Swallowing Disturbances In Parkinsons Disease
Eating is not just essential to maintaining healthy nutrition it is also a social activity, yet because it is a semi-automatic activity that takes little concentration or effort, the complexity of the normal swallowing process which involves precise coordinated muscular activity is under-appreciated. Swallowing disturbances are common in Parkinsons, bringing with them a multitude of health-related problems and risks as well as psychosocial distress. By recognizing the symptoms that indicate swallowing problems, you or your loved one can get the help you need to keep living an active, fulfilling life.
How Can I Help My Loved Ones
Swallowing difficulties increase risks of choking. You can learn the Heimlich maneuver which is a rapid first aid procedure to treat choking due to upper airway obstruction. You may never have to use it, but it can save a life.
If a loved one goes to a speech therapy or occupational therapy appointment, go with them. These specialists will also work with you and give you practical advice to make meals more enjoyable and less anxiety-inducing.
Never rush your loved ones during mealtimes.
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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Managing Swallowing Changes In Psp Cbd And Msa
In this one hour and fifteen-minute webinar speech language pathologist Julie Hicks has just one slide specific to PSP, CBD, and MSA. The rest of her presentation provides general information about working with a SLP, what swallowing evaluation looks like, and what treatment might involve. In the question-and-answer time Julie talks about when to see an SLP, the use of feeding tubes, practical tips families can use to help people slow down and control impulsivity while eating, and how to find an SLP with experience treating those with parkinsonism disorders.
Swallowing Difficulties And Parkinsons Medication
If swallowing tablets or capsules becomes difficult, it may be tempting to crush tablets or open capsules, but this should never be done, as it can cause serious side effects and/or prevent the medication working properly. Always ask your pharmacist or doctor, or check the patient information leaflet before tampering with medicines in any way. Swallowing medications with jelly, yoghurt or apple sauce may help you swallow medication more comfortably.
Many Parkinsons medicines are prepared or designed to work in a particular way that will be harmed by crushing or opening capsules. For example, some medicines have:
- Sugar or film coating: This is usually to make them taste better, but crushing may make them taste unpleasant.
- Enteric coating: This coating is designed to keep the tablet whole in the stomach, in some cases to protect the stomach or to protect the medicine from stomach acid so that it is released after passing through the stomach, for example in the intestine. This type of tablet should never be crushed.
- Modified or controlled release: These medications have been designed to release slowly and act over a longer period, so they can be taken less often. Crushing this type of tablet would lead to a rapid release of the medicine which could be harmful.
If you experience any problems you should talk to your doctor, so that he or she can prescribe medication in a form that is easier to take. Some medicines are available in liquid form.
Increased Energy Expenditure Can Be Associated With Pd:
- Dyskinesias are extra movements which can be a side effect of carbidopa/levodopa. These movements can be prominent in some people and persistent throughout the day leading to excessive energy consumption and weight loss.
- Tremor as well as muscle rigidity, if persistent, can be causes of excessive energy consumption and subsequent weight loss.
- Although the reasons are not completely understood, PD can be associated with dysregulated energy use even without extra movements. There are many theories as to why this may be the case, including abnormalities of the hypothalamus, an area of the brain that is responsible for many automatic functions including food intake and energy metabolism.
Treating Eating And Swallowing Difficulties
If you or someone you care for is experiencing difficulties with eating, swallowing or saliva control, the first step is to consult your doctor, who may refer you on to an SLT / SLP.
Your doctor may be able to adjust the timing and dose of medicines so that these are working well at mealtimes and so swallowing problems are better managed when eating. However, for some patients, medications do not affect the swallowing function.
Your doctor may also adjust your medications, or may prescribe new ones to reduce production of saliva. Some Parkinsons medicines, including levodopa, improve muscle movement and may help to reduce drooling. However, some medications, such as clozapine, which is prescribed for mental health problems, can actually increase saliva production.
Botulinum toxin can be injected into the salivary glands to reduce saliva production. This treatment will not work for everyone and injections may need to be repeated every three to six months. However, for some patients, Botox injections are not recommended and may be dangerous.
In severe cases when other treatments are not effective, radiotherapy to the salivary glands can restrict saliva production. In extreme cases the salivary glands can be surgically removed as a last resort.
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Saliva And Swallowing Challenges
In this 1-hour webinar Ianessa Humbert, PhD, discusses the normal swallowing changes that occur with aging, how swallowing issues are assessed, what happens when food goes the wrong way, and swallowing treatment options. She also briefly talks about drooling and dry mouth assessment and treatments.
Eating Swallowing And Saliva Management
Some people with Parkinsons may find they have difficulties with eating, swallowing and saliva control at some stage of their journey with Parkinsons.
Parkinsons can cause the muscles in the jaw and face to become stiff which affects the control of chewing and swallowing.
What Can You Do About Weight Loss Associated With Pd
If you do find yourself unable to maintain a healthy weight, discuss this with your doctor. The good news is that after a medical workup, he or she may suggest one or more of the following steps that can help you:
Tips and takeaways
- Despite a diagnosis of PD, weight loss should prompt a full medical workup.
- Weight loss that is attributed to PD can be caused by a variety of reasons including decreased appetite, increased energy expenditure, swallowing difficulties, and poor gut motility.
- Weight loss has been linked to a poorer quality of life in PD and may contribute to increasing frailty.
- There are steps you can take that may help. Depending on the causes contributing to weight loss, efforts to counteract weight loss could include consultation with a dietician, swallow evaluation and PD medication adjustment.
- As with all symptoms, discuss your concerns about weight loss with your doctor.
Do I Need To See A Dentist Who Specializes In Parkinsons
Most dentists will be able to treat you regardless of how advanced your Parkinsons disease is. However, it is vital that you tell your dentist you have Parkinsons disease and the associated symptoms.Your dentist will suggest a routine adapted to the condition of your mouth in order to prevent, identify and treat the problems most often associated with Parkinsons disease. They will also be able to give you brushing techniques that are best suited for the condition of your mouth.
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Dystonia And Meige Syndrome With Gpi Dbs
Bilateral GPi DBS has been shown to improve the swallowing function in majority of the studies in patients with Meige syndrome, as demonstrated by improved BurkeFahnMasden Dystonia Rating Scale speech and swallowing scores in 12 patients who followed up to 38 months on average , in 11 patients who followed up for 23 months on average , in 6 patients who followed up to 60 months , and in 40 patients who followed up at 6, 12, and 24 months after surgery . There was one study by Limotai et al. in six patients with Meige syndrome, with one unilateral and five bilateral GPi, evaluated 6 and 12 months after DSB for Unified Dystonia Rating Scale and BFMDR speech and swallowing function, but they did not find improvement in speech and swallowing function in this cohort . Bilateral GPi also has been used in patients with 11 non-Meige dystonia patients and 9 Meige syndrome patients , with significantly improved swallowing and speech scores in BFMDR up to 36 months after the DBS. Bilateral GPi also has been used in primary generalized dystonia and segmental dystonia patients , and dyskinetic cerebral palsy patients , but no changes or just slightly worsening in speech and swallowing function after DBS compared to baseline were reported.
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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Slow Muscles Carrying Food To Your Stomach
Parkinsons may also slow down the muscles carrying food down into your stomach. Food moving slowly down your food pipe to your stomach can make you feel full up. But once it arrives at your stomach you realise youre still hungry. By this time the food on your plate may have gone cold and be unappealing.
Effect Of Deep Brain Stimulation On Swallowing Function: A Systematic Review
- 1Department of Neurology, Beijing Hospital, National Center of Gerontology, Beijing, China
- 2Department of Neurology, The University of Chicago Medicine, Chicago, IL, United States
- 3Department of Organismal Biology and Anatomy, The University of Chicago, Chicago, IL, United States
- 4Speech and Swallowing Service, The University of Chicago Medicine, Chicago, IL, United States
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If You Have Swallowing Difficulty What Can Be Done
In some cases, swallowing function varies in response to dopamine medication doses, much like other aspects of motor function. Therefore, if swallowing becomes problematic, an increase in dopaminergic medications can be tried. In addition, make sure you undergo a swallow evaluation when you are in the ON state.
Even before a formal swallow study, you can take steps to increase the efficiency of your swallow. These include:
- Sit upright during all eating and drinking, even when taking pills
- Tilt the head slightly forward, not backward, as you swallow
- Take small bites of food, chew thoroughly, and do not add any more food until everything from the first bite has been swallowed
- Take small sips of liquid
- Concentrate while moving the food backward in the mouth with the tongue
- Double swallow if the food did not go down completely with the first swallow
- Sometimes taking a sip of liquid between bites of food can help to wash the food down
- If eating is very tiring, try several smaller meals spaced out during the day instead of three large meals.
Swallowing Difficulties In Parkinsons Disease
The act of swallowing involves a complex series of activities that begin in the mouth, continue in the pharynx and end in the esophagus. These include chewing, using the tongue to move the bolus of food to the back of the throat and then coordinating the muscles that both propel the food into the esophagus and protect the airway or trachea from food penetration. Swallowing dysfunction can be considered both a motor and a non-motor symptom of PD. Loss of dopamine neurons in the substantia nigra area of the brain can cause the motor dysfunction that impairs swallowing. However, loss of neurons in other areas of the brain, such as the cortex and lower brain stem can also affect the overall control and coordination of swallowing, and can be thought of as a non-motor symptom of PD. Swallowing issues are very important to diagnose. Impacts on your daily life and your health can range from difficulties with meals to more extreme cases where it could lead to choking and aspiration which can be very serious or even fatal.
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Communication Strategies For Optimal Success
In this 1-hour webinar speech language pathologist Angela Roberts reviews the changes in speech, facial expressions, cognition, voice and hearing caused by PD that can interfere with communication and meaningful connection with others. These changes impact the social, emotional, physical and practical aspects of living with PD. Communication strategies for optimizing successful conversation are shared. Registration is required, but it is free.
When You Take Medicine
In most cases, you can crush your pills and mix them with applesauce or pudding. But crushing some drugs, like Sinemet CR, can affect how the drugs work. There are some medications that should never be crushed. Ask your pharmacist which meds you can crush and which you can get as a liquid.
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Oral Dysfunction In Parkinsons: Swallowing Problems And Drooling
Two common and distressing problems that can develop in Parkinsons disease are swallowing dysfunction and drooling. I want to help you better understand these issues and learn what you can do to improve them so read on!
Thank you to Christine Sapienza, PhD, CCC-SLP and Bari Hoffman Ruddy, PhD, CCC-SLP for providing some of the material below.
Eating Swallowing And Saliva Control
Some people with Parkinsons may find they have problems with eating, swallowing and controlling their saliva.
This information looks at the issues you may face, explains why they happen and what help is available.
Eating is a social activity and problems that affect chewing and swallowing can have a big impact on how much you enjoy meal times. For example, some people with Parkinsons have told us that they feel self-conscious or embarrassed while eating because of their symptoms.
Its important to look out for symptoms related to difficulties with eating and swallowing. These can develop slowly over time and you may not notice them, so family, friends or carers should know what to look out for too.
If youre not able to swallow properly, you may experience:
- inability to clear food from the mouth
- food sticking in the throat
- a gurgly voice
- coughing when eating or drinking
- choking on food, liquid or saliva
- problems swallowing medication
- discomfort in the chest or throat
These things can lead to a number of long-term problems, including:
Talk to your GP as soon as you can if you have problems with eating or swallowing they may refer you to specialists who can help.
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How Can I Make Chewing And Swallowing Easier
The way you sit, the foods you eat, and how you eat can affect your ability to swallow. To use your posture to make chewing and swallowing easier, you can:
- Sit upright at a 90-degree angle.
- Tilt your head slightly forward.
- Stay seated or standing for 15-20 minutes after you eat a meal.
When you eat:
If you don’t make enough saliva:
- Drink plenty of fluids.
- Every once in a while, suck on ice pops, ice chips, lemon ice, or lemon-flavored water to add to your saliva. That’ll help you swallow more often.
If chewing is difficult or tiring:
- Cut back on or stop eating foods you have to chew, and eat more soft things.
- Puree your food in a blender.
- If thin liquids make you cough, thicken them with a liquid thickener. You can also use thicker liquids instead of thin ones, like nectars instead of juices and cream soups instead of plain broths.
How Do I Know If I Have A Speech Or Voice Problem
- My voice makes it difficult for people to hear me.
- People have difficulty understanding me in a noisy room.
- My voice issues limit my personal and social life.
- I feel left out of conversations because of my voice.
- My voice problem causes me to lose income.
- I have to strain to produce voice.
- My voice clarity is unpredictable.
- My voice problem upsets me.
- My voice makes me feel handicapped.
- People ask, “What’s wrong with your voice?”
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Other Symptoms That May Contribute To Weight Loss In Pd:
- People with difficulty swallowing associated with PD will typically slow down their eating and reduce their consumption in an attempt to eat without coughing or choking.
- PD often causes slowed transit of food through the gut which can impact absorption and cause weight loss
- Mobility issues and tremors may impede the ability to buy groceries, prepare meals, and eat, all contributing to reduced food intake.