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					               Parkinson’s Australia
              Parkinson’s Fact Sheet 9
               Speech and Swallowing
The clinical features of tremor and              detect subtle changes. An individual
rigidity seen in Parkinson’s (PD) may            evaluation by a speech pathologist will
precipitate swallowing and speech                also be useful to determine particular
difficulties.                                    difficulties and to assess functioning of
                                                 the respiratory system, the larynx, the
Speech Difficulties                              pharyngeal muscles and the muscles
                                                 involved in articulation. Most clinicians
About half of all people with PD are
                                                 favour a burst of intensive therapy, with
likely to develop difficulty with speech.
                                                 follow-up to reinforce techniques and
Much research has gone into the
                                                 help transfer these skills to everyday
causes, effects and relief of speech
                                                 conversation.
difficulties, and as a result there is a
large amount of information and help             Once there is awareness of particular
available. The speech changes that               issues, then it is time to try some
occur are due to incoordination and              exercises.
reduced activity of muscles that control          Be aware of your breathing. Breathe
the speech mechanism.                               in deeply before you speak so you
The main difficulties experienced are:              don’t run out of breath before the
                                                    end of a sentence.
 loss of volume, pitch, range and
  intonation in the voice;                        Concentrate on your rate of speech,
                                                    working at keeping it slow and even.
 rate of speech being either too fast
  or too slow;                                    Pretend your listener cannot hear
                                                    and has to read your lips. Force
 uncontrolled repetitions of sounds,
                                                    your lips and jaw to work hard as you
  words or phrases;
                                                    articulate words. Face your listener
 slurred speech;                                   as much as possible.
 difficulty initiating speech;                   Concentrate on finishing the sound
 reduced facial expression and                     of each word before starting the
  natural gesture;                                  next.
 a harsh breathy voice.                          Encourage your family and friends to
                                                    let you know when your voice drops.
Speech difficulties can and do cause
                                                    Acknowledge the problem with family
embarrassment and social isolation.
                                                    and friends. These reminders can
Drug treatment for Parkinson’s can
                                                    prompt you to improve yourself.
improve the voice in both volume and
intelligibility.                                  Reduce background noise.
                                                  Talk for yourself, even if it takes
Guidelines for better speech                        longer. Don’t let others talk for you.
The first step towards improving speech           It is sometimes helpful to have
is to establish a conscious awareness of            someone talk for you, for example
the way you speak.                                  when you are tired, but you be the
                                                    judge of when.
Family members may be able to help by
pointing out weaknesses in your voice,
as sometimes you may not be able to


                   Copyright Parkinson’s Australia 1998
 On the phone, hold your head up straight                    on one side first and then push food to the
  and speak directly into the mouthpiece.                     opposite side with your tongue. This is
  Practise a few words aloud before dialling or               useful as an exercise, even if it is not used
  answering, so that your voice can ‘warm up’.                when eating.
 Clear your mouth of saliva regularly whilst                You may need to swallow twice to clear each
  talking.                                                    mouthful.
 Daily deep breathing and relaxation                        Take time to eat. Be sure to swallow each
  exercises are helpful for head, neck and                    mouthful before taking the next.
  shoulders.                                                 If you do cough, stop and rest from eating
 Most of all RELAX.                                          and drinking. If it happens regularly, contact
                                                              your speech pathologist.
Swallowing Problems                                          Sit upright for at least half an hour after a
                                                              meal.
The major reason for eating and swallowing
difficulties (i.e. dysphagia) in PD is the loss of           Tablets may be difficult to swallow. Crushing
the ability to swallow quickly because of                     medications may be appropriate.
reduced ability to use particular muscles in the
mouth and throat. The severity of the move-               Dribbling
ment disorder probably does not correlate with            Most people produce around a litre of saliva a
the severity of the dysphagia. The movements              day which is usually swallowed automatically.
that are involved in swallowing are mostly under          This automatic mechanism is disrupted in PD,
automatic or involuntary control. The gradual             so other methods are needed to get rid of the
loss of control over these muscles makes it               saliva. Recent research has shown that if these
increasingly difficult for the person to clear the        do not work and dribbling becomes a significant
mouth of saliva and to swallow instinctively.             problem, it is possible that radiotherapy to the
Eating becomes slow, hesitant and more of an              salivary glands may help.
effort and drooling may become an embarras-
sing problem.                                              Swallow saliva often. Make a conscious
                                                             effort to swallow saliva before eating or
Food may collect within the mouth and at the                 talking.
back of the throat. Trying to eat too quickly may          Close your lips firmly, slurp the saliva to the
result in choking, as swallowing may not keep                back of your throat and swallow. (Remem-
pace with the placement of food into the mouth.              ber to think: UP-BACK-SWALLOW.)
Coughing just after swallowing is common,
especially after liquids, as clearing each                 Drink more frequently if dribbling is frequent.
mouthful may not be complete with a single                   Reducing milk intake has been found to
swallow.                                                     reduce dribbling.
                                                           Try to keep your head in an upright position
Suggestions for Relief                                       so that saliva will collect in the back of your
                                                             throat and facilitate automatic swallowing.
 Posture is important; keep the back as
  straight as possible.      Keeping the head
                                                          Choking
  slightly forward may assist further. Do not
  throw the head back to try to help food slide           What should you do if a person starts to choke?
  down the throat, as this may lead to saliva or
                                                           Reassure the person. Give them a tissue to
  food falling into the windpipe (aspiration) and
                                                            cough any debris into and lean them forward
  cause choking.
                                                            in their chair.
 Think through the steps involved before you
  swallow; close the lips and jaw; collect the             Do NOT pat the person on the back.
  food together, breathe in through your nose,             Apply pressure with the flat of the hand just
  lift your tongue up, then back, then swallow              below the sternum, in time with the person’s
  strongly. Breathe out and relax.                          attempts to cough.
 You can reduce food collecting in the back of
                                                           Remove any residue of food from the mouth
  the throat, by taking small mouthfuls. Chew
                                                            and pharynx.


FS9                                  Copyright Parkinson’s Australia 1998                              p. 2
 Having recovered the situation, spend a few             difficult to wear as the mouth becomes sore.
  moments analysing why the choking                       Fluids need to be taken often and food may
  occurred: Was the posture wrong? Is the                 stick to the roof of the mouth, some foods
  person tired? Were they hurrying? This may              proving impossible to eat.
  help reduce choking in future. Advice from              It has been found that people with dry mouth not
  the speech pathologist or physiotherapist               only suffer more cavities, but are also prone to
  should be sought if the person experiences              tooth sensitivity, as the tissues of the mouth
  choking frequently.                                     become dry and sometimes painful.
                                                          Coping with a dry mouth
Dry Mouth
                                                             Sipping water frequently throughout the day,
Many people with PD suffer from this frustrating
                                                              sucking on an ice cube or spraying a mist of
and damaging problem. Saliva is produced by
                                                              water from an atomiser to lubricate the
three sets of salivary glands to provide a natural
                                                              mouth, will help.
barrier against the bacteria that invade our
mouths. Xerostomia is the clinical term used by              Restrict caffeine intake and try to avoid soft
dentists and doctors to describe ‘dry mouth’ (the             drinks, alcohol, tobacco, peppermints,
lack of saliva in the mouth). Dry mouth in PD is              cinnamon and candy as these will only dry
frequently related to anti-cholinergic medication             the mouth more.
such as Cogentin, Artane, Akineton or
Kemadrin. Dry mouth may be compounded by                     To temporarily increase saliva production,
mouth breathing overnight.         Some people                chew sugarless gum or lemon drops.
alternate between drooling and dry mouth.                    For dry lips, K-Y jelly, Surgi-Lube or hydrous
People may complain of a sore, sticky, dry or                 lanolin are recommended. Avoid vaseline or
rough throat and it may be difficult to talk as               other petroleum products.
they feel hoarse all the time. Dentures may be            Consult your dentist, who is trained to deal with
                                                          the specific problems of the mouth and can
                                                          advise on the best ways to relieve discomfort.
                                                          Also ask your dentist about toothpaste for
                                                          sensitive teeth and gums. Keeping the mouth
                                                          clean will reduce plaque and therefore cavities.




                 For more information contact The Parkinson’s Association:
                 ACT       (02) 6290 1984            TAS        (03) 6224 4111
                 NSW       (02) 9767 7881            VIC        (03) 9551 1122
                 QLD       (07) 3397 7555            WA         (08) 9346 7373
                 SA        (08) 8357 8909


FS9                                  Copyright Parkinson’s Australia 1998                              p. 3

				
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