People affected by Parkinson’s can develop problems with communication and with eating, drinking and swallowing (dysphagia). As well as the more obvious motor changes, people with Parkinson’s may also experience non-motor changes that can impact on communication and more general quality of life, including depression, anxiety, apathy, fatigue, pain, sleep disturbance and cognitive changes. Speech and language therapists (SLTs) are a crucial part of the multidisciplinary team that helps people affected by Parkinson’s, and their families and carers, to manage their condition and maintain their quality of life.
A Serious Issue
Communication: Parkinson’s affects all aspects of communication. This includes language (words and content), facial expression (and hand and arm gestures), speech (articulation and pronunciation), intonation (melody of speech), and voice (phonation and vocal note). These changes to the way people affected by Parkinson’s usually communicate can affect them in their employment, social activities and day-to-day situations. This can lead to less confidence, and difficulty with getting into conversations, keeping their place in conversations, keeping up with and perceiving what others are saying, and conveying information. This can lead to feelings of loss of independence and inadequacy. It can also have significant consequences, such as the development of negative perceptions of the individual, the misdiagnosis of depression, and an impact on a person’s mental health.
Swallowing: Parkinson’s affects all aspects of swallowing. People affected by Parkinson’s can have difficulties chewing food, propelling food down their throat and clearing their throat. In the early stages, patients or carers may not always recognize the changes and symptoms of swallowing difficulties. In later stages, these difficulties pose significant risks to hydration and to nutritional and respiratory health. They can lead to fatigue and confusion, and also put the person at risk for a poorer quality of life. Eating and mealtimes can become less enjoyable, which can have a significant impact on socialization and on families and carers, and can lead to depression. Unsafe eating and drinking can also lead to an increased risk of choking, aspiration pneumonia and requiring hospital admission etc.
Drooling: Parkinson’s affects the control of saliva, which can lead to drooling. Drooling is associated with reduced swallowing ability and this is exacerbated by poor lip seal. Drooling affects everyday life, impacting on hydration levels, quality of life and social participation.
Mental Health: Parkinson’s can affect mental health and wellbeing due to the difficulties of living with the condition; for example, experiencing a fear of choking or the increased social challenges that come with drooling. People in the later stages of Parkinson’s may also be vulnerable to hallucinations, psychosis and depression.
How Speech And Language Therapy Can Help….
Speech and language therapy (SLTs)is essential for problems with communication, swallowing and saliva, in order to
maintain people’s independence and avoid hospital admission.
…With Communication
With their clinical expertise in speech, language and communication, SLTs have a unique role to play in the assessment,
education and support of people affected by Parkinson’s and their families and carers, helping them to anticipate and
adjust to changes in communication. SLTs can help create a supportive communication environment by advising on how
to remove barriers to successful communication and boost support and understanding of how best to communicate. They
can also provide advice on how to manage conversations, including on how to recognize and repair breakdowns in
understanding.
SLTs can also work directly with people affected by Parkinson’s on their voice and speech. This can include providing
personalized strategies and exercises to help with volume of speech, pace, speed of talking and facial expression. SLTs
may also recommend attention-to-effort therapies, self-monitoring and dedicated exercises to ensure gains made in clinic
can be transferred to other environments. In the later stages of Parkinson’s, SLTs can help with tools and technology to
support communication, such as Augmentative and Alternative Communication.
…With Swallowing
SLTs have a unique role in the assessment, diagnosis and management of swallowing difficulties. SLTs help people
affected by Parkinson’s to maintain a safe swallow through exercises (for example, expiratory muscle strength training),
techniques and positioning and promote safety through modifying the texture of food and fluids. This reduces the risks
associated with malnutrition, dehydration and choking, and helps prevent secondary infection. SLTs can also train and
advise families and the wider health and care workforce to help ensure that mealtimes are as safe and enjoyable as
possible. They will also liaise with pharmacies or GPs regarding medication reviews to ensure that medication is in a form
which is safe and easy to swallow.
…. With Drooling
SLTs help develop strategies to improve the safety and efficiency of swallowing and to minimize the risk of aspiration.
SLTs help develop exercises to promote a good lip seal, a favorable posture and ways to encourage force and frequency
of swallowing. Devices that give the person an auditory or vibratory prompt to swallow can help to increase swallow
frequency. Attention-to-effort instructions, similar to control of voice loudness therapies, can help deliver a more forceful
swallow. SLTs also work with carers to advise on how to help prevent drooling.
…With Mental Health
Given the links between mental health, communication needs, dysphagia and Parkinson’s, SLTs have a crucial role to
play in ensuring that people affected by Parkinson’s who have mental health problems can access and engage with
mental health referrals, assessments and interventions. SLTs can support and train mental health teams to recognize and
respond to communication needs and dysphagia so barriers to access and engagement are removed. Better
communication, safer swallowing and reduced drooling are associated with better mood and increased motivation.