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
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
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
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
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
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
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
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