Join us on a fascinating journey with Speech Language Pathologist, Brittany Peck, as we unravel the complexities of swallowing and what people with Parkinson's may be experiencing. Brittany's expertise illuminates how the reduction of dopamine, can lead to a slow-down in the oral musculature, causing difficulties in swallowing. Yet, as we learn, there's a beacon of hope with retraining and awareness.
We discuss the clinical swallow evaluation process, potential treatments, and even share some handy tricks for taking medication. If you're in a remote location, fret not! Brittany enlightens us about her home-based practice in the Finger Lakes region of New York, and how she's leveraging technology to deliver speech-language pathology services to those in rural and remote areas. Finally, we list some key indicators that could signal swallowing difficulties. So, come aboard and learn how to manage and improve swallowing issues related to Parkinson's.
Buzzsprout - Let's get your podcast launched!
Start for FREE
Check out our website www.safeathompt.com
give us a call at (585)398-6050
or send us an email at robin@safeathomept.com
Thanks for listening!
Join us on a fascinating journey with Speech Language Pathologist, Brittany Peck, as we unravel the complexities of swallowing and what people with Parkinson's may be experiencing. Brittany's expertise illuminates how the reduction of dopamine, can lead to a slow-down in the oral musculature, causing difficulties in swallowing. Yet, as we learn, there's a beacon of hope with retraining and awareness.
We discuss the clinical swallow evaluation process, potential treatments, and even share some handy tricks for taking medication. If you're in a remote location, fret not! Brittany enlightens us about her home-based practice in the Finger Lakes region of New York, and how she's leveraging technology to deliver speech-language pathology services to those in rural and remote areas. Finally, we list some key indicators that could signal swallowing difficulties. So, come aboard and learn how to manage and improve swallowing issues related to Parkinson's.
Buzzsprout - Let's get your podcast launched!
Start for FREE
Check out our website www.safeathompt.com
give us a call at (585)398-6050
or send us an email at robin@safeathomept.com
Thanks for listening!
Hello, I'm Robin Barclay and I'm here today with this Parkinson's Empowerment podcast with Brittany Peck from BPEC Speech and Swallowing. Welcome to the podcast, brittany. Thank you for having me. Great, I thought it was important to have you here because, for one thing, I know a lot of people don't know all of the things that a speech therapist can work with you on, so I thought maybe you could touch on that a little bit before we get started into the nitty gritty.
Speaker 2:Absolutely so. Yeah, our title is Speech Language Pathologist and a lot of times that's just a mouthful, so speech therapist. But then people get confused and think well, you work on speech and nothing else, but our scope of practice is actually a lot bigger than that. We work on speech as well as voice language and word finding, cognition, or your memory and thinking, and then also swallowing. That's great.
Speaker 1:That's good to get that out there so that people know that they can reach out for that kind of help, because all of those things can affect people with Parkinson's, absolutely. Yeah, so my last podcast, we had Dr Gillum on and we talked a lot about constipation and Parkinson's. So we'll maybe start with that aspect of speech and what kind of thing. Where would you start when it comes to helping people manage digestion?
Speaker 2:So, yeah, the beginning of digestion starts in your mouth, right with your saliva, and that relates to swallowing. So actually, more than 80% of people with Parkinson's do end up developing dysphagia during the course of their disease, and dysphagia is just another fancy way of saying a swallowing pyramid. So people with Parkinson's often have reduced coordination, slowness of movement and rigidity in the muscles of the mouth and the throat, and that can cause, obviously, difficulty with swallowing because we use those muscles in our mouth and throat. But one of the early signs of that is excessive saliva and drooling, and that can happen just from positioning if a person's head is tilted down or their mouth is involuntary being held open, which is usually later in the disease process, or when a person is engaged in doing something else and they're forgetting to swallow their saliva Right, because that's what I usually tell people is it's like swinging your arms.
Speaker 1:We don't have to think about swinging our arms or blinking our eyes, or usually we don't have to think about swallowing our saliva. So it's really the autonomic nervous system and not having to kind of retrain the brain Right exactly.
Speaker 2:Yeah, and that's the same with the speech bit as well. There's all of these automatic processes that we know are impacted by Parkinson's due to that reduction in dopamine in the brain and swallowing is a big part of that. We're not automatically swallowing, we're not automatically recognizing it. You're going to have that excessive saliva. People think that it's an excessive production of saliva but it's more often just the drooling because of not remembering to swallow Right.
Speaker 1:Yeah, and so you can work on it. You can improve. Yes, indeed, we can.
Speaker 2:And that's a lot of. What speech and also physical and occupational therapy do is retrain folks who have a diagnosis such as Parkinson's to do things more purposefully, more intentionally, and so they're aware to it, and just training you to be more aware of. Okay, I'm starting to notice some pooling. Now it's time to initiate that swallow. I think a big misconception that people have with Parkinson's is that it causes weakness. But the reality is that we're just not using those muscles to their full amplitude because of that reduction in automatic movements and that disuse of those muscles causes weakness and if you're not swallowing with the full amplitude of the muscle strength, those also get weaker over time and put you at risk of aspirating or having food and liquid get down into the airway rather than the esophagus to the stomach.
Speaker 1:Right. Yeah, I see that in PT too. A lot of times if I get a referral for someone and they really haven't been doing anything because of apathy, because you know they've just been not doing much walking, they're not doing their normal activities and I get in there and see them and so quickly we see an improvement in strength because we're getting them moving again. So it's kind of the same.
Speaker 2:Yeah, it's exactly in line. I tell everybody the good news is that you're going to respond really well to exercise once we get going.
Speaker 1:Yes, Right, well, good, okay. So one of the things what would be your recommendations for somebody who was having difficulty?
Speaker 2:Yeah, so there's a few different ways to kind of classify a dysphagia or a swallowing disorder. So if it's okay, I think I'll start with how the swallow works and then we can talk about the way that things can go wrong.
Speaker 1:That would be great.
Speaker 2:Yeah, so, as we mentioned, digestion it starts in the mouth right with that saliva. So you have your oral phase first and that's very cognitively based. We're placing food in our mouth, we're chewing it, manipulating it in our mouth to prepare to swallow. And again, like I said, that's very cognitively based. So we're a little more intentional about that bit. As the food or the bolus moves back in the mouth, our swallow reflects triggers and we call that the pharyngeal phase of the swallow. You can think of that as your throat muscles and that's more reflexive, but a lot of muscles basically come together to cover your airway. So the muscles of your throat then constrict and propel the food or the bolus down into the esophagus and that's the third phase of the swallow, and the esophagus is the tube that then leads to the stomach. So there's a lot of moving parts in this process, Like I said, starting cognitively, then becoming reflexive, and then we don't actually have control of the esophagus. That just propels it into the stomach.
Speaker 2:So a lot of things can go wrong. With a diagnosis like Parkinson's, you may have some slowness of movement in the oral musculature, chewing may become more difficult. Some folks have tremoring in the tongue and manipulating the food side to side, for chewing and just propelling the food back in the mouth can become challenging. And then also weakness of the throat muscles. If we're not using them again, as I mentioned earlier, to their full strength, they can start to weaken over time. If they're not contracting and constricting or if they're discoordinated in any way, our airway which is located next to the esophagus may not be fully covered and then food and liquid can spill into the airway which we call aspiration. And the problem with aspiration is that if food and liquid gets down into your lungs it can eventually lead to pneumonia and that's one of the leading causes of mortality in Parkinson's Right okay, so actually working on your voice and your loudness can actually help translate over to helping you swallow as well In some ways.
Speaker 2:Yes, Cause it's all similar. It's all the same musculature right.
Speaker 2:And the other piece of that is your breathing. A lot of people don't realize how closely coordinated your breathing and swallowing are. When we swallow, we typically have in. No, I'm paying really close attention to it. When we swallow, we typically have a holding of our breath while we swallow and then we continue exhaling. People who have any discoordination with their breathing tend to inhale after they swallow rather than exhale, and then can inhale any residue that's left in their throat, causing that to then spill down into their airway as well.
Speaker 2:Yeah, so all of those things are important to stay on top of because they're also closely intertwined as far as managing voice and breathing and swallowing.
Speaker 1:What are some warning signs of difficulty swallowing?
Speaker 2:So, like I mentioned, one of the first ones is that excessive saliva. You're not having that automatic swallow response. That's usually the first thing, but people don't often notice that. So some of the more apparent signs and symptoms to monitor for are coughing or clearing your throat while you're eating and drinking or after meals, as well as if you go to speak mid meal, for example, and you have a wet, gurgly vocal quality. Those can be indicators that maybe some food or liquid is hanging out near your airway rather than going down the esophagus to the stomach, and again, if it's near the airway, it's at risk of going into the airway and then being aspirated. Another sign to watch for is unexplained weight loss, and that's one that kind of goes under the radar. People's appetites are maybe reduced for other reasons, but unexplained weight loss can be also an indicator of difficulty swallowing Right and that kind of leads back to the constipation.
Speaker 1:I mean, if you're always feeling full and a lack of motility, you really probably don't feel like eating a whole lot, absolutely, and dehydration is a risk too as far as that goes.
Speaker 2:If you're constipated, chances are maybe there's some dehydration and difficulty swallowing, coughing. A lot of people don't like to drink so much because it's uncomfortable when you're having those frequent symptoms and that can also lead to dehydration.
Speaker 1:That is a good point, because when we have our rock city boxing classes or some of the other classes we offer for Parkinson's, we're always saying all right, water break, let's go. And then sometimes you're did you bring your water bottle? No, all right, let me go get you a cup of water, drink it, you know. So we're pushing the water here, for sure.
Speaker 2:Yeah that's definitely an important piece and sometimes it's just a little bit of, as I said, some discordination or weakness. People may feel some sticking in their throat. They may not have that cough response. It's not like they feel like it's going down the wrong pipe and have to have that cough response. Some people just feel that sensation of a lump in their throat or sticking in their throat and that can be due to weakness too, that they're not fully pushing the food bolus down into the esophagus so it's just kind of hanging out in there and not being fully cleared.
Speaker 1:Yeah, I think it would be good to have you come in and talking. You've been in before and they all love you, but I think it would be good to have you come in, or at least for me to relay some of this information, because it's helpful for me to know. Like, okay, this is why they're so hesitant to drink their water between you know, when we're taking a quick break or whatever.
Speaker 2:So yeah, absolutely. I'd love to do that. Yeah, okay, so if someone's noticing any of those signs and symptoms, not a bad idea to reach out to your doctor, ask for a referral to speech therapy, or you can also call speech therapist directly. We're able to do evaluations without a referral and what we would do is conduct a clinical swallow evaluation. So first thing we would do a interview with you, see kind of what's going on. What symptoms are you noticing? Is it the sticking in the throat? Is it frequent coughing? Do you have weight loss? How's your appetite in general?
Speaker 2:For a lot of folks we may eventually also refer you to have an objective swallow study. Because we don't have X-ray vision right, we can kind of hypothesize what's going on based on watching you eat and drink and then your interview, but without really visualizing where the breakdown is occurring, it's hard to prescribe treatment. So what we'll do is then refer you out to have a video X-ray to actually visualize what is happening where the breakdown is occurring. So what they'll do is have you eat and drink a variety of things while doing a video X-ray of your eating and drinking to see is it an oral phase problem, is it in the pharynx or the throat. Is it a weakness there or is it discoordination? Maybe it's just the esophagus. Maybe you're feeling that lump in your throat because there's some dysmotility in your esophagus and that can be managed differently than it would be if we needed to build strength in your swallow muscles.
Speaker 1:Okay, so what kind of treatments would you then work on?
Speaker 2:Well, it really depends on what we notice during the swallow evaluation. So for some folks we may need to strengthen the tongue or the base of the tongue, and we have specific exercises for that. If it's more the pharyngeal muscles, we may work on strengthening those through something that's called an effortful swallow, where you squeeze really hard when you swallow to contract those muscles with extra effort to protect your airway. If it's something that we're noticing that there is weakness in your airway protection, we may actually work on some breathing and expiratory muscle strength training to strengthen your cough response so that your airway protection in the event of aspirating is stronger. In addition to rehab, rehabilitating the muscles, we may also introduce some compensatory strategies to reduce the risk of aspiration.
Speaker 2:So some really simple things that people can start doing is, if you're noticing things sticking in your throat or that you're clearing your throat frequently during a meal, start alternating a sip every bite or two to wash things down. Using that effortful swallow that I mentioned before as an exercise will sometimes train folks to do that routinely while they're eating their meals to get that extra strength contraction to push the food down and hopefully reduce the amount of residue in the throat. We may also work on pacing and slowing the rate of intake down so that you have time to fully clear and swallow it. In more severe cases, we may also recommend modifying the textures and the consistencies of your foods. So some folks benefit from a more moist meal that's cut up small and maybe minced, because that's easier for them to manage if they have poor oral control. In other words, they're not able to chew up a pork chop the way they previously were. So cutting that into smaller pieces, cooking it more tenderly or even just choosing softer foods is sometimes beneficial for folks.
Speaker 1:People with Parkinson's have to take. If they're taking medication for their Parkinson's, they usually take it multiple times a day. Do you find that people come to you and say I'm having trouble swallowing my medication, my pills?
Speaker 2:Yeah, absolutely. In fact, that's one of the first things that people start having trouble with, before they notice it, with food and liquid is that they mention? I'm really having trouble getting my pills down, so there's a few different things that we can recommend for that too. Sometimes it's just a matter of moistening your mouth before you start so it doesn't stick on your tongue, taking it with a couple sips of water using the efferful swallow. For other folks it's helpful to put it in a bite of something like applesauce or yogurt or pudding just to kind of coat it so that it goes down a little more easily. And for other folks that aren't able to get it down with any of those strategies, sometimes we will recommend crushing it and putting it in a puree of some sort. But of course with that we want to check with the doctor to make sure that the medication could be crushed, because not all of them can.
Speaker 1:Right. So if you have an extended release, you don't want to crush it Exactly, yep. So if somebody is having trouble swallowing their pills, that might be a red flag that they, if they haven't already, that they need to go see a speech language pathologist.
Speaker 2:Absolutely yeah. One of the biggest hurdles that I find is that people get referred to speech therapy too late. So as soon as you find one of those warning signs, one of those red flags, I recommend talking with your doctor or reaching out to a speech therapist in your area just to get an initial evaluation. If nothing else, they can say okay, things look good, or here's some concerns that we have, and they may initiate a treatment program with you. But waiting too long, those muscles may atrophy over time and then it's more difficult to rehab them back to the strength that you need.
Speaker 1:Yeah, that sounds a lot like what I tell people with who are newly diagnosed don't wait till the movements get smaller and slower, because it's going to take a lot longer to recalibrate and get your movements bigger and at more normal speed again. It's so important to go see someone, like you said, even if just to get a baseline. This is where you are okay You're testing at age norms despite your diagnosis. Usually there's something to work on though. Usually it's like arm swing or gait quality, but to have that initial assessment is huge.
Speaker 2:Yeah, and I think the issue with swallowing is that we all aspirate once in a while, because we're talking and laughing while we're drinking a soda and we start coughing and that just happens chronically. So a lot of us don't realize when it becomes disordered or problematic, because we all do it once in a while. So a lot of folks who have difficulty swallowing related to their Parkinson's don't even realize that they do. So that's a big piece to be aware of is to what warning signs to watch for when to seek support and help in that.
Speaker 1:Right, it must be, because I knew I was going to have a podcast with you today, but I did it this morning and I started coughing. Yeah, I do it multiple times a week.
Speaker 2:That's what makes it hard to pay attention to, like I said, is that we all do it once in a while and for most healthy folks, aspirating isn't going to lead to pneumonia. It's for folks who have reduced mobility, folks who are maybe more sedentary and can't get around and do as much activity during the day, or folks who don't have great oral hygiene. There's three pillars of predictors for aspiration pneumonia, One being the presence of dysphagia or difficulty swallowing, the other being poor oral hygiene and then the third being reduced activity level. So if folks are active in doing their physical therapy or their exercise group, they're out walking their dog, they're very active Folks who are really on top of taking care of their oral hygiene. Those folks are less likely to develop a pneumonia, even if they do aspirate. So it's a scary thing to think about the mortality rate of aspiration pneumonia related to Parkinson's. But there's a lot of things that you can do to prevent your risk and reduce that risk overall.
Speaker 1:Which is why early treatment is and screening is so important.
Speaker 2:Absolutely, and I have a form that I often send out when I do my intake packets with my new patients. It's called the EAT in the number 10. It's just a quick survey that people can rate themselves zero to four on how severe or how difficult different things related to swallowing are, and if you score greater than I think it's a three that's an indicator that you may have disordered swallowing or dysphagia and should be seeking support in that. So we can make that available if listeners think that would be helpful.
Speaker 1:Yeah, we can put that in our show notes. Great, All right. Well, thank you so much for being here. Brittany, Do you want to? I know that we have people from all over listening to the podcast, but do you want to talk about the area you serve a little bit?
Speaker 2:Yeah, sure. So I am a home-based private practitioner, so I do home-based and virtual therapy and I primarily cover the kind of greater finger lakes region, so the southern finger lakes, more rural areas, folks who aren't able to make it up into the city to get therapy.
Speaker 1:That's great. Well, thank you so much for coming today. We'd love to have you back to talk more. I'd love to Maybe on another topic, another area that speech pathologists cover. So this was very helpful information and we'll talk to you soon. Thanks for having me, yep. Brittany's website is BepeckSpeechAndSwallowingcom. Her email is Bepeck at speechandswallowingorg and you can reach her by phone at 607-218-7318.