Posted 05 September 2013 - 01:28 AM
Posted 09 September 2013 - 07:59 AM
It sounds like your father is facing several challenges. I will address those that I can as a speech-language pathologist. For other concerns you should also consult with a physician. I cannot comment on blood pressure but I do have experience with drooling issues associated with PD. I agree with your impressions from the research that excessive salive is mostly attributable to decreased swallow ability. The primary strategy that I use for my patients with this problem is an intensive exercise based approach. Chin down posture helps some individuals but without seeing your father in person it is not possible to comment about whether it would help him. If your father has pneumonia for the second time in in two months then this is a serious issue. You should ask the neurologist prescribing the medications whether the thickening agent interferes with the absorbency of PD medications specifically. If liquids need to be thickened for safety of the swallow then ALL liquids need to be thickened. Water can be one of the most challenging consistencies because it can go "down the wrong way" before the person with PD begins to control the bolus. Even if the speech therapists on island don't know PD, they may know swallowing. It is important to have a swallowing evaluation that includes a modified barium swallow study to determine swallow safety and prevent your father from losing any more weight.
University of Rhode Island
Posted 09 September 2013 - 03:01 PM
Posted 24 September 2013 - 01:14 AM
Hi, I took my father to do the swallowing evaluation like you suggested, but unfortunately it was a waste of time. She did not do a barium study. All she had him do was drink water and eat some apple sauce, and almost everything she told me contradicted everything I have ever read about how to treat dysphasia which was extremely disconcerting. She said that there was nothing we could do to prevent aspiration. She was not in favor of using thickeners, and she told us he should eat with his head up. Now I am going to have a difficult time convincing my family why they should not listen to her. I wanted to ask you one more question. I bought a soft, cervical collar for my dad, because I read that this can help him keep his head up and help with his drooling and maybe even his breathing. Do you think the cervical collar will actually help him?
Posted 03 October 2013 - 03:13 PM
I'm sorry you did not get the information you were seeking or that the results were not explained in a way that was understandable. This might be a case where you need a second opinion from someone who works with people who have Parkinson disease regularly. Without seeing your father in person, I cannot comment on the benefits of a cervical collar. My experience is that patients need to do more to actively control the swallow to swallow safely. The specific swallow recommendations that are appropriate for your father are as unique to each individual so I can't tell you what they should be without evaluating him myself. While I can't give you specific swallowing recommendations, I can tell you that frequent oral care is essential. This will cut down on the bacterial levels in the mouth and can reduce the risk of an infection developing if material is being aspirated. Frequent means mornings, evenings, and before and after each meal. Other general safe swallow strategies include:
-Sitting upright with the hips flexed at 90 degrees for all meals and when taking medications
-Remain sitting for 30-45 minutes after a meal to allow gravity to aid in digestion
-Eat more frequent smaller meals so as not to tax the swallowing muscles by eating after they are tired
-Swallow twice for each food or liquid presentation and swallow HARD/WITH EFFORT
I wish you the best in getting your questions answered.
University of Rhode Island
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