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Parkinson’s Disease impacts voice and swallowing
WHY?
THE LARYNX
Functions of the Larynxbreathing
thoracic fixationcoughing
swallowingvoice/phonation
“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
SWALLOWING STAGES BY PHASE
Oral Phase
• Food enters oral cavity
• Mastication and bolus formation
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SWALLOWING STAGES BY PHASE (cont’d)
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.
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SWALLOWING STAGES BY PHASE (cont’d)
Esophageal Phase• Upper esophageal sphincter relaxes.• Bolus passes to esophagus.• Esophageal contracts sequentially.• Lower esophageal sphincter relaxes.• Bolus reaches stomach. RLG
“Radical dietary changes and artificial feeding are drastic measures by any standards”.
M.J. Feinberg, MD (1990)
RLG
RESIDUAL
Leftover material in the oral pharynx after swallow has occurred.
PENETRATION
Entry of material into the laryngeal vestibule to the level of the vocal folds.
ASPIRATION
Entry of material below the level of true vocal folds.
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)
Gurgly vocal quality predictive of who will
aspirate on VFSS
Linden (1993)
SCALE PREDICTIVENESS OF PNEUMONIA RISK IF FED
FACTORS• Multiple or progressive disease/one diagnosis• Multiple medications (>5)/ <5 medications• NPO (PEG)/ oral• Oral hygiene fair – poor/ good – excellent
• Smoker / non-smoker
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SCALE PREDICTIVENESS OF
PNEUMONIA RISK IF FED (cont’d)
FACTORS• Inpatient / outpatient• Physical ability (mobile)/ sedentary• Reflexive cough (present) / absent – delayed• Cognitive status (fair-poor)/ good – excellent• Secretion Pooling (minimal) / copious
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SCALE PREDICTIVENESS OF
PNEUMONIA RISK IF FED (cont’d)
Score
• < 7 = Use extreme caution
• 5–6 = fair – good
• <3 = good – excellent
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General Postural/ Feeding Instructions
• Upright, 90 degree position
• Concentrate on each swallow
• Take full tsp.
• Pause between bites/sips
General Postural/ Feeding Instructions (cont’d)
• Alternate liquid/dry swallows
• Refrain from talking while chewing/swallowing
• Chew each bite thoroughly
• Hold breath, swallow high and hard, swallow again
COMMUNICATION
“MUTUAL UNDERSTANDING OF
SHARED INFORMATION”
Relative vocal loudness level of an individual with Parkinson’s
Disease
• Shout• Loud• Normal loudness• Soft• Very soft
» Vocal loudness level of an individual with Parkinson’s Disease
THINK LOUD!
THINK BREATHE!
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.
Conversational Strategies Checklist (cont’d)
• 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.
Conversational Strategies Checklist (cont’d)
• 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 partner’s efforts.
• Be patient with yourself.
THERAPY
“The human body is one of the greatest compensatory mechanisms.”
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