The Importance of a Swallowing Evaluation in Parkinson’s Disease
If you are experiencing any difficulty swallowing in the course of your Parkinson’s disease, it is important to seek out a clinical swallowing evaluation with an experienced speech language pathologist to best determine an individualized treatment plan. It is particularly imperative for those with PD to have this test as there is a higher risk of something called “silent aspiration”. This is when food, liquid or medication goes down the wrong way however the body doesn’t respond appropriately to expel it (i.e. cough).
What’s Involved in a Swallowing Evaluation?
The first part of a swallowing evaluation is the clinical assessment. The speech pathologist will take a detailed medical history and ask you about the swallowing issues you are experiencing. Next is the oral motor exam. This is a test that looks at how the muscles in your face, mouth and throat are functioning. Your therapist may ask you to smile widely, press your tongue against a tongue depressor, wiggle it side to side, cough, wrinkle your brow, puff your cheeks with air, voice different sounds etc.
The next part involves having you swallow different textures of food: liquid, puree, mixed texture, harder solids etc. The therapist will be observing different things: How are you able to chew, prepare, control and transfer various food textures? How long does it take? Is there any spillage from the lips? How well are you able to clear food from your mouth? Are you aware when food spills out? Next they will likely feel your throat when you swallow. They are testing for how briskly your throat rises when you swallow. This indicates how well you are closing your airway when you swallow and how well you are opening your food tube to allow the food to pass through to the stomach. Next they will observe what happens after the swallow. Is there coughing or throat clearing? Is there a change in voice quality? A wet or bubbly sounding voice can indicate that something has gone down the wrong way as food and liquid that passes over the vocal folds will change the sound of the voice.
The Instrumental Assessment
If your speech pathologist feels it is indicated, they may book you for a swallow x-ray. This could be referred to as an MBS (Modified Barium Swallow) or a VFSS (Video-Fluoroscopic Swallowing Study). This test is performed in an x-ray department. The therapist will mix different food textures with barium (a chalky white mineral that shows up on x-ray). They will ask you to swallow these items while you are being x-rayed. This test allows the speech pathologist to see exactly what is happening when you swallow and will help to guide the treatment plan. During the test they may have you do special head positions or specific manoeuvres to see if there are any strategies that improve swallow efficiency and airway protection.
After the test, the speech pathologist will meet with you to review the results and discuss your treatment plan.
Treatment may involve any of the following:
- Food texture modifications
- Positioning strategies or specific swallowing tips/manoeuvres during meals
- Specific swallowing exercises
- Speech/voice therapy or exercise program
Speech Therapy for Swallowing Issues in Parkinson’s?
Yes! Parkinson specific speech and voice exercises can help with strengthening the respiratory, articulatory and phonatory systems. Remember that speech therapists manage both communication and swallowing issues because of the similarities in anatomy and physiology. When you regularly engage in Parkinson specific voice and speech exercises you are also targeting swallowing function!