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Swallowing and Parkinson’s Disease

Quick Facts:

  • Swallowing difficulty can occur at any stage of Parkinson disease (PD), even the early stages
  • The leading cause of death in PD is aspiration pneumonia due to swallowing disorders.
  • Evaluation and treatment of swallowing disorders are performed by a speech language pathologist
  • Swallowing disorders are treatable

Difficulty swallowing, or dysphagia, can happen at any stage of Parkinson disease and can be localized to the mouth, throat, and esophagus. Signs and symptoms can range from mild to severe and may include:

  • Drooling
  • Difficulty swallowing certain foods or liquids
  • Coughing or throat clearing during or after eating/drinking
  • Needing to swallowing multiple times per bite or sip
  • Feeling as if food is getting stuck
  • Frequent heartburn/reflux

As the disease progresses, swallowing can become severely compromised and food/liquid can get into the lungs, causing aspiration pneumonia. Aspiration pneumonia is the leading cause of death in Parkinson’s. There is also a risk for severe choking, when food lodges in the airway and prevents the ability to breathe.

It is important to take note of any changes to swallowing function, because there is opportunity to intervene early and preserve both health and quality of life. Swallowing disorders are managed by the medical team with a speech-language pathologist and physician. Evaluation typically involves an interview, a physical examination of the head and neck, trials with food/liquid and if indicated, an instrumented examination, either with a moving x-ray, called videofluoroscopy (also known as a modified barium swallow study) or by visualizing the throat with a scope (called endoscopy). New technologies are being developed that may be able to detect Parkinson’s-related changes to swallowing function even before someone begins to notice swallowing difficulty. One example is high-resolution manometry, a technique that measures pressures generated in the throat during swallowing (see figure below).

Images from a videofluoroscopic (x-ray) swallow study (left) and high-resolution manometry (swallowing pressures) study (right) from a healthy individual (top) and a person with Parkinson disease (bottom). In the person with PD, note airway invasion of the swallowed contrast (white arrow), reduced opening of the upper esophagus (black arrow), and need for multiple swallows (magenta arrow).

Treatment of swallowing disorders is specific to the nature of the swallowing problem, but can involve strategies to help food or liquid go down safely (swallowing hard, holding your breath while swallowing, tucking the chin while swallowing), diet changes (thickening liquids, making foods softer), exercises, or a combination of these. In some cases, alternatives to oral feeding, such as a feeding tube, are indicated. However, just because you have a swallowing problem, it does not mean that you will need a feeding tube.

Because Parkinson disease is progressive, swallowing abilities can change over time, underscoring the need for early intervention and frequent follow-up. It may be beneficial for you and your healthcare team to have a “baseline” swallowing study as a comparison for later in the disease progression. Sometimes the signs of a swallowing disorder can be subtle, so it is important to be vigilant. Below are some signs that you may have a swallowing problem:

  • You have recently lost weight without trying
  • You tend to avoid drinking liquids
  • You have heartburn or a sore throat
  • You tend to drool
  • You get the sensation of food stuck in your throat
  • You cough, choke, or clear your throat during or after meals
  • You have trouble keeping food or liquid in your mouth
  • You have trouble moving food to the back of your mouth
  • You have difficulty swallowing pills
  • You have lost your appetite
  • It takes you a long time to eat a meal
  • Sometimes you have a fever for no apparent reason

If you think you have difficulty swallowing, ask your physician to refer you to a speech-language pathologist for a swallowing evaluation.  

References and Resources:

  • Beyer, et al. Causes of death in a community-based study of Parkinson’s disease. Acta Neurol Scand. 2001;103(1):7-11. PubMed link
  • Ciucci, et al. Early identification and treatment of communication and swallowing deficits in Parkinson disease. Semin Speech Lang. 2013;34(3):185-202. PubMed link
  • D’Amelio et al. Long-term survival of Parkinson’s disease: A population-based study. J Neurol. 2006;253(1):33-7. PubMed link
  • Jones & Ciuicci. Multimodal swallowing evaluation with high-resolution manometry reveals subtle swallowing changes in early and mid-stage Parkinson disease. J Parkinsons Dis. 2016;6(1):197-208. PubMed link
  • Michou & Hamdy. Dysphagia in Parkinson’s disease: A therapeutic challenge? Expert Review of Neurotherapeutics. 2010;10:875-8. PubMed link
  • Pflug, et al. Critical dysphagia is common in Parkinson disease and occurs even in early stages: A prospective cohort study. Dysphagia. 2018; 33(1):41-50. PubMed link
  • Plowman-Prine, et al. The relationship between quality of life and swallowing in Parkinson’s disease. Mov Disord. 2009;24:1352-1358. PubMed link


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The Shaking Man (A Prose Poem), Part 1

The Shaking Man (A Prose Poem), Part 1

By Reinfred Addo

(For Terri Beamer Shelor and Karen Gaines–incredible instructors, mentors, and speech-language pathologists)

continue reading →



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Dysphagia in the News: 33% of Aging Americans will Develop Dysphagia

Research out of Johns Hopkins University suggests that at least 1 in 3 adults in the US will develop difficulty swallowing as they age. A startling statistic coming from their report states that 25% of aging adults diagnosed with dysphagia will die within one month of receiving their diagnosis, and 50% dying within a year.

Dysphagia can result in serious medical complications including choking, pneumonia, malnutrition, dehydration, weight loss, all of which can lead to death.

It is critical that dysphagia clinicians and researchers continue to improve the prevention and treatment of this disorder.

At the NFOSD, our mission is to advance the treatment of swallowing disorders in our lifetime, and one of the first steps needed to do so is to increase awareness of the prevalence and negative outcomes of dysphagia.

Click Here to read the article from Daily Mail

 



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Applying for Disability Benefits with Head and Neck Cancer

Byline: This article was written by the Outreach Team at Disability Benefits Help. They provide information about disability benefits and the application process. To learn more, please visit their website at http://www.disabilitybenefitscenter.org/ or by contacting them at help@ssd-help.org.


Approximately 4% of all cancers diagnosed in the United States are located in the head and neck area, and researchers estimate that over 65,000 American men and women were diagnosed with some form of this cancer in 2017.

Head and neck cancer include all occurrences that appear in the area, with the exception of brain cancer. Common forms include cancer of the:

● Lips
● Larynx
● Mouth
● Nasal cavity or sinuses
● Throat
● Tongue

Treatment plans will vary according to the location of the tumor, stage that the cancer has reached, and your overall health. General approaches include chemotherapy, radiation therapy, surgery, and targeted therapy. Individually or as part of an overall treatment combination, these cancer-fighting treatments can leave you too exhausted to maintain full-time employment. If this happens to you, you may qualify for Social Security Administration (SSA) disability benefits, which can help meet the costs of your cancer treatments while compensating for lost income.

Medical Eligibility with Head and Neck Cancer

When you apply for disability benefits, the SSA refers to the Blue Book, which lists recognized disabilities and the criteria for meeting each one. Section 13.02 Soft tissue cancer of the head and neck covers all local cancers except those of the salivary glands and thyroid, which have their own listings.
Certain types of head and neck cancer will result in an automatic approval of your disability claim. They include:

● Esophageal Cancer
● Salivary Cancers
● Sinonasal Cancer
● Thyroid Cancer

You will also qualify with head and neck cancer that has spread, cannot be operated on or removed, or is a small cell carcinoma. If you have a head or neck cancer whose symptoms and treatment are expected to leave you completely disabled for at least a year, you will also be approved for benefits. Reviewing the Blue Book online will give you a better idea of how you may qualify for your particular condition.

The Compassionate Allowances Program

The SSA designed the Compassionate Allowances Program to deliver benefits more quickly to applicants with serious and clearly disabling conditions. Certain head and neck cancers qualify for a Compassionate Allowance, and if you have any type that is a small cell carcinoma, has spread, and/or can’t be removed or operated on, your claim will also be reviewed and approved more rapidly. If you qualify for a Compassionate Allowance, your claim can be approved in as little as 10 days, instead of the months that a regular application entails.

Receiving Benefits Without Meeting a Listing

Certain head and neck cancers are treatable if caught in the early stages. For example, with early detection, throat cancer treatment has an estimated 95% success rate. In this situation you will not qualify for disability benefits unless at least 12 months of treatment are required and any associated side effects and complications will leave you too disabled to work full-time. If this happens to be the case with you, you may qualify for a medical vocational allowance.

This allowance is intended to make benefits available to applicants who did not meet a listing but are still unable to maintain gainful employment. Your eligibility will be determined by factors such as your functional capacity, employment history, and even age, as older applicants can find it more difficult to be retrained for a career they can pursue during their cancer treatments.

To evaluate your application, the SSA will review your residual functional capacity (RFC) form, which details the ways that having cancer has impacted your ability to work at a job you are trained and qualified for. This form must be filled out by your oncologist and submitted along with your original application.

Applying for Disability Benefits

Applying consists of completing an application form and submitting it to the SSA, along with medical documentation that supports both your diagnosis and prognosis. Examples include:

● Physical examination results
● Endoscopy test results
● Lab tests such as blood and urine analysis
● Imaging results for tests like X-rays, MRIs, CT scans and/or PET scans
● Pathology reports
● Anti-cancer treatment results

You may apply online or call 1-800-772-1213 to schedule an appointment at your closest SSA office. Once your benefits start arriving, your financial worries will ease and you can focus on improving your quality of life during treatment and beyond.



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Caregiver’s Guide to Dysphagia in Dementia

Byline: Rinki Varindani Desai is an ASHA-certified medical speech-language pathologist and BIAA-certified brain injury specialist, specializing in the rehabilitation of cognitive-linguistic and swallowing disorders in adults. She is the founder and admin of the Medical SLP Forum, co-author of the mobile app Dysphagia Therapy and co-founder of Dysphagia Grand Rounds. Rinki currently serves on ASHA’s SIG 13 Editorial Committee as Associate Editor of Perspectives, on the Dysphagia Research Society’s Website, Communications, and PublicRelations Committee and has been selected to participate in ASHA’s Leadership Development Program 2017-2018. She has presented at national and international conferences on topics related to adult dysphagia and written numerous articles for leading SLP blogs and magazines. Originally from Mumbai, India; Rinki currently practices in Rochester, New York as Healthpro Rehabilitation’s SLP Team Leader for the Western NY region. You can follow her Medical SLP updates on Facebook and Twitter or reach out to her at rinkislp@gmail.com.


Dementia and Dysphagia

Dementia is not one specific disease. It is a broad term that describes a wide range of symptoms associated with a decline in memory, communication, and other thinking skills; severe enough to reduce a person’s ability to perform everyday activities (Alzheimer’s Association). continue reading →