Parkinson’s Disease (PD) is a movement disorder that affects almost one million people in the United States. PD affects movement and causes stiffness, shaking, and difficulty with walking, coordination, and balance. In later stages of the disease, most patients with PD develop dysphagia and other conditions that affect a person’s activities of daily living.
Dysphagia refers to difficulty with swallowing. In a neurological disorder that affects muscle coordination and condition, swallowing ability should be assessed routinely. Common complaints from someone with PD are difficulty chewing, difficulty moving food to the back of the mouth, sensation of food stuck in the throat, and frequent coughing and choking. Due to weakened muscles, coughing can be inefficient to clear the airway. People may experience slowness, drooling, or spillage. Some people with PD have sensory impairments and may not feel when food particles or liquids are near the airway and have no trigger to cough. This leads to silent aspirations or food remaining in the throat, both of which are extremely dangerous. A swallowing evaluation should be conducted routinely, even if there are no complaints.
Involuntary muscle movements and stiffness from PD can affect swallowing control can also increase risk of choking and aspiration. The most common factor that influences the severity of dysphagia is the coordination of respiration and swallowing. People with PD often have reduced strength and coordination when coughing. Other aspects of swallowing can be involved with PD. Lack of attention during meals can affect the swallowing phases. In later onset of PD, excess saliva production and drooling have been observed, which leads to more frequent (and unfortunately, more inefficient) swallowing.
A speech language pathologist has extensive knowledge and clinical training in swallowing and communication disorders. An SLP is qualified to conduct a complete dysphagia evaluation. In a swallowing evaluation, the SLP completes a detailed case history and asks questions related to eating, drinking, and nutrition. The SLP visually examines the face and oral components, as well as breathing patterns. The most vital component to the dysphagia evaluation is an instrumental assessment, such as the Fiberoptic Endoscopic Evaluation of Swallowing (FEES), to visualize what happens inside during a swallow. Of the few instrumental measures available, FEES is a favored assessment, as it uses real-time video imaging, no radiation exposure, and can be done at a residence or in a clinic. The FEES assessment takes 20-30 minutes and is covered by Medicare, Medicaid, and most private insurances. During the FEES assessment, the SLP displays and records the images as the person swallows samples of different food and liquid consistencies. After the assessment, the SLP provides a detailed report, thoroughly explains results, and provides recommendations and strategies for safe and effective swallowing. If ongoing services, monitoring, or therapy are required, the person can also be treated by an SLP.
Swallowing is crucial when it comes to taking medication, hydration, and nutrition. Inefficient swallowing can lead to choking and aspiration. Unfortunately, one of the most common causes of death in patients with PD is aspiration pneumonia. It is strongly recommended to assess, monitor, and treat dysphagia, even in the early stages of PD. Having peace of mind or knowing strategies to prevent complications from dysphagia is so important in maintaining the health and wellbeing of someone with PD.
Contact Louisiana Voice and Swallow Solutions for additional information at (225)269-9971.
“Parkinson’s Disease: Hope Through Research”, NINDS, Publication date March 2020. NIH Publication No. 20-NS-139