I decided to post this again- it is so important- there is a very good video the link is at the end of this post.
1/19/2013
Read this Examiner.com article about swallowing issues in Parkinson's disease.
People with Parkinson’s disease (PD) should be wary of increased
episodes of coughing and changes in voice quality, because experts say these
symptoms could be a sign of a serious swallowing problem which can be fatal.
Parkinson’s disease is a progressive neurological disorder that
occurs when vital brain cells that control movement and coordination die or
become impaired. Symptoms vary, but the disease is often characterized by
uncontrollable shaking, limb stiffness, slow movement and difficulty walking.
Studies show that Parkinson’s can also cause a host of other life-altering
cognitive and physical changes including difficulty swallowing, chewing,
speaking and pushing food through the digestive system, as these functions
depend on muscles that may be weakened due to changes in the brain.
Many Parkinson’s patients, especially those in the later stages
of the disease, experience difficulty swallowing, a condition known as dysphagia, which can affect
their quality of life and cause life-threatening complications like aspiration
pneumonia, malnutrition and dehydration, said Leslie Mahler, Ph.D., an
assistant professor in the Department of Communicative Disorders at the University
of Rhode Island who specializes in adults with neurological disorders. “The
complication to be most concerned about is whether food is going down the right
way,” she said.
According to the National Institute of Health, the leading cause
of death for people with Parkinson’s disease is aspiration pneumonia, which
occurs when the lungs and the airways to the lungs get inflamed or infected due
to food or liquids going into the lungs when consumed rather than into the
stomach. Parkinson’s patients are also at risk for asphyxiation or choking to
death due to food blocking the airway and stopping breathing.
It is important to know the warning signs of a swallowing
disorder, because some people may appear to be eating and drinking normally,
but they are not, said Dr. Mahler, a speech-language pathologist. Early intervention
and proper management of swallowing abnormalities are the keys to preventing
major complications, she said.
One of the warning signs of dysphagia is drooling, Dr. Mahler
said. The natural tendency to swallow slows down in many Parkinson’s patients
so they do not swallow as often as they use to, and as a consequence they tend
to drool, Dr. Mahler explained. The decrease in swallowing causes a buildup of
saliva in the mouth which leaks out resulting in uncontrollable, unsightly
drooling that can be a major source of embarrassment, said experts at the
National Parkinson Foundation (NPF). This excess saliva can also cause a
buildup of phlegm in the throat.
Anticholinergic medications can reduce drooling by restricting saliva
production, but research shows these medications cause dry mouth and have
serious side effects like memory impairment, constipation, confusion and hallucinations especially in the
elderly. Researchers also found that severe drooling can be treated with
botulinum toxin (Botox) injections into the salivary glands, but the effect of Botox
only last a few months.
Coughing or choking during or after meals is another sign that
food is either stuck in the throat or that it has gone down the air passage
(windpipe) into the lungs instead of into the esophagus – the muscular tube
that carries food, liquids and saliva from the mouth to the stomach.
Doctors said coughing is actually a good sign, because it is a
reflex reaction that happens when food goes down the wrong way or is trapped in
the throat. Coughing can help keep food and liquid out of the airway and
prevent them from going down the lungs. However, sometimes food can enter the
wind pipe without any sign of coughing or choking causing silent aspiration.
Other warning signs of dysphasia identified by the NPF are: a
gurgly voice; a sensation that something is stuck in the throat; difficulty
keeping food or liquid in the mouth; difficulty swallowing medication;
unintended weight loss; chest discomfort; heartburn; a sore throat; and
slowness in eating.
In severe cases, patients may have to use a feeding tube to
maintain hydration and nutrition, Dr. Mahler said, adding that, “It is possible
for someone to eat and drink what they can and get the rest through tube
feedings.”
Dr. Mahler advises people who think they have a swallowing
problem to see a speech-language pathologist, who is experienced in treating
Parkinson’s patients, for a swallowing evaluation. “People with Parkinson’s who
have difficulty swallowing often have voice problems, because speech and
swallowing share common anatomy,” she said. “It has been estimated that as many
as 89 percent of people with PD have a speech disorder that can impact their
quality of life.”
Speech therapy can help people improve swallowing and increase
vocal loudness by teaching them muscle strengthening exercises, Dr. Mahler
said. A technique known as the Lee Silverman Voice Treatment (LSVT Loud), an
intensive speech exercise program, has proven to be effective in treating
Parkinson’s patients with speech problems, she said, and at least one study
shows that it has also had a positive impact on improving swallowing function.
Another therapy that can improve swallowing functions is
Expiratory Muscle Strength Training (EMST). This relatively new therapy,
developed by experts at the University of Florida Center for Movement Disorders
and Neurorestoration, teaches patients how to strengthen the muscles involved
in swallowing and breathing.
The NPF and Parkinson Disease Foundation also recommend the
following tips to help alleviate swallowing and drooling problems:
•
Drink frequent sips of water or suck on ice chips during the day
and before meals to help increase swallowing and thin phlegm;
•
Reduce sugar intake, as sugar increases saliva;
•
Suck on sugarless candy or chew sugarless gum for temporary
relief from drooling;
•
Take smaller bites of food, chew food thoroughly and eat
slowly;.
•
Sit upright for at least 15 minutes after eating;
•
Take small sips of water or beverage when eating;
•
Sit upright with head slightly forward when eating, drinking and
taking pills. Tilting head backwards can increase the risk of food or liquids
going into the lungs. If a glass is half empty, refill it;
•
Maintain an upright posture and keep chin up, because a flexed
neck or stooped posture exacerbates drooling;
•
Rinse mouth after meals;
•
Eat softer foods, pureed if necessary;
•
Drink tea with lemon or carbonated beverages to help thin
phlegm;
•
Avoid dairy products, as they can make phlegm worse;
•
Drink thicker liquids, as they are easier to swallow, because
they do not go down as fast;
•
Moisten dry foods to make them easier to swallow; and
Sleep with head raised up to prevent choking.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Inspiration pneumonia - pneumonia
which results from food getting into the lungs as a result of swallowing the
wrong way.
Video created by Roxann Diez-Gross of the Children's
Institute of Pittsburg. (It provides understanding about the "how" of
swallowing, and makes me think that some "cognitive understanding"
... and perhaps some exercises or brain training may be one of the most important
things I can do to extend my longevity.
VERY GOOD VIDEO:
http://vimeo.com/62903648
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