NEGLECTING YOUR SWALLOWING DIFFICULTY ?

April 3, 2024Gajanan BandodkarUncategorized

Enjoying your favourite FOOD gives you genuine happiness and  pleasure.Food not only plays an essential role in your nutritional well being but also gives you immense mental satisfaction. But  PD patients are at a very high risk of developing swallowing difficulties which is termed as dysphagia. They start to have problems taking their daily pill, drinking water , and having their meal. Finishing the food on the plate is like getting a job done rather than relishing your meal time. Spending long hours on the dinner table struggling to swallow the food is very tiresome and frustrating. Apart from the mental impact that dysphagia has, it can lead to dehydration and malnutrition along with complications like food aspirations. Food entering the airway, can cause lung infections(pneumonia), which is found to be the major reason for mortality in PD patients. Swallowing difficulties have been found to be in 80 % of PD patients. It is a long standing problem in the course of having parkinsons. Symptoms can start in the early stages of PD, but studies indicate 10% of persons with PD report dysphagia despite symptoms.Early detection and management strategies have been found to be beneficial in having safe feeding and avoiding aspirations. If you feel any changes like excessive drooling, coughing while eating, hoarse voice post meal or any other difference in your swallowing ,it is time to speak to your doctor or a Speech Therapist. This article will explain to you about normal swallowing, abnormalities in PD swallowing functions, symptoms, tips and exercises for dysphagia management. 

Normal swallowing process has 3 phases :

1. Oral 
2. Pharyngeal
3. Esophageal 

You can have a better understanding about this process through this video :

https://www.youtube.com/watch?v=wqMCzuIiPaM&t=41s

Why do PD patients have chances of getting Aspirated ?

1. Reduced movement and Rigid Swallowing muscles : Tongue and  jaw muscles have less movements in PD patients which leads to difficulty in bolus formation and moving it forward towards the pharynx. This reduced movement also causes food residue, drooling, and also the person has to do multiple swallows . Suprahyoid is a muscle found in the pharynx, which is reported to be  weak. It plays a key role in  proper food pipe opening. Also these muscles develop rigidity making this whole swallowing process effortful.

1. Inefficient Cough : Cough is an important mechanism of airway protection and usually the most common sign of aspiration. However, in PD patients, cough is frequently less elicited, even in the early disease stage . The strength to produce a sequential cough is very important for cleaning the lower airway. In PD Rigidity and weakness develops in the expiratory muscles leading to a not so effective cough. 

1. Impaired Swallowing – Breathing Coordination:  The coordination between both of them is very vital for airway protection which is found to be disrupted in parkinson’s patients. As the disease progresses various changes like rib cage stiffness, abdominal muscle and diaphragm weakness, stooped posture . These all changes result in an abnormal breathing pattern, thus hampering its coordination with swallowing.

• Other impairments: 

1. 1. Reduced lower airway closure.
   2. Involuntary movements of tongue and jaw interfering with the swallowing control.

Identify your symptoms :

Identification of symptoms can also be done through a questionnaire named Swallowing Disturbance Questionnaire,which to be self assessed. It has 15 questions related to phases of swallowing. If you score equal or more than 11 , it is considered high risk for dysphagia. Kindly put this in notice to your concerned medical professional.

You can download the form from the link below  and score yourself.

• Swallowing Disturbance Questionnaire.pdf

I wish to recommend a few tips and exercises which have been linked with management of dysphagia through this video. 

This video is for informational purposes only. Each individual medical situation is different . Kindly consult with your medical professional before implementing.

REFERENCES:

1. Miseon Kwon,Oro-Pharyngeal Dysphagia in Parkinson’s Disease and Related Movement Disorders,J Mov Disord 2019; 12(3): 152-160.

2. Karen Fontes,Dysphagia progression and swallowing management in Parkinson’s disease: an observational study, Brazilian Journal of Otorhinolaryngology,Volume 81, Issue 1, January–February 2015, Pages 24-30
3. Haewon Byeon,Effect of simultaneous application of postural techniques and expiratory muscle strength training on the enhancement of the swallowing function of patients with dysphagia caused by parkinson’s disease,J. Phys. Ther. Sci. 28: 1840–1843, 2016
4. George Umemoto,Management of Dysphagia in Patients with Parkinson’s Disease and Related Disorders.Intern Med. 2020 Jan 1; 59(1): 7–14.
5. MinLi,Effect of feeding management on aspiration pneumonia in elderly patients with dysphagia,Chinese Nursing Research,Volume 2, Issues 2–3, June–September 2015, Pages 40-44

Chin-Man Wang,Home-Based Orolingual Exercise Improves the Coordination of Swallowing and Respiration in Early Parkinson Disease: A Quasi-Experimental Before-and-After Exercise Program Study,Front. Neurol., 30 July 2018