Parkinson’s Disease: Communication & Swallowing Tips for Clients & Carer’s

By Laura Harding

What is Parkinson’s Disease?

Parkinson’s Disease is a progressive nervous system disorder that affects movement. Nerve cells in the Basil Ganglia (an area in the brain) are responsible for the coordination of movements and maintaining good posture. When the brain starts a movement, the basal ganglia uses chemicals to send ‘electric impulse like’ messages to the muscles. These messages tell what muscles to move and how quickly to move. The main chemical that passes these messages is called Dopamine.

What does Parkinson’s Disease look like?

People with Parkinson’s can have difficulty with writing, speaking, changing positions and maintaining balance. In addition to this, people with Parkinson’s can also have trouble swallowing, have a quiet and monotone speech, cramps, reduced facial expressions, difficulty sleeping, constipation, incontinence or memory loss. It’s important to remember that these symptoms vary between each individual, and not everyone will experience all of these symptoms.

What causes Parkinson’s Disease?

While we aren’t really sure why, Parkinson’s causes the nerves in the basil ganglia to die. When this happens, dopamine is reduced and the signals that help to control these movements are weak or lost. When this happens, the movements become difficult to start, weak, slow and jerky. These symptoms gradually develop over a period of time. However, it is important to remember that this is different from one person to another.

What is the treatment for Parkinson’s Disease?

At the moment, the cause and the cure are unknown. However, despite its progressive nature, there are medications and strategies that can help manage a person’s symptoms. These can help a person living with Parkinson’s live a full and productive life.

Communication Strategies

Effective communication involves the use of verbal speech or written words to convey information from one person to another. This is most important when we are sick or if we need something from someone. If a person living with Parkinson’s is experiencing a few of the symptoms from above, e.g. quiet voice, limited control of facial expressions, unable to write etc, then effective communication can be really hard.
  • Minimise background noise: If you don’t have other noises to compete with, you will be able to be heard much easier!
  • Face the person you are speaking to: Facing the person you want to talk to and making eye contact with them will help to keep their attention. This will also remind them to have patience with you
  • Speak slowly: This will help to make sure your words don’t run together and make your speech clear.
  • Use shorter sentences when talking: Using shorter sentences will help to reduce times when your voice “fades out”.
  • Take a big breath before talking
  • Break down a long sentence using ‘breath brakes’ smaller words: Hi (breath) my (breath) name (breath) is (breath) ….
  • Slow down
  • Remind the person of these strategies when they are trying to communicate with you
  • Ask the person Yes or No questions: Using simple yes/no questions when talking with a person living with Parkinson’s is an easy strategy. The use of yes/no questions allows for an effective communication without a large amount of effort.
  • Be patient: Giving them extra time to get their message across and respond to you helps.
  • Ask them to use shorter sentences or key words only: This can help them to get their message across quicker, and can be vital if it’s an important matter.

Augmentative and Alternative Communication Devices

As the disease progresses, how loud or how fast a person can speak may change. Their speech may start to become hard to understand, with difficulty articulating some speech sounds. To help them communicate clearly, a person living with Parkinson’s can use an Augmentative and Alternative Communication system, also referred to as AAC. There are a large variety of AAC so when it comes to choose which device is best for you or someone you are caring for; it is worth looking around. The devices range from a picture board to a text-to-speech device with voice amplifiers. The main things to consider are what are their cognitive abilities, their speech and language abilities, attitude and their own personal preferences.

Smartphone & Tablet apps

Try searching the app store using “speak loud”, “speak up” or “Parkinson’s speech”. Any app that has a decibel meter to show you how loud you are talking and what level of loudness is considered a normal range. When using these kinds of apps – place the smartphone or tablet opposite you where another person would generally sit to mimic a standard conversation.

Voice, Breathing and Facial Muscle Exercises

In general, we use exercise to keep out bodies healthy and in shape. So, following the same idea we can use different voice exercises to help keep you voice quality as loud and as clear for as long as possible!
  • Sustained ‘eee’or ‘aah’:
    • Take a DEEP breath in and say ‘eee’ as loud as you can for as long as you can. Do this 3 times!
    • Time yourself! Try as see if you can go for the same length of time every time, or even longer!
  • Increasing Volume:
    • Count 1 – 2 – 3 – 4 – 5 making sure you get louder on each number!
    • Take a breath between each number, release each breath before starting the next one e.g. (in)1(out) – (in) 2(out) – (in)3(out) – (in)4(out) – (in)5(out).

Posture is important to help maximise the amount of available space in your lungs i.e. how big of a breath you can take! Its recommended that you should sit upright with your back supported and your feet flat on the floor. A helpful trick to use when doing your breathing exercises is placing one hand on your stomach just below your ribs. This is where the movement should be happening when you take a deep breath in

Diaphragmatic Breathing – 2x Daily (Morning & night)

  1. Relax your shoulders and sit back or lie down.
  2. Place one hand on your belly and one on your chest.
  3. Inhale through your nose for two seconds, feeling the air move into your abdomen and feeling your stomach move out. Your stomach should move more than your chest does.
  4. Breathe out for two seconds through pursed lips while pressing on your abdomen.
  5. Repeat x 5

Pursed Lip Breathing – 2x Daily (Morning & night)

  1. Inhale slowly through your nostrils.
  2. Purse your lips, as if pouting or about to blow on something.
  3. Breathe out as slowly as possible through pursed lips. This should take at least twice as long as it did to breathe in.
  4. Repeat x 5

These exercises help increase our awareness of what our muscles are doing when we are talking and swallowing. It’s best to do practice these movements while sitting down, making sure to do each exercises 10x in a row at least 2x a day.

Cheeks

  • Raise the right cheek – hold for 3 seconds
  • Raise the left cheek – hold for 3 seconds
  • Smile as wide as you can – hold 3 seconds

Lips

  • Smile saying “eee” – hold for three seconds
  • Purse your lips saying “ooo” – hold for 3 seconds
  • Alternate between “ooi” & “eee”

Eyes

  • Raise your eyebrows up – hold for 3 seconds
  • Squeeze your eyes closed as tight as you can – hold for 3 seconds
  • Alternate between raising your eyebrows & squeezing your eyes shut

Safe Swallowing Strategies

A safe swallow is when any food or drink that you have goes straight down to your stomach. One of the risks associated with Parkinson’s is a gradual decline in the ability to safely swallow due to the loss of control of muscles in the mouth (lips, jaw, tongue) or due to loss of sensation. This means that instead of food or drink going safely down to the stomach, some can go “down the wrong pipe” and enter the airways. This can happen to anyone from time to time, and usually triggers a large reflexive cough (also known as aspiration) strong enough to push the food/drink particles out. In people with Parkinson’s, this reflexive cough isn’t always strong enough to successfully remove the particles. This can then lead chest infections or aspirated pneumonia.

  • Sit completely upright when eating or drinking
  • Minimise distractions during meals (no TV or talking)
  • Alternate between small mouthfuls and small sips of water
  • Eat frequent smaller meals throughout the day (e.g. instead of having 3 big meals, have 6 smaller meals)
  • Eat meals that have a consistent texture (e.g. casseroles, blended think soups) as opposed to meals that have mixed textures (e.g. minestrone soups)
  • Avoid dry, flaky, crumbly foods such as toast, nuts, biscuits, fruit skins. These can sometimes cause irritation to the throat while you’re eating.
  • Modify the thickness of your food and drink (soft & moist, pureed or minced foods), thickened drinks such as nectar juice or even using a thickener.
  • Eating slowly, or excessive chewing
  • Easily fatigued during meals
  • Difficulty in chewing foods
  • Unexplained weight loss
  • Trouble swallowing tablets
  • Feeling like there is food stuck in your throat
  • Frequent chest infections or pneumonia
  • Wet or gurgled sounding voice after eating or drinking
  • Coughing, chocking or throat clearing when eating or drinking

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