication. Changes in the quality of your voice may be the first sign of speech problems followed by the inability to have fluid speech and clear and distinct speech sounds. Speech problems that are severe enough to reduce your ability to be easily understood usually do not occur until later in the course of Parkinsons disease.
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It Is Common To See Singing And Choir Programs For People With Pd What Are Your Thoughts On This Type Of Activity
There is still much to learn about how singing impacts the communication of people with PD. At this point in time, when asked, I tell people that we dont have enough evidence to say that singing can be used as a substitute for skilled speech-language pathology services. Given that there are such excellent, evidence-based treatments that specifically target the communication problems that people with PD experience, I advise people to pursue SLP services early and as often as needed, and view singing/choir experiences as a wonderful supplement to what they learn in therapy. Occasionally, people with PD can have voice difficulties that affect how they should use their voice during singing, so it is best to consult the expert first. This is much the same as seeing a physician and physical therapist before you launch into a new exercise program. Singing is a wonderful way for people with PD to use their new voices that have been rehabilitated in therapy. It also promotes social engagement and offers opportunities to communicate and be cognitively stimulated. It is a wonderful mood booster to combat the depression and apathy that can sometimes occur with PD.
Swallowing And Saliva Management
This one-hour talk is in three parts.; What a speech language pathologist is, how they can help someone with PD.; Why you should be concerned about swallowing problems, some indications you may have a swallowing issue, what a swallowing assessment by an SLP might look like, and recommendations an SLP might make to improve swallowing.; And, why you should be concerned about having either too much or too little saliva and how to manage either situation.
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Living With Parkinson Disease
These measures can help you live well with Parkinson disease:
- An exercise routine can help keep muscles flexible and mobile. Exercise also releases natural brain chemicals that can improve emotional well-being.
- High protein meals can benefit your brain chemistry
- Physical, occupational, and speech therapy can help your ability to care for yourself and communicate with others
- If you or your family has questions about Parkinson disease, want information about treatment, or need to find support, you can contact the American Parkinson Disease Association.
How Parkinsons Affects Speech And Communications
Some people living with Parkinsons will not experience speech and communication difficulties. However, a large number of people do develop problems with speech and non-verbal communication. The stage when these problems might emerge is different for everyone. The symptoms will vary from person to person but may include:
- Reduced volume of speech
- Reduced body language, including hand gestures
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Compensatory And Therapeutic Swallowing Techniques
Compensatory strategies control the flow of food and help to eliminate symptoms, but do not alter the swallow physiology. Compensatory strategies used in the treatment of PD to be discussed include postural changes, increasing sensory input, and altering food consistencies. Eating while upright with the chin tucked to the chest or the head tilted forward at a 45 degree angle may be helpful for patients with a delay in triggering the pharyngeal swallow, reduced tongue base retraction, or reduced airway entrance closure or protection. Increasing sensory input may benefit patients who are delayed in triggering the pharyngeal swallow. Foods that help to increase sensory input include highly seasoned food, cold foods, sour foods, and possibly carbonated beverages. Altering food consistencies or elimination of consistencies from the diet should be explored only after other compensatory strategies have been examined. In general, thick viscous consistencies will be difficult for patients with PD to swallow who experience reduced tongue base retraction and pharyngeal contraction. Emphasizing foods that are moist and form a cohesive bolus has been suggested for patients with poor pharyngeal contraction, and blenderized food that requires minimal chewing may be necessary for patients with severe dysphagia. Similarly, thin liquids are typically the most difficult consistency for patients with reduced laryngeal closure.
How Can Listeners Help People Who Have Difficulty Speaking And Communicating
Here are some ways friends and family of people with Parkinsons disease can ease speaking and communication difficulties:
- Talk to the person with Parkinsons disease face-to-face only, and look at the person as he or she is speaking.
- Ask questions that require a simple “yes” or “no” answer.
- Repeat the part of the sentence that you understood.
- Ask the person to repeat what he or she said, to speak more slowly or spell out the words you did not understand.
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Ii Characteristics Of Dysarthria In Parkinsons Disease
Speech rate characteristics as well as dysfluency in PD also deserve comment. Speech rates vary widely in persons with PD. Instrumental measures suggest that some speakers with PD have a normal rate, other individuals have a speech rate that is slower than normal and other persons have a speech rate that is faster than normal. In fact, hypokinetic dysarthria, which is the type of dysarthria most often associated with PD, is the only dysarthria for which rate may be faster than normal. Perceptual impressions of rate in PD must be confirmed with instrumental measures, as listeners perception of the rate of Parkinsonian speech grows abnormally rapidly. That is, for a sentence produced at the same physical rate by a speaker with PD and a neurologically normal speaker, the sentence produced by the speaker with PD will be perceived by listeners to be faster. Imprecise articulation and monopitch or reduced variation in voice fundamental frequency in the acoustic speech signal of PD have been proposed as potential explanations. Dysfluency occurs in approximately 15 to 45% of persons with PD, typically at the beginning of utterances or after a pause. The dysfluency is typically mild in severity and is characterized by rapid, blurred phoneme repetitions.
How Do You Know Its Time To See A Speech
People should be aware that changes can occur in multiple areas of the body that contribute to communication. People may find that they are being asked to repeat themselves frequently. They may find that their voice is hoarse or breathy, or that they are clearing their throat frequently to turn on their voice. They may feel that they are running out of air and need to speak in shorter sentences. They may be misunderstood by others because of the reduced clarity of their speech or their soft voice. People may give them feedback that they appear bored or upset due to the use of a monotone voice and reduced facial expression. These changes often occur gradually and those close to the person with PD may not notice. It is good to be aware of how well strangers understand the person with PD in order to gauge whether or not there are changes in verbal and nonverbal communication. ;If youre experiencing any of these symptoms on a somewhat regular basis, it is time to see an SLP. You do not need to wait for symptoms to be severe in order to seek professional help. Early intervention can make a positive difference.
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Treating Speech And Language Problems In Parkinsons Disease
Potential treatments for speech and language problems of PD include medication, behavioral therapies, and surgery. The most recent assessments of these therapies suggest, however, that surgery is not effective for speech problems, although it may improve some of the severe motor problems of PD. In addition, there are no medication;therapies that are effective when used alone.
Treating the basic motor problems of PD optimally appears to be a prerequisite for improving speech problems. That is, if the PD motor problems are untreated, the speech problems do not respond well to behavioral treatments. PD medication is, therefore, necessary but not sufficient. In short, the optimal treatment strategy for speech and language problems of PD appears to be a combination of PD medication plus some form of behavioral speech therapy.
Speech Therapy And Parkinson’s
Research shows that 89 percent of people with Parkinsons disease experience speech and voice disorders, including soft, monotone, breathy and hoarse voice and uncertain articulation. As a result, people with PD report they are less likely to participate in conversation, or have confidence in social settings than healthy individuals in their age group.
Speech disorders can progressively diminish quality of life for a person with PD. The earlier a person receives a baseline speech evaluation and speech therapy, the more likely he or she will be able to maintain communication skills as the disease progresses. Communication is a key element in quality of life and positive self-concept and confidence for people with PD.
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How Are Speech Problems Treated
There are many options to help improve your speech. A speech-language pathologist can help you pick the right approaches for you. Speech-language pathologists are trained health care professionals who specialize in evaluating and treating people with speech, swallowing, voice, and language problems.
Ask your doctor for a referral to a speech-language pathologist. It is also important to contact your health insurance company to find out what therapy and procedures are eligible for reimbursement and to find a list of SLPs covered by your plan. Finally, visit a SLP who has experience treating people with PD.
How Can Great Speech Help
A Speech and Language Pathologist can help improve swallowing, voice, and communication skills that are common manifestations of PD. The therapist can teach strategies to overcome communication deficits including soft speech, Dysarthria , Aphasia , and/or changes in memory, organization, problem solving or cognition.
We have therapists who specialize in dealing with the progression of Parkinsons and have a host of drills and strategies to raise voice volume, promote word retrieval and increase conversational skills. We have also found role playing to be extremely effective in re-teaching social skills which require both word retrieval and conversation.
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Closing The Gap For Voice Impairment In Parkinsons
Speech and voice impairments are common among those living with Parkinsons. As many as 90% of people with Parkinsons experience difficulties such as hypophonia or a more monotone, raspy or breathy voice . Speech can become less intelligible and can make communication difficult, especially if paired with decreased facial expressions . ;It comes as no surprise that speech and voice impairments can impact quality of life. ;;
B Feeding Modifications And Drooling
Adaptive utensils may be helpful for promoting and extending independent eating. Later-stage PD may be accompanied by dementia, which complicates management of feeding and swallowing, as patients may be unable to follow directions for some compensatory strategies. Patients also may be unable to feed themselves, necessitating a trained feeder. Feeders should be trained to monitor the safety of each swallow as well speed and duration of meal. Because patients with PD may take longer to swallow, a longer mealtime should be allowed. Relatedly, for patients with reduced pharyngeal wall contraction and posterior tongue base retraction or who demonstrate impulsive feeding behavior, taking too much food too rapidly can result in increased risk of aspiration owing to collection of food in the pharynx. Smaller bites at a slower rate should be encouraged. Enteral feeding by means of a percutaneous endoscopic gastrostomy may improve quality of life by providing nutritional support., For patients who are able, PEG does not preclude some nutrition by mouth for pleasure or nutrition.
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What Is Parkinson Disease
Parkinson;disease is a movement disorder. It can cause the muscles to tighten and become rigid This makes it hard to walk and do other daily activities. People with Parkinsons disease also have tremors and may develop cognitive problems, including memory loss and dementia.
Parkinson;disease is most common in people who are older than 50. The average age at which it occurs is 60. But some younger people may also get Parkinson disease. When it affects someone younger than age 50, it’s called early-onset Parkinson disease. You may be more likely to get early-onset Parkinson disease if someone in your family has it. The older you are, the greater your risk of developing Parkinson disease. It’s also much more common in men than in women.
Parkinson disease is a chronic and progressive disease.; It doesn’t go away and continues to get worse over time.
Strengths And Limitations Of This Study
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We provide the first same-study overview of associations at various stages along the potential pathway to reduced functional communication in Parkinsons disease .
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Ours is the first study to consider the acoustic characteristics of the speech of British people with PD.
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Our study was cross-sectional and therefore cannot provide definitive insight into causality.
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Studies in this field, including ours, tend to have smaller sample sizes than many other fields in applied health science research, reflecting both the methodological challenges of speech analysis and the challenges of recruiting from this population.
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What Devices Can Help Speech For Those With Parkinson’s Disease
Here’s a sample of the devices that are available to help people with Parkinson’s disease communicate more clearly.
Palatal lift. A dental apparatus that is similar to a retainer. It lifts the soft palate and stops air from escaping out of the nose during speech.
Amplification. A personal amplifier can be used to increase the volume of the voice. The amplifier also decreases voice fatigue.
TTY telephone relay system. A telephone equipped with a keyboard so speech can be typed and read by a relay operator to the listener. Either the whole message can be typed or just the words that are not understood can be typed.
Low technology devices. Notebooks and language boards can be used as alternative communication techniques.
High technology electronic speech enhancers, communication devices. Computers with voice synthesizers and dedicated communication devices are available.
If you are interested in purchasing an electronic communication aid discuss this with your speech therapist before contacting sales representatives for these devices.