Developing A Management Plan
Once a diagnosis of gastroparesis is confirmed, an appropriate management plan can be considered for the patient. Management of gastroparesis is focused on improving gastric emptying itself and methods to circumvent the inconsistency in drug absorption that may result from gastroparesis. A range of gastroparesis treatment guidelines are available to help guide therapeutic choices, although these have not been developed specifically for gastric motility issues arising in patients with PD . As a result, implementing clinical guidelines for gastroparesis in patients with PD is not that straightforward, as certain recommendations are not applicable in PD, for example the use of metoclopramide.
The management of gastroparesis in patients with PD, just as in the case of dysphagia, will ideally need a multidisciplinary approach with input from both the neurology/movement disorders team and gastroenterology colleagues . Management options for gastroparesis in patients with PD generally fall into three categories: dietary modifications, medical management, and physical/mechanical interventions.
Dietary modifications
Physical activity
Regular physical activity has been shown to have substantial overall benefits for patients with PD . However, studies in healthy subjects have shown that exercise can also be an important management tool for gastroparesis , so this is something that should be considered in the overall management of patients with PD who experience gastroparesis.
How Do I Know If I Have A Swallowing Problem
- I have recently lost weight without trying.
- I tend to avoid drinking liquids.
- I get the sensation of food being stuck in my throat.
- I tend to drool.
- I notice food collecting around my gum line.
- I tend to cough or choke before, during or after eating or drinking.
- I often have heartburn or a sore throat.
- I have trouble keeping food or liquid in my mouth.
What Is The Cause
PD damages the nerves in the brain. It causes problems with movement and communication, including changes in speech. The exact way that PD causes speech and swallowing problems remains unclear.4,5
The nerve cells in the heavily damaged area of the brain produce dopamine. This is a chemical messenger that transmits signals to parts of the brain that help regulate smooth, purposeful movement.4
The muscles in the face, mouth, and throat also need to move to generate speech and help with swallowing. Doctors think that damage to dopamine-producing nerve cells leads to dysfunction in the movement of muscles involved in speech and swallowing, along with those in the trunk and limbs.4
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Unmet Needs Areas For Future Research
This consensus process identified several critical areas for the timely and correct diagnosis of dysphagia in PD that could not be properly addressed by the panel of experts due to the lack of reliable evidence. Future studies need to focus on the reliability of clinical methods to screen and assess dysphagia in PD and should better define the conditions when instrumental investigations are required. Other areas worth attention are the development of validated all-inclusive scales for rating dysphagia severity in PD, and of PD-specific tools to assess the impact of dysphagia on QoL.
In particular, there was agreement among the consensus participants that future research should aim to address the following additional questions:
What are the pathophysiological elements of dysphagia in PD and their neurophysiological correlates in terms of oropharyngeal sensory and motor impairment?
Spl Immediately After Treatment
We conducted four types of studies to evaluate the efficacy of SPL. A total of 141 participants were tested with three voice tasks, and voice testing revealed a higher SPL level in the LSVT group than the control group, with high heterogeneity . After subgroup analyses, the SPL level increased during pronunciation vowel , while reading of the rainbow passage , the monologues , and the heterogeneity was not significant across four studies .
SPL immediately after the treatment during a reading of vowel, rainbow passage, and monologues.
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What Can Be Done
The first step is to get a referral to a speech language pathologist . This professional will take a medical history and interview you about eating and swallowing. Next you will probably have a swallowing evaluation, using either a video x-ray or an endoscopic exam. During this procedure, you will swallow different consistencies of food and liquids, and the SLP can observe the entire swallowing process: from your first sip and bite, through the mouth, down the throat and esophagus, and into the stomach. This is the best way to find out the extent and cause of swallowing problems. Then the SLP can recommend treatment.
Exercise
Just as exercise can ease other PD-related movement difficulties, it can also help with swallowing. One technique is the Lee Silverman Voice Technique , familiar to many people with PD as a therapy to improve speech. It helps a person to exaggerate speaking and swallowing. In addition, working with an SLP on an individualized program can help you swallow hard to better move food from the mouth down the throat.
Change the Food
Swallowing difficulties can be eased by pureeing solid foods or thickening liquids, to avoid liquid going down the airway. Talk to a speech-language pathologist for help with these modifications.
Box 4recommendations On Prognostic Value Of Dysphagia In Pd
| a.Does dysphagia influence the prognosis of the PD? Statements are based on core literature consisting of Class I , II , and III and IV level studies and expert opinion. The presence of dysphagia negatively influences the prognosis of patients with PD. The presence of dysphagia, and more specifically, anterograde aspiration in the lungs is strongly correlated to a higher risk of choking and aspiration pneumonia. Poor oral care, load of comorbidities and cognitive impairment are possibly associated to a worse prognosis in dysphagic PD patients. |
| b. What factors or associated conditions can influence the prognosis of dysphagia in PD? Long duration and greater severity of PD has a negative impact on the swallowing function. An impaired cough response has a negative impact on dysphagia severity. |
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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.
Dysphagia For Medication Depending On The Type Of Tablet Or Capsule
Table illustrates the frequency of impaired swallowing efficiency and swallowing safety as well as the mean values of subjective difficulty and anxiety during swallowing depending on the type of tablet or capsule. The Friedmans-test revealed a difference in swallowing efficiency , subjective difficulty and subjective anxiety depending on the type of tablet or capsule. However, the Friedmans-test for swallowing safety did not suggest differences between the type of tablets or capsules. The post-hoc analysis of pairwise comparisons for swallowing difficulty further revealed more severe difficulty with the large tablet vs. the small capsule and vs. the small tablet . The post-hoc analyses of pairwise comparisons for swallowing efficiency as well as subjective anxiety did not reveal significant results. No statistical difference was detected in swallowing efficiency, safety, subjective difficulty or subjective anxiety per the large capsule vs. any other dosage form. However, the raw data in detail suggest a tendency for higher swallowing efficiency of capsules compared with tablets, and greater anxiety when swallowing larger capsules and tablets compared with small products.
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What Are The Risks Associated With Dysphagia
For most people with Parkinsons, swallowing challenges are mild at first and may stay that way for quite some time. However, dysphasia typically gets more severe as Parkinsons progresses. No matter its severity, it can have a significant impact on your quality of life, and at any stage, if left untreated, it can cause serious complications, such as those listed below.
About This Neurotech Research News
Abstract
Online internal speech decoding from single neurons in a human participant
Speech brain-machine interfaces translate brain signals into words or audio outputs, enabling communication for people having lost their speech abilities due to diseases or injury.
While important advances in vocalized, attempted, and mimed speech decoding have been achieved, results for internal speech decoding are sparse, and have yet to achieve high functionality. Notably, it is still unclear from which brain areas internal speech can be decoded.
In this work, a tetraplegic participant with implanted microelectrode arrays located in the supramarginal gyrus and primary somatosensory cortex performed internal and vocalized speech of six words and two pseudowords.
We found robust internal speech decoding from SMG single neuron activity, achieving up to 91% classification accuracy during an online task .
Evidence of shared neural representations between internal speech, word reading, and vocalized speech processes were found. SMG represented words in different languages as well as pseudowords, providing evidence for phonetic encoding.
Furthermore, our decoder achieved high classification with multiple internal speech strategies . Activity in S1 was modulated by vocalized but not internal speech, suggesting no articulator movements of the vocal tract occurred during internal speech production.
This works represents the first proof-of-concept for a high-performance internal speech BMI.
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What If I Have An Emergency How Will I Communicate
- Use an intercom system or baby monitor to alert others that there is an emergency.
- Use bells or buzzers if you are not able to speak. Use codes that signify urgency. For example, a tinkling bell may mean, Id like company while an air-horn means theres an emergency.
- Carry a portable phone that is equipped with pre-programmed numbers.
- Pre-program all of your telephones so they can automatically dial the necessary emergency number.
- Consider a life call button if you spend time alone.
Show Sources
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Cost Analysis Of Home Telerehabilitation For Speech Treatment In People With Parkinsons Disease
- Telerehabilitation in Communication Disorders and Mental Health2020
- Telerehabilitation in Communication Disorders and Mental Health2020
- The SAGE Encyclopedia of Human Communication Sciences and Disorders2019
- The SAGE Encyclopedia of Human Communication Sciences and Disorders2019
- SAGE Handbook of Mixed Methods in Social & Behavioral Research2010
- SAGE Research MethodsCase
- James F. Sallis and morePhysical Activity & Behavioral Medicine
- Encyclopedia of Medical Decision Making2009
- The SAGE Encyclopedia of Human Communication Sciences and Disorders2019
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What Causes Parkinson Disease
As is the case with many other neurodegenerative disorders, the vast majority of Parkinson disease cases occur spontaneously with no known genetic inheritance from generation to generation. These so-called sporadic cases make up more than 90% of all cases of PD. However, inherited forms of PD have been identified of both the dominant and the recessive type. With both early and late age onset forms, the various gene defects responsible have pointed to selected biochemical pathways that could serve as key targets for future therapeutic intervention. One area of particular interest is the role played by oxidative damage in the substantia nigra as a causal factor in PD.
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Dysphagia For Medication And Motor Complications
A significant linear regression equation was found to predict motor complications according to the summarized score of the MDS-UPDRS-part-IV with age and the dysphagia for medication score as independent variables. R-square was 0.128, indicating that ~13% of the variance was explained by the model. Dysphagia for medication significantly predicted motor complications whereas age was not a predicting variable . Because of the violation of the homoscedasticity of the residuals and the normal distribution of the residuals, additional wild bootstrapping with 2000 iterations was performed in which dysphagia for medication also predicted motor complications .
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Treatment And Therapy Options
If you are worried about dysphagia, a good first step is to speak with your neurologist. Your neurologist can recommend a speech-language pathologist . The SLP will examine you and recommend therapy or treatment options.1
An examination will likely include a questionnaire and imaging test. During the imaging test, the SLP will use a video X-ray or a small camera in your nose to watch you eat and drink. Your SLP may also give you a water swallowing test. In this test, your SLP determines how much water you can easily drink. These exams show your SLP where problems are happening and help them recommend options for you.2
There are different types of therapy your SLP may recommend. One method is the Lee Silverman Voice Technique . The LSVT was first designed as a therapy to help people with speaking difficulties from PD. However, the therapy can also help people swallow safely. The LSVT is a regular regimen that emphasizes exaggerated swallowing and speaking. This helps people practice swallowing hard, which can help move food down the throat.4,5
Another therapy option is called Expiratory Muscle Strength Training . This training focuses on strengthening the muscles that help you breathe. During EMST, your SLP may have you use a handheld tool. This tool trains and strengthens your breathing muscles, just like how someone might lift weights at the gym. Training these muscles also impacts swallowing and makes it safer and easier.6
Clinical Characteristics And Prevalence Of Dysphagia
66 subjects were enrolled in the study. All patients fully completed the FEES protocol. Table illustrates demographic and clinical characteristics of the cohort as well as prevalence and severity of OD for food and liquid and overall dysphagia for medication across all tablets and capsules. Both forms of dysphagia were common in PD patients and occurred with at least mild impairment in ~70% of patients.
Table 1 Demographics and prevalence of oropharyngeal dysphagia for food and liquid and dysphagia for medication: SD standard deviation, OD oropharyngeal dysphagia, PAS Penetration Aspiration Scale.
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Limitations Of The Study
Some limitations of the present work are worth mentioning. The first regards the recruitment of participants, which, in the absence of a strictly codified methodology for selection, was based on practical considerations and on their voluntary acceptance of our invitation. This approach led to the formation of an expert group with a prevalent representation of neurologists compared to other specialists, and a prevalence of Italian specialists compared to specialists from other countries. Thus, it is possible that the statements elaborated by this panel group do not reflect entirely the point of view of the wider international medical and scientific communities. It is worth noting, however, that we put in place several measures to involve as many experts in the field as possible and that, once the panel was created based on voluntary adhesion, the ruling process was supported by a thorough revision of the data available from the literature. This approach seemed the best compromise between spending more time in trying to include a larger group of experts and the need to deliver this consensus in an acceptable time frame to provide timely guidance to clinician on a critical issue in the management of PD patients. Another shortcoming of our consensus statements is that PD patients, their carers or representatives were not involved in the process. Indeed, their contribution would have certainly been relevant, especially as regards the quality of life topic.
Dysphagia Or Difficulty Swallowing And Parkinsons
Dysphagia or difficulty swallowing is a common problem that can happen at any stage of Parkinsons and is described as difficulty moving food, liquid, saliva or medication from your mouth to your stomach. Eating and drinking can be uncomfortable, stressful and even dangerous if you have dysphagia. If not managed properly life-threatening medical problems such as pneumonia, choking, poor nutrition and dehydration can occur. Early detection and individualised treatment of dysphagia is crucial to prevent complications and improve your quality of life.
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Understanding The Connection Between Dysphagia And Parkinsons
Every year, 60,000 Americans are diagnosed with Parkinsons disease , a progressive disorder of the nervous system that affects movement and causes tremors and stiffness. Of those patients, 80 percent will develop dysphagia, or difficulty swallowing, over the course of their illness as they lose control of their mouth and throat muscles.
Dysphagia can reduce quality of life and lead to malnutrition, dehydration, and aspiration, which occurs when a patient accidentally inhales food or fluid into their windpipe and lungs. Aspiration can lead to a dangerous condition called aspiration pneumonia, the leading cause of death in patients with PD.
It is critical to learn to recognize the symptoms of dysphagia in those who have been diagnosed with PD, especially during Parkinsons Awareness Month this April. They include:
- Unintentional weight loss
- Feeling like theres food stuck in the throat
- Food collecting around the gum line
- Coughing or choking before, during, or after eating and drinking
- Heartburn or sore throat
- Difficulty keeping food or liquid in the mouth
For those diagnosed with PD and dysphagia, treatment is personalized depending on the type and cause of the swallowing disorder, but can involve several of the below strategies that can make consuming foods and liquids easier and safer: