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#1 Kazie

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Posted 25 June 2011 - 09:15 PM

Does anyone else have the problem with their patient drooling. This is a very big problem for us. Is there any medication that will help other than surgery to remove saliva glands?

Thanks, Kazie

#2 Dr. Mahler

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Posted 14 July 2011 - 02:33 PM

Kazie,

Drooling has long been discussed in the literature for people with PD. One reason drooling is problem is because people with PD tend to swallow less frequently than people without PD. Another reason is because the muscles of swallowing are weak and limited in movement as a result of the PD so the swallow becomes less efficient. Saliva is good for eating and swallowing. My recommendation is to start an intensive oral motor exercise program to improve swallow function. That could help solve the drooling problem particularly during the day. At night, you may need to cover the pillow with a towel. A speech-language pathologist experienced in treating people with PD should be able to help you with an evaluation that determines what exercise program is best for this individual with a drooling problem. The earlier the exercises are started the better the potential for improvement and to maintain safe swallowing.

Thank you for writing.

Sincerely,

Leslie Mahler, PhD, CCC-SLP
Leslie Mahler, PhD, CCC-SLP

Associate Professor

University of Rhode Island

#3 Dr. Bassich

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Posted 14 July 2011 - 03:37 PM

I agree with Dr Mahler's advice, put wish to add some other suggestions:

1 - Some persons with excessive drooling find relief with botox injections into the salivary glands. This provides short-term relief (3-6 months) and most be done by a physician who is experienced and knows the important sites in the neck to target these glands.
2 - Anticholingeric meds have a side effect of 'dry mouth.' You might consult with your neurologist to see if you are a candidate for an anticholinergic drug.
3 - Automatic behaviors such as blinking your eyes or swallowing become diminshed in persons with PD. You can ask those around you to remind you to swallow. Some people wear a device that beeps at regular intervals to remind them to swallow.
4 - Raising the head of your bed or using extra pillows to prop your head up while sleeping can also help.
5 - Papaya juice decreases the thickness of saliva. So if you feel you saliva is thick, you might want to see if drinking papaya juice helps.

Hope these suggestions are helpful tips.

Celia J. Bassich, PhD, CCC-SLP
Faculty Member, NPF, Allied Team Training for PD

#4 Rachael Kilmer

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Posted 23 October 2011 - 10:54 PM

Dr. Mahler,
I'm a SLP student and I'm doing a mock therapy session on swallowing. My question for you is what "intensive oral motor exercises" should be used? I'm just trying to find out a little more about what types of therapy should be done with dysphagia in PD patients. The ones I'm planning to use are all more pharyngeal and I'm not sure if I should include more? I have "Effortful swallow", tongue exercises like using words with /k/ and /g/, the supraglottic swallow, and the Mendlesohn maneuver. What is typically used?

Thanks and I appreciate any help you can give,
Rachael Kilmer


Kazie,

Drooling has long been discussed in the literature for people with PD. One reason drooling is problem is because people with PD tend to swallow less frequently than people without PD. Another reason is because the muscles of swallowing are weak and limited in movement as a result of the PD so the swallow becomes less efficient. Saliva is good for eating and swallowing. My recommendation is to start an intensive oral motor exercise program to improve swallow function. That could help solve the drooling problem particularly during the day. At night, you may need to cover the pillow with a towel. A speech-language pathologist experienced in treating people with PD should be able to help you with an evaluation that determines what exercise program is best for this individual with a drooling problem. The earlier the exercises are started the better the potential for improvement and to maintain safe swallowing.

Thank you for writing.

Sincerely,

Leslie Mahler, PhD, CCC-SLP



#5 Dr. Bassich

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Posted 25 October 2011 - 10:14 AM

I agree with Dr Mahler's advice, put wish to add some other suggestions:

1 - Some persons with excessive drooling find relief with botox injections into the salivary glands. This provides short-term relief (3-6 months) and most be done by a physician who is experienced and knows the important sites in the neck to target these glands.
2 - Anticholingeric meds have a side effect of 'dry mouth.' You might consult with your neurologist to see if you are a candidate for an anticholinergic drug.
3 - Automatic behaviors such as blinking your eyes or swallowing become diminshed in persons with PD. You can ask those around you to remind you to swallow. Some people wear a device that beeps at regular intervals to remind them to swallow.
4 - Raising the head of your bed or using extra pillows to prop your head up while sleeping can also help.
5 - Papaya juice decreases the thickness of saliva. So if you feel you saliva is thick, you might want to see if drinking papaya juice helps.

Hope these suggestions are helpful tips.

Celia J. Bassich, PhD, CCC-SLP
Faculty Member, NPF, Allied Team Training for PD



#6 Dr. Bassich

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Posted 25 October 2011 - 10:21 AM

Dear Rachal,
Your list of exercises is great! However, I would add more tongue base exercises, designed to improve tongue base ROM. Some are describe in Dr Logemann's text 'Evaluation and Treatment of Swallowing Disorders' 2nd Ed 1998, p. 210:

1 - Pt can be asked to pull the tongue straight back in the mouth as far as possible and to hold it for 1 sec.
2 - Pt should pull back and pretend to gargle as hard as possible and then release.
3 - Pretend to yawn, which also pulls the tongue base back.

I find that the super-supraglottic swallow is too difficult for most persons with PD.

Hope you find these suggestions helpful.

Dr. Celia Bassich
Faculty, Allied Team Training for PD, NPF

Edited by Dr. Bassich, 25 October 2011 - 10:22 AM.
typos


#7 Dr. Mahler

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Posted 29 November 2011 - 01:41 PM

Rachel,

This is a good question. There has been research done about what elements of exercise need to be included to actually improve swallow function. Joanne Robbins and her colleagues have published about this. They have found that incorporating principles of motor learning is a key element in treatment. This means having the person exercise at 60-75% of their maximal effort. This can be measured using a pressure transducer such as the Iowa Oral Pressure Instrument (IOPI). Lip exercises should also include intensity of practice or high repetitions of the target exercise. The effortful swallow could be effective at bolus clearance with the potential to also strengthen muscles of swallowing. There is also preliminary evidence in a study by El Sharkawi et al. that swallowing improves following LSVT. However, I would not consider LSVT a swallow treatment. The goal of LSVT is to improve speech and understandability for people with PD.

I hope this helps. Please write again if you have further questions.

Leslie Mahler, PhD, CCC-SLP


Dr. Mahler,
I'm a SLP student and I'm doing a mock therapy session on swallowing. My question for you is what "intensive oral motor exercises" should be used? I'm just trying to find out a little more about what types of therapy should be done with dysphagia in PD patients. The ones I'm planning to use are all more pharyngeal and I'm not sure if I should include more? I have "Effortful swallow", tongue exercises like using words with /k/ and /g/, the supraglottic swallow, and the Mendlesohn maneuver. What is typically used?

Thanks and I appreciate any help you can give,
Rachael Kilmer


Leslie Mahler, PhD, CCC-SLP

Associate Professor

University of Rhode Island




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