SWALLOWING DISORDERS (DYSPHAGIA) IN PARKINSON’S (ISMS) PAY ATTENTION THIS SEASON

This is the time of year when swallowing issues become even more prevalent than usual. This may be because of anxieties involved with the holiday season, because many of the foods available during this time of year are different, or because the disease has moved to this phase, and probably because dehydration during this time of year is of epic proportions. So, drink your fluids.

The American Speech Language Association says the following: Swallowing disorders, also called dysphagia (dis-FAY-juh), can occur at different stages in the swallowing process:

• Oral phase – sucking, chewing, and moving food or liquid into the throat;
• Pharyngeal phase – starting the swallowing reflex, squeezing food down the throat, and closing off the airway to prevent food or liquid from entering the airway (aspiration) or to prevent choking;
• Esophageal phase – relaxing and tightening the openings at the top and bottom of the feeding tube in the throat (esophagus) and squeezing food through the esophagus into the stomach.

Swallowing difficulty can occur at any stage of Parkinson’s disease. Evaluation and treatment of swallowing disorders are performed by a speech language pathologist. Swallowing disorders are treatable. The leading cause of death in Parkinson’s is aspiration pneumonia due to swallowing disorders.

General signs of a swallowing disorder may include:

• coughing during or right after eating or drinking;
• wet or gurgly sounding voice during or after eating or drinking;
• extra effort or time needed to chew or swallow
• food or liquid leaking from the mouth or getting stuck in the mouth;
• recurring pneumonia or chest congestion after eating;
• weight loss or dehydration from not being able to eat enough.

Because of these symptoms a person with Parkinson’s:

• may have poor hydration and/or poor nutrition;
• may be at risk of aspiration (food or liquid entering the airway), which can lead to pneumonia;
• may have less enjoyment of drinking and/or eating;
• or may suffer from embarrassment causing isolation in and from social situations involving eating.

A swallowing disorder can be diagnosed by a speech-language pathologist (SLP) who specializes in swallowing disorders. They can evaluate individuals who are experiencing problems eating and drinking. This evaluation is done by:

1. taking a careful history of medical conditions and symptoms;
2. looking at the strength and movement of the muscles involved in swallowing;
3. observing feeding to see posture, behavior, and oral movements during eating and drinking possibly perform special tests to evaluate swallowing, such as:
   • modified barium swallow – individual eats or drinks food or liquid with barium in it, and then the swallowing process is viewed on an X-ray;
   • endoscopic assessment – a lighted scope is inserted through the nose, and then the swallow can be viewed on a screen.

Treatments are available and depend on the cause, symptoms, and type of swallowing problem. A speech-language pathologist may recommend:

• specific swallowing treatment (e.g., exercises to improve muscle movement)
• positions or strategies to help the individual swallow more effectively;
• specific food and liquid textures that are easier and safer to swallow.

After the evaluation, family members or caregivers can help by:

• asking questions to understand the problem and the recommended treatment;
• assisting in following the treatment plan;
• help with exercises;
• prepare the recommended textures of food and liquid, making sure that recommendations for eating safely are followed;
• keep track of how much food or liquid is consumed.

A speech-language pathologist plays a primary role in the evaluation and treatment of swallowing and feeding disorders. They are typically referred by your Medical Doctor and their work is typically covered by insurance. HOWEVER, if your doctor doesn’t automatically refer you for a speech-language pathology evaluation please do not hesitate to ask.