PARKINSON

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PARKINSONS DISEASE

• Rebecca L. Gould, MSC, CCC-SLP
• rebec26050_at_aol.com
• [phone]
• www. med-speech.com

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Parkinsons Disease impacts voice and swallowing

• WHY?

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THE LARYNX
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Functions of the Larynxbreathingthoracic
fixationcoughingswallowingvoice/phonation
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• More than 15 million Americans have some degree
  of dysphagia, and with regular treatment 83
  recover or significantly improve.
• Bello, J. (1994) compiled by Communication
  Facts. ASHA Research Division
• RLG

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SWALLOWING STAGES BY PHASE

• Oral Phase
• Food enters oral cavity
• Mastication and bolus formation
• RLG

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SWALLOWING STAGES BY PHASE (contd)

• Oro-pharyngeal Phase
• Tongue elevates and propels bolus to pharynx.
• Soft palate elevates to seal nasopharynx.
• Larynx and hyoid bone move anterior and upward.
• Epiglottis moves posteriorly and downwards to
  close.
• Respiration stops.
• Pharynx shortens. RLG

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SWALLOWING STAGES BY PHASE (contd)

• Esophageal Phase
• Upper esophageal sphincter relaxes.
• Bolus passes to esophagus.
• Esophageal contracts sequentially.
• Lower esophageal sphincter relaxes.
• Bolus reaches stomach.
• 
  
  
  RLG

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• Radical dietary changes and artificial feeding
  are drastic measures by any standards.
• M.J. Feinberg, MD (1990)
• 
  RLG

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RESIDUAL

• Leftover material in the oral pharynx after
  swallow has occurred.

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PENETRATION

• Entry of material into the laryngeal vestibule
  to the level of the vocal folds.

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ASPIRATION

• Entry of material below the level of true vocal
  folds.

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Incidence and patient characteristics associated
with silent aspiration in the acute care setting

• Coughing is a physiologic response to aspiration
  in normal healthy individuals. No cough in
  response to aspiration silent aspiration
• Smith, C.H. et al (1999)

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• Gurgly vocal quality predictive of who will
  aspirate on VFSS
• Linden (1993)

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SCALE PREDICTIVENESS OF PNEUMONIA RISK IF FED

• FACTORS
• Multiple or progressive disease/one diagnosis
• Multiple medications (gt5)/ lt5 medications
• NPO (PEG)/ oral
• Oral hygiene fair poor/ good excellent
• Smoker / non-smoker
• RLG

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SCALE PREDICTIVENESS OF PNEUMONIA RISK IF FED
(contd)

• FACTORS
• Inpatient / outpatient
• Physical ability (mobile)/ sedentary
• Reflexive cough (present) / absent delayed
• Cognitive status (fair-poor)/ good excellent
• Secretion Pooling (minimal) / copious
• RLG

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SCALE PREDICTIVENESS OF PNEUMONIA RISK IF FED
(contd)

• Score
• lt 7 Use extreme caution
• 56 fair good
• lt3 good excellent
• RLG

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General Postural/ Feeding Instructions

• Upright, 90 degree position
• Concentrate on each swallow
• Take full tsp.
• Pause between bites/sips

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General Postural/ Feeding Instructions (contd)

• Alternate liquid/dry swallows
• Refrain from talking while chewing/swallowing
• Chew each bite thoroughly
• Hold breath, swallow high and hard, swallow again

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COMMUNICATION

• MUTUAL UNDERSTANDING OF SHARED INFORMATION

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Relative vocal loudness level of an individual
with Parkinsons Disease

• Shout
• Loud
• Normal loudness
• Soft
• Very soft
• Vocal loudness level of an individual with
  Parkinsons Disease

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THINK LOUD!
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THINK BREATHE!
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Conversational Strategies Checklist

• Gain eye contact with your communication partner
  before speaking.
• Avoid speaking when you are tired.
• Speak in a quiet environment.
• Take your time while speaking.
• Exaggerate your articulatory movements.

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Conversational Strategies Checklist (contd)

• Speak louder.
• Take natural pauses while speaking.
• Keep your face free from distractions.
• Use body language to convey turn taking.
• Allow yourself time for a conversation.
• Avoid repeating words and phrases.
• Use body language to convey turn taking.

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Conversational Strategies Checklist (contd)

• Rephrase your message if your communication
  partner does not understand you.
• Use an alternative system to communicate if your
  speech is difficult to understand.
• Appreciate your communication partners efforts.
• Be patient with yourself.

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THERAPY

• The human body is one of the greatest
  compensatory mechanisms.
• RLG

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