Speech Therapy for Parkinson’s Disease Swallowing Problems
Eating and swallowing are complex neuromuscular activities consisting essentially of three phases: an oral, pharyngeal and oesophageal phase. Each phase is controlled by a different neurological mechanism. The oral phase is voluntary (i.e. biting and chewing). The pharyngeal phase of the swallow is initiated after the oral phase and is coordinated by the swallowing centre of the brain (located in the medulla oblongata and pons) (Miller et al., 2006). The swallow reflex is controlled by the autonomic nervous system during the pharyngeal and oesophageal phase (Miller et al., 2006).
Successful swallowing results in the transference of food from the mouth to the stomach, whilst protecting the airway. Any difficulties or disruption in the sequence of the swallow can lead to adverse consequences. The term ‘Dysphagia’ means difficulty swallowing (Logemann, 1997). Dysphagia can refer to difficulties at any stage of the swallowing process. This includes chewing, control of food in the mouth, initiating and controlling the pharyngeal phase of the swallow.
Research regarding the specific swallowing changes associated with Parkinson’s disease indicates deficits at both the oral and pharyngeal phases of the swallow (Miller et al., 2006). Oral phase difficulties include disturbed lingual motility resulting in prolonged oral transit time, difficulty with bolus formation and poor anterior to posterior transfer of bolus (El Sharkawi, Ramig, Logemann, Pauloski, Rademaker, Smith, Pawlas, Baum & Werner, 2002). Significant difficulties with dry mouth may also occur due to the side effects of PD related medications (e.g. L-DOPA – Levadopa) (Brooks, 2008).
Oropharyngeal bradykinesia and rigidity, incomplete cricopharyngeal relaxation, reduced cricopharyngeal opening and delayed initiation of the swallow reflex have been suggested as possible features of dysphagia in patients with Parkinson’s disease (Baijens and Speyer, 2009).
Consequences of Dysphagia
Difficulties swallowing can begin in the early stages of Parkinson’s disease and can lead to adverse medical and psychosocial outcomes (Baijens & Speyer, 2009).
Aspiration is a term that refers to foreign particles entering the trachea (windpipe). In healthy individuals, aspiration symptoms may occur (e.g. coughing after drink) – usually without negative health outcomes. In persons with Dysphagia, the risk is heightened due the consistency of difficulties associated with the swallow function. Depending on the nature and severity of the Dysphagia, a person may have difficulty swallowing foods and/or fluids (Baijens & Speyer, 2009).
Dysphagia has been linked to the development of dehydration, malnutrition, chest infection and pneumonia (Baijens & Speyer, 2009). Aspiration pneumonia is a pulmonary infection that can develop as a result of foreign particles in the bronchial tree (i.e. a result of aspiration). The nature of particles aspirated can heighten the risk of developing aspiration pneumonia (e.g. chemical or bacteria). The development of infection depends on the nature of the aspirant, the overall health of the individual and the function of the airway defence mechanism (Logemann, 1997).
Research indicates that the psychosocial consequences of swallow dysfunction secondary to Dysphagia are significant for people with Parkinson’s disease (Miller et al., 2006). Studies show that Dysphagia leads to alteration of eating habits, loss of mealtime enjoyment due to slowness, changed diet, feelings of stigma and sadness and the need for social adjustment (Miller et al., 2006). Research identifies that further concerns are linked to the impact on those caring for a person with Parkinson’s disease (Miller et al., 2006); specifically, the drain on time and energy with preparing meals, the disruption of family life, reduced social interaction (e.g. not having people over for dinner), separate food preparation (i.e. texture modified diets) and the extended time required to complete meals (Miller et al., 2006).
Therapy for swallowing disorders associated with Parkinson’s disease.
You can read more about therapy options for Dysphagia here.
Management of swallowing difficulties should include education of the person with Dysphagia and their family and friends to ensure the whole support team is equipped to support optimal management.
Should you have any questions about Dysphagia, please contact our speech pathologist’s Eugene and Jenna to organise a consult.
Mr Eugene Pillay and Ms Jenna Butterworth are qualified and accredited Speech Pathologists. They are Australian trained speech pathologists who work as speech therapists for adults. Eugene and Jenna are both Speech Pathology Australia members and have many years of experience managing adults with speech and language problems. Committed to providing personalised and evidence-based treatment, they tailor their therapy to each person’s individual needs.
Results focused speech therapy
ENT Clinic have created comprehensive speech pathology resources, that together with our speech pathologists consultation, can be used to create a customised treatment plan. This will ensure that you will experience results focused, effective speech therapy!
To make an appointment with Eugene and Jenna, Contact Us Today!