Don’t Let PD Drown or Mute Someone!
Parkinson’s disease (PD) is a neuro-degenerative disorder affecting certain nerve cells (neurons) of a specific area of the brain. It usually affects a person’s movement. Symptoms of Parkinson’s disease usually begin gradually and progressively become severe. People with Parkinson’s may suffer from issues involving chewing, swallowing or speaking. These problems can arise anytime, but usually tend to increase as PD progresses. Just like how PD affects movement in other parts of the body, it can also involve the muscles in the face, mouth and throat that are used in speaking and swallowing.
Speech Problems
Parkinson’s disease can affect a person’s speech. The voice not only becomes soft but might be slurred too. The speech might seem unemotional and the ends of sentences might be inaudible. Their speech is usually slow. Some patients might speak very fast leading to stammering or stuttering. Many a time, their voice may sound breathy or hoarse arousing suspicion of other throat disorders.
Memory and cognitive problems (Parkinson’s non-motor symptoms) can also affect speech. The affected person might find it difficult to choose the appropriate words and hence this might lead to a slow speech. The motor symptoms of PD like decreased facial expression (frozen or masked face), slowness and stooped posture, may add to the burden of existing speech problems. A listener may get incorrect cues and may feel a lack of emotion.
These speech problems render communication with family, friends and physicians difficult. They may be misinterpreted as showing a lack of interest in the conversation or aloofness. This can also have an adverse effect on their professional and social life.
Adjusting the dose of medications might not be sufficient to address the speech problems faced by these persons. Speech therapy typically plays a pivotal role in helping them out. Some patients might benefit from assisted communication devices (microphones and touchpads), which enhance or amplify speech.
Swallowing Problems
In PD, swallowing problems are a major cause of concern. While consuming food, patients might face difficulties like coughing and choking and they will clear their throat often. They might also complain of a feeling of food getting stuck in the esophagus when they swallow.
To check how much of a swallowing problem a patient has, we can get x-rays done or a video recording of the throat (FEES) while they swallow foods of varying consistencies. This test identifies the site of the problem (whether the mouth or throat) and whether food is going into the airway instead of the food pipe.
We see that many people with swallowing problems become frustrated or embarrassed and keep away from social activities. The worry is, difficulty in swallowing can lead to inadequate nutrition, dehydration and aspiration (when food enters the wind pipe).
Aspiration, which can be silent, can lead to pneumonia — the leading cause of death in PD. Thus, it is important to ensure that people with PD can eat safely.
Swallowing therapy is the main modality of treatment, so the patient may be referred to a speech and swallowing therapist. While medications might not completely sort out swallowing issues, exercises to strengthen the muscles involved in swallowing will help. Changes in diet include consuming thick liquids and patients will also be taught measures to make swallowing easier like eating smaller mouthfuls of food and lowering chin to the chest while swallowing food.
In extreme cases, significant swallowing problems lead to weight loss because a person is unable to meet the daily calorie requirement and becomes malnourished. In such situations, a feeding tube may be placed to aid the patient in taking sufficient nutrition.
Drooling
Because of the difficulties experienced with swallowing, people affected by Parkinson’s might have drooling saliva. This affects their confidence and they feel embarrassed to go out. As a result, they might isolate themselves socially.
Treatment for drooling can be done with behavioral changes – they can be gently reminded to keep their mouth closed to prevent drooling. They can also be given hard candies to trigger swallowing. In later stages of Parkinson’s, medicines can be given to reduce salivation, which will in turn bring down drooling.
Thus, speech and swallowing problems can have a significant impact on the lives of people with Parkinson’s and their families. We should support them appropriately to avoid isolation and depression. Established treatment strategies and good support from the care-givers will surely help strengthen their voice and improve swallowing. This will not only boost their confidence but will also significantly improve their health and well-being.
