Changes in swallowing are frequently found in PD. It has been reported that as many as 95% of people with PD have dysphagia (Bird, Woodward, Gibson, Phyland, & Fonda, 1994; Logemann, Blonsky & Boshes, 1975; Potulska, Friedman, Krolicki & Spychala, 2003). When dysphagia is present it has a negative impact on quality of life by interfering with the ability to take medications, maintain hydration and nutrition, and may result in aspiration pneumonia. Pneumonia is one of the leading causes of death in PD (Beyer, Herlofson, Arsland, & Larson, 2001; D’Amelio, Ragonese, Morgante, Reggio, Callari, Salemi & Savettieri, 2006). Swallowing disorders in PD are caused by motor and sensory components. Muscle rigidity, weakness and bradykinesia can affect all phases of swallowing and sensorimotor abnormalities may reduce the person’s awareness of symptoms of dysphagia (Robbins et al. 1986; Labuszewski & Lidsky, 1979).
Although swallowing difficulties can be present in early stages of PD, typically they are more prevalent as the disease progresses. Given the complexity of normal swallowing and the variability of changes in swallowing due to PD, it is not possible to describe which type of treatment intervention might be most appropriate for a given individual.
Treatment options include postures such as chin down to alter the bolus flow, maneuvers such as an effortful swallow to improve bolus clearance in the pharynx, changes in consistency of liquids or foods, and possibly adding non-oral feeding alternatives such as a feeding tube in the stomach. An evaluation with a speech-language pathologist who is experienced in treating people with PD will determine which treatment strategy is best for an individual.
If you or a family member are experiencing changes in swallowing that make it difficult to take pills and/or coughing during meals, please talk to your physician and seek a referral to a speech-language pathologist (SLP). An SLP can evaluate communication and swallowing.
Leslie Mahler, PhD, CCC-SLP _________________ Leslie Mahler, PhD, CCC-SLP Assistant Professor University of Rhode Island