For an individual with Parkinson's disease, simple things like walking out to buy lunch, ordering food and eating can be difficult. What many people do not realise is that there is help readily available to help people with Parkinson disease tackle some of these difficulties.

How is swallowing affected in Parkinson disease?

Swallowing is often affected in people with Parkinson disease. Swallowing water or food can be dangerous when the function of the muscles involved become weak. Water or food can then enter the lungs without people realising it.

The problem is often further complicated as the sensation required for safe swallowing declines. Swallowing is a complex sequence of events which require functioning muscles, as well as intact sensation. When that sensation is poor, the individual cannot accurately sense when to trigger a swallow. In addition, if that water accidentally enters the airway, it may not always elicit a cough, which helps to clear the airway of foreign objects.

A speech therapist can help detect if any of these problems are present and provide recommendations to better cope with such symptoms. It may be necessary for the individual to do a radiological swallow examination, called the video-fluoroscopic study of swallowing (VFSS) which helps speech therapists determine which food and fluid consistencies are safest.

Some helpful tips for a caregiver looking after a loved one with Parkinson's are:

1. Allow the person with Parkinson's disease to eat at his / her own pace, and with an appropriately sized spoon. Never rush someone with Parkinson's disease.
2. If necessary, fluids can be fed with a spoon. Drinking from a straw actually requires more coordination, and is not always recommended.
3. Look out for any coughing,throat clearing or choking during mealtimes or when drinking. This is often a sign that things are going into the airway, and possibly into the lungs.
4. Monitor closely for signs of infection, such as excessing phlegm or fever. Have a doctor check the individual’s lungs.

How is communication and speech affected in Parkinson disease?

Someone with Parkinson's disease might find it difficult to initiate speech. Speech can range from soft and slurred, to rushed and cluttered. At times, initiation of speech might be affected by cognitive changes that occur as the disease progresses.

Speech therapy aims to teach strategies to help the individual communicate better. It is crucial to work through a period of therapy to better ensure that strategies taught are used in as many circumstances as possible.

One approach to working with speech in Parkinson disease is to encourage the use of a loud voice. Focusing on improving voice loudness often has a corresponding positive effect on speech clarity. An intensive period of therapy also helps ensure that what is learned is learned well and applied. It may be useful to teach additional strategies to help individuals maximise their communicative potential.

It can be very frustrating for individuals with Parkinson's disease and their caregivers to encounter a breakdown in communication. Likewise, it can be frightening to know that food and water can pose a real threat to anyone with a swallowing difficulty.

Seeing a speech therapist early can help individuals to anticipate some of these difficulties and to cope with them if they are already present.

If there are concerns about your communication and/or swallowing, please consult a doctor to obtain a Speech Therapy referral.

You may also click on the links of the SingHealth Speech Therapy Departments with the relevant services to find out more or obtain contact details:

• Changi General Hospital (CGH)
• Sengkang General Hospital (SKH)
• Singapore General Hospital (SGH)
  

Ref: S13 

Check out other articles on Parkinson's disease:

Myths About Parkinson's

Parkinson's: Early Signs and Symptoms

What to Do When Parkinson's Strikes

Parkinson Treatment: How Deep Brain Stimulation (DBS) Works