Speech and swallowing difficulties aren't necessarily the first association to come to mind when you hear the diagnosis of Parkinson's disease, but the reality is that this progressive disease may result in changes in both communication and swallowing abilities. Just as PD affects movement in other parts of the body, it also affects the muscles in the face, mouth and throat that are used for speaking and swallowing.
Did you know? Speech therapy should ideally commence before the onset of symptoms
Here's what you can expect...
Main symptoms related to speech and swallowing:
Changes in the quality and intelligibility of speech
Changes in the quality and loudness the voice
Difficulty expressing non-verbal communication (such as conveying emotion using facial expressions)
Dysphagia (difficulty chewing and/or swallowing)
Stages of speech therapy intervention
1. Initial contact
A baseline assessment of speech, voice and swallowing will be conducted. This will include a case-history questionnaire, speech and non-speech tasks, a swallow assessment and may include a swallowing "x-ray"
Education re: the progression of symptoms and what to expect
Counselling, both the patient and family members
2. Intervention
Teaching techniques to improve speech intelligibility
Swallowing exercises
Expiratory muscle strength training
Modifying food and/or liquid consistency when necessary
Teaching techniques to increase the loudness of the voice
3. Management and maintenance
Continued monitoring of symptom progression
Therapy continues and should be adapted as symptoms progress and/or change
Signs and symptoms that may indicate the need for a follow-up session with your Speech Therapist:
Speech, voice and communication
People have difficulty hearing or understanding you
You sound different to yourself, your tone may sound monotonous
Your voice may be soft and you have to strain to produce voice
You may have difficulty difficulty control your rate of speaking
People have difficulty interpreting your non-verbal communication and may mistake your 'masked' facial expression for disinterest
Swallowing
Unexplained weight-loss
A sensation of food getting stuck in the throat or frequent throat clearing
Drooling
Food residue in the mouth after meals
Coughing when eating or drinking
Difficulty controlling and moving food/liquid around in the mouth
Recurrent chest infections
Why is it important to identify and manage swallowing difficulties timeously?
Risks associated with swallowing disorders:
Pulmonary Aspiration: when food, liquids, or vomit enters the airway or lungs. Aspiration may occur without overt signs, called silent aspiration, or one may cough/choke
Aspiration pneumonia. A form of pneumonia caused by pulmonary aspiration
Severe dysphagia, the inability to maintain nutritional intake adequately and/or safely, may require non-oral feeding methods such as feeding tubes
In conclusion... Communication and swallowing disorders are common in people with Parkinson's Disease. PD can not only progressively diminish quality of life for a person with PD but also cause emotional and financial stress for the patient and their family. The earlier a person receives a baseline evaluation and speech therapy, the more likely they will be able to maintain communication and swallowing abilities as the disease progresses.
Have any additional questions for me?
Warm regards,
Charlize
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