Ask an Expert: Sherri Zelazny Discusses Communication and Swallowing Difficulties in Parkinson’s
Sherri Zelazny has been a speech-language pathologist for over 30 years. She is LSVT® certified, and has been involved with the Parkinson’s community since the beginning of her career. She also volunteers her time to facilitate Parkinson Society British Columbia’s Communication & Swallow Workshops, and serves on the Board of Directors.
What are some of the common speech & communication problems in Parkinson’s disease? What about swallowing problems?
Hypokinetic dysarthria is the term used to describe communication problems in Parkinson’s disease. The most common communication difficulty that people with Parkinson’s disease (PD) experience is low vocal volume or soft voice. This is something that can occur even before a formal diagnosis. Other communication changes can include hoarseness, mumbling, and changes in speaking rate.
Dysphagia is the term used to describe swallowing disorders. The most obvious signs of swallowing problems are coughing and choking; these issues can occur during or after eating or drinking. Other symptoms may include difficulty chewing, slower eating, avoidance of certain foods, drooling, fatigue with eating, and difficulty starting the swallow. Some subtle problems, when identified early, can be effectively managed.
How can people with Parkinson’s be proactive in maintaining their ability to communicate and swallow?
Communication and swallowing changes are among the first motor symptoms identified by people with PD – sometimes even before they have been seen by their general practitioner or a neurologist. With over 80% of people with PD experiencing some degree of communication and swallowing problems, the most proactive thing people with PD can do is see a Registered Speech-Language Pathologist (RSLP) who has experience working with Parkinson’s clients. I cannot stress enough: the earlier, the better for evaluation and treatment as it will help maintain quality of life. Although you do not need a referral to see an RSLP in BC, it is important that your team of healthcare professionals work together and know what you are pursuing for your care. Talk to your physician or neurologist about the importance of early contact with an RSLP.
What are some self-management strategies for strengthening communication and ensuring safety when swallowing?
Following evaluation by an RSLP, exercises and strategies can be introduced to improve communication and swallowing.
Another option is the Lee Silverman Voice Treatment® (LSVT®), which is an evidenced-based voice therapy for people with PD. It runs 4 times per day for 4 weeks. During the program, regular home voice exercises are established to be maintained after the sessions with the Speech-Language Pathologist are completed. Since this is most often a service offered through private practice, I understand it is not attainable or realistic for most.
We started the Communication & Swallow Workshops to introduce people to voice exercises they can incorporate into their routine at home. This was not intended to take the place of contact with an RSLP. Instead, I do introduce some voice and swallowing exercises that people can start before they see a professional.
In the workshops, I discuss swallowing evaluation, exercises, and strategies. The tricky thing here is that not everything works for everybody, and, in some cases, a strategy that helps one person may cause risk for another. It is very important that people with PD are referred for a comprehensive swallowing evaluation so that we know exactly what to recommend.
How can carepartners help people with Parkinson’s maintain their communication and swallowing abilities?
Carepartners are an important member of the team for support, love, encouragement, and transportation. Sensory proprioception, your brain’s ability to know what your body is doing, is impaired in PD. This means the person with PD doesn’t always have awareness of how they are moving through their day. They may need a reminder to perform exercises and use strategies that have been recommended to improve communication and swallowing. Education about PD is as important for the carepartner as it is for the person with PD. Every member of the healthcare team should be willing to learn about PD and, most importantly, learn from each other.
How do speech-language pathologists treat advancing symptoms of communication and swallowing?
Communication and swallowing problems do not necessarily progress from mild to severe in Parkinson disease. Someone may have mild problems throughout their journey, some may start with more severe problems, or some may see symptoms worsen with disease progression. I always start with exercises and strategies before recommending more significant changes such as changing texture of food and drink, a feeding tube, or using an augmentative communication system, such as a picture or alphabet board, or text-to-talk software. We would really like to be able to avoid such dramatic solutions. This is another reason to support early contact with an RSLP.
What can someone expect from attending a Communication and Swallow Workshop?
Knowledge is power. One of our goals in providing these workshops is to help people with PD and their carepartners understand issues related to communication and swallowing problems with Parkinson’s disease. Historically, only 3-4% of people with PD have pursued evaluation and treatment with an RSLP. These workshops provide us with the ability to educate, and connect people with the support they need to maintain quality of life.
Are there any technological tools people can use for communication and swallowing issues?
The question I get asked the most is about a personal amplifier. I am not a huge fan of this in general for people with PD. This tool only amplifies what you have – it does not make you better. If the only concern is low vocal volume, it might be helpful, but if there are other changes to voice quality, articulation, or rate of speech, the amplifier will simply make all of that louder.
There are a few tools out there that may be helpful. An expiratory muscle strength trainer can help strengthen muscles needed for voice, swallowing, and coughing. A strong cough is important for swallowing safety. The stronger your expiratory muscles, the better. Delayed auditory feedback through a device can also be effective for some people with PD in improving fluency of voice and speech.
As with any new therapy, pursue these tools with the support of an RSLP. Using devices that are not helpful can cause unnecessary frustration and waste valuable time that could be spent utilizing more effective tools, exercises, and strategies.
Any closing words or advice for people with Parkinson’s and their carepartners?
The PD community is one of the most proactive groups of people I have worked with over the years. From researchers to people with PD and carepartners, I consistently witness people pursuing opportunities for improvement and education. Stay positive and take advantage of all that is out there to help you get up and moving every day. Learn and do.
Additional Resources
If you have any questions related to communication and swallowing with Parkinson’s disease, you can reach out to Sherri at the Surrey Voice Clinic.
Surrey Voice Clinic | https://bit.ly/surreyvoiceclinic | sherri@surreyvoiceclinic.com | 778-574-2747
To find a Registered Speech-Language Pathologist in your area, use the following resources:
Speech & Hearing BC | www.speechandhearingbc.ca | 1-877-222-7572
College of Speech & Hearing Professionals | www.cshhpbc.org | 604-568-1568
Lee Silverman Voice Treatment® Global | www.lsvtglobal.com | 1-888-438-5788
This content was published in the Spring 2019 edition of our quarterly magazine, Viewpoints. The content was accurate as of this publication date.