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The Expert Care Experience: Speech, Swallowing, and Parkinson’s

The Expert Care Experience: Speech-Language Pathology

This blog is the third in a series detailing the roles of each member of a comprehensive care team. Read the first post on social work and the second post on occupational therapyLearn more about the healthcare professionals that are part of a comprehensive care team and how you can put your care team together today.

The ability to verbally communicate basic wants and needs, to interact socially with friends and loved ones, to enjoy favorite foods and special holiday meals, and to fully participate in society are not only necessary, life-sustaining functions, but also add enrichment and meaning to our lives. A speech-language pathologist (SLP) specializes in evaluating function and providing treatment in the areas of communication and swallowing across the lifespan (ASHA, 2016).

As Parkinson’s disease (PD) progresses, changes to both speech production and swallowing function are expected. The SLP’s role on the PD interdisciplinary care team is to monitor these changes and intervene when necessary to maintain or improve function in these areas that tremendously impact quality of life. In the podcast Down the Hatch: Swallowing Disorders in Parkinson’s Disease, Dr. Ianessa Humbert invites Drs. Karen Hegland and Emily Plowman to share their expertise in the identification and management of both speech and swallowing disorders across all stages of PD. The doctors engage in an informative discussion about working with other providers on the care team, the importance of self-advocacy for people with PD, and the research behind effective intervention strategies.

The pattern of speech changes associated with PD is called hypokinetic dysarthria. Dysarthria means abnormalities in the strength, speech, range, steadiness, tone, or accuracy of movements required for breathing and speech production. In PD, these changes may be reflected as reduced respiratory drive, softer voice, hoarse vocal quality, less emphasis and intonation on syllables, short rushes of speech, and trouble articulating words (Duffy, 2013). As Dr. Hegland elaborates in the podcast, people with PD often describe these speech changes in the following ways:

  • “I’m not speaking loudly enough.”
  • “People ask me to repeat myself more often.”
  • “My voice sounds raspier.”
  • “My spouse says that I’m mumbling.”

While PD affects each person differently, these changes typically appear and progress slowly with the disease over time.

At some point during the course of PD, a person may develop a swallowing disorder, or dysphagia. Dysphagia refers to swallowing problems involving the oral cavity (mouth), pharynx (throat), esophagus, or gastroesophageal junction (area where the esophagus connects to the stomach; ASHA, 2016). For people with Parkinson’s and caregivers, describing these swallowing problems can be challenging. The changes do not always have obvious signs, and the symptoms of swallowing dysfunction in PD can vary greatly from person to person. Common symptoms of dysphagia reported by people with PD include the following:

  • Having difficulty with foods or liquids going into the airway, or “down the wrong pipe,” which causes more frequent coughing or choking during meals;
  • Having difficulty swallowing the full amount of food in their mouth, requiring multiple swallows to get things down; and
  • Feeling that foods get stuck in the throat after swallowing.

Sometimes people change the amount or type of foods eaten because of these difficulties. Another aspect that the SLP may ask about is whether the person with Parkinson’s has experienced recent (in the past 6-12 months) pneumonia, chest infection, or unintentional weight loss, as these could also indicate difficulty swallowing.

The best way for SLPs to determine the extent and cause of the swallowing disorder is through a videofluoroscopic swallowing evaluation. This evaluation captures moving X-ray images of the patient swallowing various consistencies of food and liquid, allowing the SLP to visualize the entire swallow, and ultimately make appropriate recommendations. Because swallowing is “hidden” in the neck, using this method to evaluate swallowing is critical to determine how a patient is actually doing in terms of airway protection (making sure food and drinks don’t “go down the wrong pipe”) and efficiency (making sure all the food is swallowed and not sticking somewhere in the throat).

Understanding the changes to speech and swallowing function that may arise as PD progresses is important for both people with Parkinson’s and caregivers. Awareness of these symptoms allows you to advocate for yourself and allows your caregiver to better advocate for the you, too. In fact, you should consult with an SLP soon after the PD diagnosis, even before you experience any swallowing difficulties! If you implement certain behavioral strategies and learn swallowing exercises, you can prevent or delay the onset of swallowing problems, preserving airway safety and improving swallowing efficiency along the progression of PD.

References

American Speech-Language-Hearing Association. (2016). Scope of practice in speech-language pathology [Scope of Practice]. Available from www.asha.org/policy/.

American Speech-Language-Hearing Association. (2016). Adult Dysphagia. Available from http://www.asha.org/Practice-Portal/Clinical-Topics/Adult-Dysphagia/

Duffy, J. (2013). Motor speech disorders: Substrates, differential diagnosis, and management (3rd ed.) St. Louis, Mo,: Elsevier Mosby.

Sara Kesneck is a second-year Master’s degree student in speech-language pathology who is completing her clinical practicum at the University of Florida Center for Movement Disorders and Neurorestoration.

Photo: Ianessa Humbert, PhD, CCC-SLP; Emily Plowman, PhD, CCC-SLP; Karen Hegland, PhD, CCC-SLP