February: Speech and Swallowing

February: Speech and Swallowing

Dr. Caitlin A. Bender, OTD, OTR/L

Dopamine’s Role

Dopamine is a significant neurotransmitter, meaning it is responsible for allowing electrical signals to pass throughout the brain. Dopamine helps us to produce smooth, controlled movements and is typically produced in the substantia nigra. It can be easy to overlook the smaller, fine-tuned muscles at times, but dopamine fuels the muscles within our mouths and throats, which are critical for day to day functions like swallowing and speaking. Everyday we rely on these muscles for enjoying food and communicating with our loved ones, however Parkinson’s Disease can affect the precise movements required for these functions, with research suggesting that up to 89% of those diagnosed experience speech impairments. Speech impairments impact not only one’s social participation due to reduced voice volume and clarity, but also one’s safety, as reduced swallowing can increase the risk for aspiration. 

Reasons for Speech and Swallowing Difficulties

Dysphagia

• Also known as difficulty swallowing (pocketing food during meals, clearing throat frequently throughout the day, coughing during/after swallowing).

Dysarthria

• Also known as impaired speech (overall pace changes, words slur together, or sentence volume could trail off entirely).

Weaker jaw and face muscles

• Parkinson’s can cause these muscles to become less efficient which affects how much control you have while chewing or swallowing. Decreased efficiency and control can make it difficult to swallow.

Difficulty coordinating the tongue

• The tongue is incredibly important in swallowing. It helps control the food and push it to the back of your mouth, which then triggers your swallow reflex.

Drooling

• Caused by reduced swallowing and lip closure. Exacerbated by forward, flexed posture, and impacts speech quality.

Strategies for Managing Speech and Swallowing

General tips:

• Limit distractions during medication management and feeding to improve concentration and avoid aspiration.

• Take your time. Working through movement with Parkinson’s Disease requires thinking through the sequence of events and completing the task with focus. 

• Use breathing drills and chin tucks as needed to assist with swallowing.

Foods to avoid:

• Avoid dry and crumbly foods that require vigorous chewing.

• Limit tough stringy meat and instead try well-cooked, tender chicken or ground meat.

• Avoid nuts, seeds, or coconuts that can lead to pocketing or choking.

• Avoid sugary foods that can create more saliva and increase drooling.

Proper posture:

• Sitting or standing with proper, upright posture will allow for the structures of the throat to be in proper position, which will improve your performance with speech and swallowing. Poor posture can also exacerbate drooling as it makes swallowing more difficult, and leads to gravity causing saliva to pool forward and escape through open lips in people with Parkinson’s Disease. 

Assistive Equipment: 

• Try using different drinking methods such as straw versus cup. This may improve performance with swallowing

• One-way valve straws may also be useful if normal straw use is difficult. 

• Cut-away mugs may be useful for those with limited neck mobility. 

• Try different utensil shapes and sizes to aid in food portioning and ability to close lips around utensils. This will ultimately aid in a better swallow.

Staying active: 

• Pitch Glides: Helps to work on pitch, diaphragm control, and voice projection. Take a deep breath, start at a low pitch and glide up as high as you can saying the "ah" or "ee" sound. Hold on the highest note a count of three. Repeat this exercise going down to the lowest note. (If glides are difficult, this exercise can be completed using a "stair-stepping" approach).

• Lip closure exercises: Helps to reduce drooling. Start by taking a deep breath and then filling your cheeks with air. Keep the lips sealed as you try to move the air from cheek to cheek. 

• Tongue Range of Motion: Helps to reduce pocketing of food. Begin taking the tip of your tongue and pressing it into the side of your cheek (like you have a mint in your mouth), and repeat on the other side. Work on rolling your tongue back and pressing against the roof of your mouth as well. 

• Take 5 Breathing: Good breath control can aid in both speech and swallowing performance. Place your pointer finger at the bottom of your thumb, and breathe in for 5 seconds as you slide up. Breathe out for 5 seconds as you slide down. Keep going until you have finished tracing your fingers and you have taken five slow breaths.

References

Aragon, A., & Kings, J. (2010). Occupational Therapy for People with Parkinson’s Disease: Best Practice Guidelines.

 Parkinson’s Foundation. (2024). “Speech & Swallowing Issues.” www.parkinson.org/understanding-parkinsons/non-movement-symptoms/speech-swallowing. 

Ramig L, Halpern A, Spielman J, Fox C, Freeman K. (2018). Speech treatment in Parkinson's disease: Randomized controlled trial (RCT). Mov Disord. (11):1777-1791. doi: 10.1002/mds.27460. Epub 2018 Sep 28. PMID: 30264896; PMCID: PMC6261685