Wednesday, March 27, 2024

Swallowing Exercises For Parkinson’s Disease

Why Might I Need Tongue

Parkinson’s swallowing exercises at home: How You Breathe Matters

You might need to practice tongue-strengthening exercises if you have trouble swallowing. This is a medical condition called dysphagia.

Dysphagia can lead to aspiration. This is when food or other material accidentally enters the airways or lungs. This is serious, because it can lead to pneumonia and other problems. Dysphagia requires prompt diagnosis and treatment.

As part of your treatment plan, your doctor and SLP may prescribe swallowing exercises, such as tongue-strengthening exercises. This may be in addition to other treatments such as dietary changes, changes in eating position, medicines, or surgery. Over time, these exercises can strengthen your swallowing muscles. This, in turn, may improve your swallowing and prevent aspiration.

Different medical conditions can lead to swallowing problems. Some examples are:

  • Blockage in the esophagus such as from a tumor or history of intubation
  • History of radiation, chemotherapy or both to the neck or throat for cancer

Your SLP may be more likely to prescribe tongue-strengthening exercises if he or she suspects you are having trouble with your first phase of swallowing. For example, this might happen from a stroke or with dementia.

Parameters Of Oropharyngeal Swallowing And Respiratory Signals

The results of repeated measures ANOVA revealed no significant difference in SRP before and after the program in patients with PD , indicating that SRP was not longer after the program in patients with PD. However, SPR significantly differed among the different water bolus volumes .

Figure 2. Parameters of oropharyngeal swallowing and respiratory signals before and after the home-based orolingual exercise program in patients with early-stage Parkinson disease. s, seconds sEMG, surface electromyography V, voltage 2nd: second.

In summary, a low rate of piecemeal deglutition , a high rate of protective respiratory phase patterns, and a low amplitude of laryngeal excursion were observed after the 12-week home-based OLE program. Regarding the temporal parameters of oropharyngeal swallowing and respiratory signals, the duration of the SRP, TET, ET, and second deflexion associated with swallowing the three small water bolus volumes tended to be shorter after the OLE program than before the program in patients with PD however, this difference was not statistically significant. Taken together, our data derived from the noninvasive swallowing and respiration assessment indicate that the coordination of swallowing and respiration in patients with early-stage PD improved after the 12-week home-based OLE program.

Why Is Swallowing Affected In Parkinsons Disease

Generally, we all swallow more than 500 times a day and usually clear our mouths subconsciously.

The rigidity of PD affects the muscles involved in our automatic swallow and the muscles of the jaw and face may be weakened. This results in a reduction in swallowing and affects the control a person may have over their teeth. The weakened muscles may also reduce the tightness that a person achieves in closing their lips. Everyone has difculty swallowing if they cannot close their lips tightly.

If a person cannot chew their food adequately it can also cause problems. Some particles of food are swallowed easily but some may remain in the mouth. This is called piecemeal swallowing and is a common feature of PD. People are unaware that they have more food to swallow and as a result may choke. Food remaining in the mouth can harbour infections.

Often the tongue bunches up in PD and this can cause food to be pushed out through the teeth instead of controlled down the throat.

PD may also affect the muscles involved in carrying the food down into the stomach and make the process much slower.

It can also make the person feel full up, as the food passing down the oesophagus is moving so slowly.

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Swallowing And Saliva Management

This one-hour talk is in three parts. What a speech language pathologist is, how they can help someone with PD. Why you should be concerned about swallowing problems, some indications you may have a swallowing issue, what a swallowing assessment by an SLP might look like, and recommendations an SLP might make to improve swallowing. And, why you should be concerned about having either too much or too little saliva and how to manage either situation.

Dysphagia Or Difficulty Swallowing And Parkinsons

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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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Why Worry About Problems With Swallowing

There is a high incidence of silent aspiration in PD this is when food enters the airway and passes down into the lungs without any of the usual signs of coughing or choking.

The main risks associated with swallowing problems are:

  • Asphyxiation food blocking the airway and stopping breathing.
  • Aspiration pneumonia an infection on the chest as a result of food, liquid or infected secretions from the mouth going into the lungs rather than into the stomach.
  • Malnutrition not eating enough to maintain good general health . Malnutrition may make someone more susceptible to infections. See the Parkinsons Associations Information Sheet on Problems with Eating and Drinking in Parkinsons Disease for further information on the impact of swallowing problems on eating and drinking and self-help tips to deal with this problem.
  • Dehydration not drinking enough leading to other medical complications, such as constipation.
  • In light of these risks, it is important that people experiencing difculties swallowing alert their doctor.

    Tips For Managing Drooling In Parkinsons

    Sailorrhea, or drooling, refers to pooling of saliva in the mouth. It occurs in around 50-80% of all Parkinsons patients, particularly men. This blog post explains the cause, risk of aspiration, anxiety, and social embarrassment, with 10 helpful tips & treatment options to help with this pesky problem.

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    Swallowing Exercise Introduced Early May Benefit People With Parkinsons Disease

    When attending seminars for persons with Parkinsons disease I am always a bit annoyed when I hear speakers refer to swallowing and speech symptoms as non-motor symptoms of Parkinsons disease . After all, approximately 100 muscles are involved in speech production and 50 paired muscles involved in swallowing, hence when patients present with problems, they are manifesting motor speech or swallowing symptoms.

    Current models that attempt to explain the pathway for Parkinsons such as the one proposed by Braak et al give evidence for the presence of speech and swallowing abnormalities as early motor signs of the disease, or what are referred to as preclinical or prodromal stages of the disease .

    Involvement of the dorsal motor nucleus of the glossopharyngeal and vagal nerves in the early stages of PD, suggest that voice and speech abnormalities might be among the first manifestations of the disease, perhaps developing at stages 1-2 in Braak et als model.

    It has also been suggested by some researchers that the voice and speech abnormalities during the initial phases of the disease are too subtle to be detected, perhaps due to compensatory adjustments, and later in the disease these motor speech symptoms are often not as responsive to dopamine replacement as the limbs.

    How early should swallowing exercises begin?

    Traditional Dysphagia Assessments And Therapies In Stroke

    Darlene Coleman – Swallowing Strengthening Exercises for Parkinsons

    More than 50% of stroke survivors experience dysphagia however, most of them recover their swallowing function within a week . The proportion of stroke survivors with dysphagia at 6 months is reported to be approximately 11-13% . Constant awareness and review of swallowing are needed after stroke because of the diverse course of the symptoms over the six subsequent months. The assessment and management of dysphagia are important for minimizing the risk of food and liquid aspiration as well as pneumonia.

    Screening for dysphagia includes the water-swallowing test and repetitive saliva-swallowing test. To assess the swallowing dysfunction in detail and detect silent aspiration, a video fluoroscopic swallowing study or fiberoptic endoscopic evaluation of swallowing should be used. A VFSS provides information on bolus flow, the movement of each organ, and the anatomy . A FEES can be performed even at the bedside and is able to detect silent saliva aspiration.

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    Strategy For Rapidly Progressive Dysphagia In Prd Psp And Msa

    Dysphagia symptoms in PRD, PSP, and MSA appear earlier after the onset than in PD . The median dysphagia latencies were reported to be 42 months in PSP, 67 months in MSA, and 130 months in PD. This suggests that early dysphagia symptoms in PRD are distinguishable from those in PD.

    In PSP, the most common cause of death is pneumonia that occurs subsequent to silent aspiration . The reported prevalence of dysphagia in PSP is up to 80%, and the early development of dysphagia leads to repeated aspiration pneumonia and a short survival time . Medication, adjustment of food consistency, feeding techniques, and PEG feeding should be attempted in order to prevent pneumonia. Relative to PD patients, PSP patients exhibit a poorer response to medications with mild improvement in dysphagia , and the management of dysphagia in the later stages of PSP is more challenging than in the earlier stages. The early deterioration of the cognitive function or dementia may influence the treatment difficulty. However, despite adjusting the food consistency and feeding techniques, most PSP patients ultimately require PEG feeding within a few months after the initial development of pneumonia . Nevertheless, whether or not PEG placement prolongs the survival time is unclear .

    The authors state that they have no Conflict of Interest .

    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.

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    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

    What Specialist Help Is Available For Swallowing Problems

    Pin on Parkinson

    Anyone worried about or experiencing problems with swallowing should seek a referral to a Speech and Language Therapist.

    Your doctor or consultant can refer you to a Speech and Language Therapist working in the HSE. However, there is unfortunately a shortage of qualied Speech and Language Therapists working in the HSE in Ireland.

    You can also refer yourself to see a private Speech and Language Therapist. A medical referral may be required for swallowing problems and this can be done by a GP, Consultant or Parkinsons Disease Nurse Specialist within a hospital. See the Parkinsons Associations Information Sheet on Speech and Language Therapy for more information on Speech and Language Therapy in Parkinsons Disease.

    If you decide to seek assistance from Speech and Language Therapist privately, you will have to pay for this private treatment. However, there may be some reimbursement for such therapies under private health insurance schemes. You will need to check your individual policy for specic reimbursement entitlements. Tax relief may be obtained on specialist therapy fees .

    As well as advising on speech and language problems, these professionals are also experts in swallowing. They can assess swallowing problems and may be able to give the person exercises to help overcome them. This may include Lee Silverman Voice Therapy which has been shown to result in sustained improvements in swallowing following therapy.

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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.

    Problems With Tongue Muscles

    Parkinsons can also cause problems in the tongue muscles. The tongue is important in swallowing. We use it to move food around and push it to the back of the mouth to trigger the swallowing reflexes. Parkinsons can also impair the reflexes that protect our windpipe from food and drink. A problem coordinating breathing and swallowing may make this problem worse.

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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.

    How Do I Get Ready For Tongue

    My Parkinson’s Story: Speech and Swallowing

    Before you start your tongue strengthening exercises, you may need to change your positioning. Your SLP will give you specific instructions on how to do this, if needed. For example, it may be better if you do these exercises while out of bed.

    It is also helpful to remove distractions from your environment. Turn off the TV, and do them at a time when you wont have visitors. This will let you fully focus on your exercises and receive the most benefit from them. You can do these exercises at any time that is convenient for you.

    Your SLP can let you know if there is anything else you need to do before getting started.

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    What Kind Of Exercise Can I Do If I Have Trouble Standing Or Walking

    Even with advanced Parkinsons symptoms, you can still reap the benefits of some activities. If you have trouble walking or balancing, hold a bar or rail to exercise and stretch. If standing or getting up is tough, exercise and stretch in a chair or bed. Physical exercise performed in a seated position, such as biking on a recumbent bike can allow you to exert yourself in a safe manner.

    Facial exercises may help combat difficulties speaking or swallowing:

    • Chew your food longer and more vigorously.
    • Exaggerate your face and lip movements when you speak.
    • Make faces in the mirror.
    • Sing or read out loud.

    Mental exercises give your brain a workout and can improve memory. For example:

    • Name as many animals as you can in 1 minute.
    • Play brain games and do puzzles.
    • Solve math problems in your head.

    You can also add activity in small bits throughout your day:

    • Park further away from stores so you walk longer distances.
    • Stretch or do leg exercises while watching TV.
    • Swing your arms more when you walk, and take long strides.
    • Take the stairs instead of the elevator.

    Diet And Fluid Modifications For Dysphagia

    Depending on your level of dysphagia your Speech Pathologist may suggest foods be chopped, minced or pureed and liquids thickened. The International Dysphagia Diet Framework, shown below, outlines the different types of food textures and liquid categories that may be suggested. The framework was developed to provide standardised terminology and definitions to describe food textures and liquid thickness.

    Below is a brief summary of some of the common texture modified diets and thickened liquids that may be suggested for people with Parkinsons who have dysphagia. For detailed information on the different food and drink categories as well as testing methods that help ensure consistent production of prescribed foods and liquids visit iddsi.org

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