Speaking Effectively A Strategic Guide For Speaking And Swallowing
Booklet includes self-evaluations and caregiver surveys to determine at what point professional help is needed. Professional examinations are described along with recommendations for both home and professional intervention to improve speech, make eating easier and safer, and reduce drooling. Maintaining communication to reduce isolation is encouraged.
You May Find The Following Helpful:
- Avoid hard, dry or crumbly foods.
- Meat that is tough or chewy can be difficult to swallow. Try using a gravy or sauce, chop meat up and consider different cooking methods, such as casseroling, as this makes meat more tender.
- Having a drink with your meal makes chewing and swallowing easier.
- Good posture and a comfortable position while eating will help with swallowing.
- Try taking smaller mouthfuls.
Choosing Foods For Successful Eating
Part of formal swallow therapy will be to make appropriate food suggestions that you can eat safely. Good food choices include:
- Foods that dont require vigorous chewing. Avoid dry and crumbly foods.
- Moderately textured wheat breads instead of very coarse, nutty breads or very soft, white breads.
- Oatmeal, cream of wheat or moistened dry cereals instead of coarse, dry cereals.
- Well-cooked, tender chicken/turkey, well-cooked fish without bones, chopped and ground meats, instead of stringy, tough meats that require a lot of chewing.
- Soft casseroles and poached or scrambled eggs
- Mashed potatoes or rice, moistened with gravy or margarine, instead of wild rice or French-fried potatoes.
- Soft, cooked pasta elbows, instead of long spaghetti.
- Soft, well-cooked vegetables, cut up or creamed, instead of raw vegetables or those with a hard texture.
- Pureed or mashed fruits, fruit juices and fruit sauces, instead of fruits with seeds or hard outer skins. Avoid nuts, seeds or coconut.
- Custard, yogurt, ice cream or other soft desserts
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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?”
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.
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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.
Risks Associated With Dysphagia
Many people can find dysphagia embarrassing or frustrating. Difficulty swallowing can impact your quality of life, but it can also have serious effects.2
Dysphagia can cause malnutrition or dehydration. It can also cause aspiration, the medical term for food going down the wrong pipe. Aspiration can lead to aspiration pneumonia, which is the leading cause of death for people with PD. This is a type of lung infection that occurs when food, saliva, liquids, or vomit is breathed into the lungs or airways leading into the lungs, instead of being swallowed.1
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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.
Swallowing Is Part Of Living
Eating is among the most basic of human functions. It is necessary for sustaining life, but even more importantly, it is essential to enjoying life. In many cultures, eating is central in social gatherings, in celebrations, and in everyday family life. When we eat, our brain typically rewards us and reinforces that behavior to survive. It is well known that when we taste food with our taste buds, a message is sent to our brain regarding taste, texture, and temperature. Thus, eating certain foods causes the brain to release endorphins, serotonin, and dopamine, also called happiness hormones”.When we swallow, our brain orders our muscles from our lips to the ring-like sphincter muscle at the bottom of our esophagus to carry out a tightly choreographed series of actions so that the food entering our mouth is chewed, processed, carefully swallowed, and pushed down to our stomach all while protecting delicate nearby structures such as the nasal cavity, the voice box, the airway, and the lungs.
Speech And Swallowing In Pd
Apathy describes a lack of interest, enthusiasm or motivation. It is a non-motor symptom of Parkinsons Disease and interferes with the effective management of PD symptoms, since apathetic people are less inclined to exercise and follow their medication schedules. Here are some resources to understand apathy and how to cope with it.
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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What Emergency Type Devices Should A Person With Parkinsons Disease With Speech And Voice Problems Have At Hand
To preparing for emergencies:
- 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 might mean, “I’d like company,” while an air horn might mean there’s an emergency.
- Carry a cell phone that is equipped with pre-programmed numbers. Preprogram all of your telephones so they can automatically dial the necessary emergency number.
- Sign up for a “Life Call” button service if you spend time alone. Pressing a button on a device usually worn on the wrist or around neck signals a service company that alerts loved ones and/or your local emergency service.
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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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.
If I Have Speech And Voice Problems How Can I Maintain And Improve My Communication
Some tips to improve communication include:
- Choose a quiet, low-noise space. Turn off televisions, radios and other devices that create noise.
- Speak slowly.
- Make sure your listener can see your face. Look at the person while you are talking. A well-lit room improves face-to-face conversation, increasing the ability to be understood.
- Use short phrases. Say one or two words or syllables per breath.
- Plan periods of vocal rest before planned conversations or phone calls. Know that fatigue significantly affects your ability to speak. Techniques that work in the morning might not work later in the day.
- Keep your throat hydrated. Drink plenty of water. Dont drink caffeinated or alcoholic beverages. Use a humidifier if the air in your home is dry.
- Keep an upright posture, straight chin, slightly lifted neck to improve airflow from lungs to your vocal cords.
- If you are soft spoken and your voice has become low, consider using an amplifier.
If some people have difficulty understanding you, these additional strategies might help:
Survey On Drooling In Parkinson’s
In October and November 2020, the EPDA carried out a survey focused on drooling a very important yet often-overlooked Parkinsons symptom.
The results demonstrate how much of an impact sialorrhea can have on people with Parkinsons not just on swallowing itself but also on quality of life and communication. They also show that a large percentage of people have not discussed this important symptom with their healthcare professionals and have therefore not received suitable advice about the possible treatment options available.
Learn more about this project and including all the survey findings, as well as important recommendations and advice on how to manage your sialorrhea if you have Parkinsons.
Do I Have Swallowing Disturbances
As mentioned, it may be difficult to identify swallowing disturbances in people with Parkinsons because they dont always present with the typical symptoms of a swallowing problem. It is important to recognize any sign of swallowing disturbances, which may include:
- Complaints of swallowing difficulties
- Food getting stuck in the throat
- Difficulty placing and manipulating food in the mouth
- Coughing or choking before, during, or after swallowing
- Difficulty swallowing pills
- Unexplained weight loss
- Gurgly or wet-sounding voice immediately after swallowing
- Increase in saliva in the mouth after a swallow, toward the end of the meal or after a meal
- Recurrent chest infections
- Choking on food, liquids, or saliva
- Problems swallowing medication
- Discomfort in the chest or throat
- Heartburn or reflux
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Demographic And Clinical Data Of The Sample
A total of 62 individuals with PD, 40 men and 22 women , were included. The mean duration of the disease of the total sample was 9.0 ± 6.4 years and the mean H & Y stage was 2.3 ± 0.8 . A total of 32 patients reported drooling symptoms , and 30 did not exhibit drooling. No differences in the age , gender , duration of the disease , and H & Y state existed between groups. Table 1 summarizes the demographic and clinical data of the groups.
How Are Swallowing Problems Treated
The first step to addressing swallowing issues is to speak to a neurologist about getting an evaluation performed by a SLP. This professional will take a medical history and interview the person with PD about eating and swallowing.
This is typically followed by either a video X-ray or an endoscopic examination, so the medical specialist can observe the swallowing process as an individual sips liquid and eats food, as these substances flow from the mouth, down the throat and esophagus, to the stomach. With these tests it is possible to see where the trouble is occurring and to recommend therapies.
Follow the recommendations of the swallowing specialist, which may include the following:
- Exercise and Swallow Hard. Just as exercise can ease other PD-related movement difficulties, it can also help with swallowing. The Lee Silverman Voice Technique® helps a person exaggerate speaking and swallowing. Working with an SLP on an individualized program helps the person to swallow hard and move food from the mouth down the throat.
- Expiratory Muscle Strength Training. This therapy strengthens respiratory muscles, improves cough and swallowing and reduces aspiration.
- Change in food. Modifying liquids and solids can help. For people who find liquids get into the airway, liquids may need thickening. Taking bigger or smaller bites or sips or pureeing solid foods may help. First get an evaluation, so the SLP can recommend how to modify food and liquid.
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My Parkinson’s Story: Speech And Swallowing
This 8-minute video alternates between an interview with a man and his wife and healthcare professionals. The man and his wife share how Parkinson’s has affected his speech and swallowing. The healthcare professionals explain how Parkinson’s affects speech and swallowing. Speech therapy can improve speech volume and enunciation as well as swallowing control and drooling. They also advise specific changes to eating habits and avoiding some types of foods to prevent choking.
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.
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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.
Word Of Caution: Rule Out Other Health Problems First
Weight loss is a non-specific symptom and could be a sign of many medical problems including cancer, thyroid disease and other endocrine abnormalities, as well as inflammatory bowel disease and other malabsorption syndromes. Because of this, it is imperative, that weight loss is not assumed to be due to PD without a medical workup.
Once a medical workup is complete and your primary care physician is confident that there isnt a second medical problem contributing or causing weight loss, then the weight loss can be attributed to PD.
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How Do You Know If You Or Your Loved One Has A Problem With Swallowing
Swallowing difficulties can start very subtly and initially not be obvious to either the person with PD or their loved ones. There are signs to look out for before swallowing difficulty becomes overt . Some of the signs you should pay attention to include:
- Slow rate of eating people with difficulty swallowing may slow down their eating in order to avoid coughing or choking
- Fatigue during eating or decreased enjoyment of food
- A sensation that food is sticking in the throat
- Coughing or excessive throat clearing during eating
- Difficulty in swallowing pills
- Unexplained weight loss people with difficulty swallowing may reduce their consumption in an attempt to eat without coughing or choking
- Change in dietary habits people with difficult swallowing may alter their diet in order to avoid foods that cause difficulty. This may not be a choice made consciously
- Diagnosis of a pneumonia this could be caused by aspiration, or entry of a foreign substance into the airway
If you think there might be a swallowing issue, it is important to speak with your doctor about it. There are steps you can take to properly assess the situation and improve your swallowing function. This can in turn reduce your risk of choking, make eating more enjoyable, and lessen the chances of unwanted weight loss and/or other discomforts.