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How To Control Drooling With Parkinson’s

A Exercises To Improve Swallowing Difficulty :

Management of Drooling in Parkinson’s

A speech-swallow therapist evaluates how your muscles move while swallowing. They can teach you important exercises to improve swallowing difficulty and prevent Aspiration.

Speech therapists specially trained in Parkinsons can teach you exercises such as Expiratory Muscle Strength Training or Lee Silverman Speech Therapy or LOUD therapy.

These specialized training sessions are tremendously helpful in improving voice. But these exercises also make swallowing easier.

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Excessive Saliva And Drooling In Parkinsons

Saliva is needed for the first stages of digestion, including chewing and swallowing. This watery substance contains enzymes that start to digest our food.

Many people with Parkinsons experience poor saliva control, which may result in excessive saliva and drooling, or alternatively, in a dry mouth and other eating problems.

Role Of Saliva In Health And Well

Two primary functions of saliva concern its role in maintaining oral pH and microbiotic homeostasis, and facilitating swallowing and speaking.46 Saliva possesses antimicrobial, anti-viral and anti-fungal properties which aid oral cleansing, protect against infection and support tissue repair it dilutes sugars and helps stabilize acidity it contributes to remineralization of dental enamel. It serves as a buffer for extremes of temperature or against noxious substances. It lubricates the oral cavity, thereby supporting formation and transport of the bolus to the pharynx. It acts as a first stage in digestion and stimulates interaction with chemosensory receptors to aid taste and smell perception. It supports smooth and accurate movement of the tongue and lips for speech.

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What Is Expiratory Muscle Strength Training


Expiratory muscle strength training was first developed for high school band students to increase exhalation strength.

It involves people blowing into a device against resistance. Its a bit like blowing into a large straw but instead of the breath passing freely through the straw, the air encounters resistance. You find you have to blow harder, which helps strengthen the target muscles.

Just like a gym workout, people repeat this action multiple times and do this training five times a week.

Since its development, some studies by other researchers have found this training not only increases exhalation strength but also improves cough strength and the swallow. Problems with coughing and swallowing are difficulties often experienced by people with Parkinsons.

We were interested to know whether this training also resulted in improvements in drooling.

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How Much Does Parkinson’s Cost America

Each family touched by Parkinson’s spends about $26,000 per year out of pocket to cope with the disease, Beck said, far more than is spent on heart disease and diabetes.

An earlier study from the Michael J. Fox Foundation and others found that Parkinson’s costs the U.S. $52 billion every year and will cost $80 billion annually by 2037.

The federal government now spends over $200 million a year to address Parkinson’s. But Okun said that an investment of $3 billion a year is what’s needed to find viable treatments, better understand the disease and hopefully learn to prevent it.

More research funding also helps attract more scientific talent to the field, Beck said. “If they see it’s going to be hard to do research in Parkinson’s because there’s not a lot of money there, they’re going to go into something else.”

Contact Karen Weintraub at

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

Assessment Of Saliva Flow

Evaluation of saliva flow is challenged by a range of issues, including: difficulty obtaining objective measures in naturalistic settings time and place variability that exists in respect of natural variation in flow rates fluctuations in motor function experienced by pwPD that can impact on swallowing and saliva control the variety of situations across pwPD concerning where they experience difficulties or not and the subjective nature of whether an individual perceives there to be a problem present or not. Similar to other activity limitations in PD such as dysphagia and dysarthria, perceived magnitude of psychosocial impact of drooling, dry mouth and excess saliva does not necessarily correlate significantly with objective measures of saliva flow and loss.3,19,6567

These factors underline that no single assessment captures all dimensions important for establishing baseline and outcome measures of salivation/drooling. Accordingly, outcome evaluation covers a range of measurements, with a focus on key variables that encompass the patients own chosen concerns and goals.

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Eating And Swallowing Problems And Parkinsons

Research suggests that eating and swallowing difficulties affect about a 90% of all people with Parkinsons. The true figure may be even higher as some people do not report the problem to their health care team.

Swallowing is a motor function that includes three stages.

  • The first stage is the oral phase: food is chewed and mixed with saliva to form a soft ball called bolus. The tongue then pushes the bolus to the back of the mouth, triggering the swallow reflex.
  • The second stage is the pharyngeal phase: it is the involuntary closure of the larynx by the epiglottis and vocal cords, which temporarily inhibites breathing. These actions prevent food from going ‘down the wrong pipe’ into the trachea .
  • The third stage is the esophageal phase: the bolus moves into the esophagus, the muscular tube that contracts to push the bolus into the stomach.

Unfortunately, many people with Parkinsons experience swallowing problems due to reduced control and muscle tone of the jaw, lips, tongue and throat muscles, especially in later stages of the condition. Eating and swallowing becomes slower and requires more effort.

People with Parkinsons are at particular risk of aspiration due to a delay in the triggering of their swallow reflex. This compromises the effectiveness of the airway protection while swallowing. This can lead to aspiration pneumonia due to a lack of coughing if food enters the windpipe, allowing food to reach the lungs unchecked.

Treating Eating And Swallowing Difficulties

I have problems with drooling due to Parkinson’s Disease. What can I do about it?

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.

Anticholinergic medications may help to reduce the amount of saliva you produce but are not suitable for everyone. For more information see Managing medication.

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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Tips For Difficulty With Saliva Control Caused By Parkinsons

By Doris Kasold 9 am on July 21, 2015

When an elderly person has Parkinsons disease, muscle spasms sometimes lead to difficulty with swallowing. This means that the saliva they would normally swallow builds up and escapes through the corners of the mouth. If your loved one has difficulty controlling saliva, read on for Clearwater Home Care experts tips for managing saliva production.

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.

Another symptom of Parkinsons can be producing excessive saliva. The stiffer facial muscles can change the nature of saliva, which may become thicker and stickier.

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Side Effects Of Using Botox

In general, side effects of Botulinum toxin can be due to over-weakening of the injected muscle, which, if done on leg and foot muscles, for example, could interfere with walking.

Uncommonly, Botulinum toxin can diffuse to neighboring muscles and cause more widespread side effects. For example, injections of neck muscles could result in toxin diffusing locally to muscles used for swallowing and cause difficulty swallowing. Even less common, are side effects due to travel of the toxin to more distant parts of the body via the bloodstream. For example, injections of any body part could theoretically result in difficulty swallowing or breathing if the toxin travels to these muscles. This is very rare however and Botulinum toxin injections are typically very safe. The full risk profile for your particular situation however, needs to be discussed with the physician performing the injections.

There are typically no limitations after the injections and you can return immediately to your normal activities.

Although dermatologists often use Botulinum toxin for cosmetic purposes, only a neurologist is qualified to determine whether the injections can help with certain PD symptoms. If you are interested to investigate whether Botulinum toxin injections may help you, discuss this with your neurologist. If he/she feels that they may be helpful, but does not perform them, he/she can refer you to a neurologist who does.

Tips and takeaways

Conditions Treated Using Botulinum Toxin In Parkinsons Disease

Pin on Parkinsons Desease
  • Dystonia Dystonia refers to an involuntary twisting of a body part, which can be painful and can interfere with a persons desired movement. In PD, dystonia can be a motor symptom due to the disease, appearing first thing in the morning before taking medication or as a dose of medication is wearing off. Alternatively, dystonia can be a side effect of Levodopa. A common dystonia in young onset PD involves toe curling or foot inversion . This dystonia often occurs only in particular circumstances such as while walking or running. Other dystonias involve frequent and persistent eye closure, known as blepharospasm, or neck turning, known as cervical dystonia. These can be associated with PD, but may also accompany other forms of parkinsonism such as Multiple System Atrophy or Progressive Supranuclear Palsy. Botulinum toxin injections, targeting the particular muscles that are moving excessively, can be effective in all these scenarios.
  • Tremor Although Botulinum toxin is not commonly used for this purpose, there are case reports in the literature showing its effective use for the control of tremor.
  • Drooling Likely due to the decreased swallowing rate of patients with PD, sialorrhea, or drooling, can be a feature of the disease. Drooling is not only an annoyance, but can result in significant embarrassment and social isolation. Botulinum toxin injections into the salivary glands can decrease production of saliva and thereby decrease drooling.
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    Assessment Tools For Drooling In Pd

    The assessment tools to evaluate drooling in PD include both objective and subjective measures. Objective tools were developed to measure the volume of saliva and salivary flow. The limitations of these tools are that they are time-consuming and cannot evaluate the psychosocial impairment. Therefore, subjective tools were developed. The subjective measures in many previous studies were the UPDRS part II salivary subscores to evaluate drooling treatment responses and visual analog scales to assess the frequency, familial and social distress however, not all scales are validated. Three drooling-specific rating scales including the Drooling Severity and Frequency Scale , Drooling Rating Scale and Sialorrhea Clinical Scale for PD have been used to evaluate drooling in PD. The DSFS, a semi-quantitative scale, was used in studies to evaluate drooling in PD and cerebral palsy . The scale is composed of two domains: the severity of drooling rated on a five-point scale and frequency of drooling rated on a four-point scale. Since the DSFS is easy to administer it is widely used. However, the limitations of this scale are no assessment of the psychosocial impact, no validation and no evidence of correlation between this scale and the objective measures of salivary secretion.

    Efficacy Of Botulinum Toxin For Treating Sialorrhea In Neuromuscular Conditions

    • 1Department of Neurology, University of Missouri, Columbia, MO, United States
    • 2Assistant Professor of Neurology, Department of Neurology, University of Missouri, Columbia, MO, United States

    Background: Drooling related to bulbar weakness and dysfunction is a common concern in patients with neuromuscular disease. While there are numerous medications to manage sialorrhea, they are often limited by side effects and lack of efficacy. Botulinum toxin has shown to benefit ALS patients in a few studies, but there is scant data on the benefit in other neuromuscular conditions.

    Objective: To assess the effectiveness of Botulinum toxin in reducing sialorrhea in patients with various neuromuscular disease.

    Design/Methods: 25 patients with documented neuromuscular illness and concern for drooling was followed for 6 weeks after Botulinum toxin injection. These patients had one of the following diagnoses: Duchenne muscular dystrophy , myotonic dystrophy , oculopharyngeal muscular dystrophy , inclusion body myositis , primary lateral sclerosis , amyotrophic lateral sclerosis , spinal muscular atrophy type 2 and 3 , spinal-bulbar muscular atrophy , and Beckers muscular dystrophy . A subjective drooling scale and drooling thickness score was calculated on these patients prior to the injection and 4 and 6 weeks after the injection. Botulinum toxin 2030 units were injected into bilateral parotid gland and submandibular gland .

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    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
    • 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.

    What Is A Swallowing Evaluation

    Drooling in Parkinson’s Disease

    If because of the above signs there is concern that swallowing difficulties exist, your doctor may recommend a swallow evaluation, which can be performed by a speech and language pathologist.

    There are two main ways to evaluate someones swallow:

    • Modified barium swallow study This is the most common test that is performed. The person is asked to ingest different consistencies of barium and moving x-rays are taken that follow the barium as it is swallowed. This x-ray video pinpoints the areas of the swallow that are problematic and helps to determine the correct exercises to address the problem.
    • Fiberoptic endoscopic evaluation of swallowing is another type of test that can be performed to evaluate swallow. During this procedure, a very thin flexible fiberoptic tube which is hooked up to a camera and light source, is passed through the nasal passage. The tube does not go down the throat, but allows swallowing to be observed. This procedure is painless and well-tolerated by most individuals.

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    What Causes The Drooling

    Drooling occurs because the natural tendency to swallow every now and again is slowed down. It is not caused by an increase in saliva. The reduction in swallowing combined with a reduced awareness, stooped, poor posture and an inadequate lip seal affects the control of the saliva in and from the mouth. As a result, saliva tends to accumulate in the mouth and, rather than being swallowed, it can overflow.

    Many people have poor lip closure due to their Parkinsons and a flow of saliva from the mouth will occur if the lips do not seal tightly. There is also a tendency for the head to be bent forwards so that the chin points downwards. This will make the drooling worse.

    Apart from interfering with speech, and being embarrassing for the person with Parkinsons, overflowing of saliva can cause a soreness and rawness of the skin on the chin clothes can become stained and many people have stale breath because of their drooling difficulties. When a person with Parkinsons experiences extreme problems with excessive salivation, specialist help is usually required.

    Swallowing Exercises Can Be Very Helpful To Improve Your Swallowing

    After a formal swallow assessment, swallowing therapy sessions can be designed for you, involving exercises tailored to the specific parts of your mouth and throat that are causing the swallowing problem. Sessions may involve practicing compensatory swallowing strategies with various types of foods in order to maximize safety and efficiency while swallowing.

    During swallow therapy, recommendations may include:

    • Best feeding techniques
    • Exercises to strengthen oral and throat muscles
    • Compensatory techniques to assist in safe swallowing
    • Oral and mouth care techniques
    • Appropriate food selection and ways to modify food texture
    • Safe positioning strategies
    • Patient/family education

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