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Michael Ehlers

Literature for swallowing strengthening

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I am 63 diagnosed with PD 10 years ago. I take 3 Sinemet every 2 hours. Later in the day or when I have a bad 'off' time I start to have issues swallowing.


I do some exercises I've seen in PD articles or web surfing. I stretch the front off the neck muscles by holding my chin in different positions and looking upwards.

I also do exercise in which I stick out my tongue for 10 seconds Out, up, down, left and right.


Can you recommend a book or literature for 'better' exercises if these are wrong or just more.


Thank you

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Without seeing you in person, it is hard for me to determine what exercises are best suited to improve your "swallow issues".  I have not read any studies supporting the movements that you have described for improving swallowing in people with PD.  Changes in swallowing are frequently found in people with PD.  It has been reported that as many as 95% of people with PD have dysphagia (Bird, Woodward, Gibson, Phyland, & Fonda, 1994; Logemann, Blonsky & Boshes, 1975; Potulska, Friedman, Krolicki & Spychala, 2003).  When dysphagia is present it has a negative impact on quality of life by interfering with the ability to take medications, maintain hydration and nutrition, and may result in aspiration pneumonia.  Pneumonia is one of the leading causes of death in PD (Beyer, Herlofson, Arsland, & Larson, 2001; D’Amelio, Ragonese, Morgante, Reggio, Callari, Salemi & Savettieri, 2006).  Even when there are no difficulties with swallowing, mealtimes can be effortful for people with PD possible causing them to fatigue easily and eat less.


Muscle rigidity, weakness and bradykinesia that are present in the limbs can also affect all phases of swallowing (Robbins et al. 1986; Labuszewski & Lidsky, 1979).   In addition, sensorimotor abnormalities may reduce the person’s awareness of symptoms of dysphagia.


Some Symptoms of swallowing disorders called, “dysphagia” may include:

  • Frequent coughing during meals
  • Coughing while drinking liquids or taking pills
  • A wet gurgly sounding voice quality
  • Recent unexplained weight loss
  • Recent diagnosis of pneumonia
  • Difficulty making the food “go down”

Which symptoms are you experiencing?


There are a number of reasons why swallowing can be "difficult" for a person with PD.  The reason you need to get a referral for an evaluation with a speech- language pathologist (SLP) is so that they can identify the unique causes of the swallowing difficulty for you as an individual. The evaluation usually consists of an examination of the muscles for chewing and swallowing and then possibly a modified barium swallow study if the SLP suspects a problem in the pharyngeal stage of the swallow, which is more difficult to observe directly. When the evaluation is done the SLP should be able to describe your swallowing problems, the underlying physiology causing the problems, your risk for aspiration, and treatment strategies that appropriately address the cause of the problems.

Although people with PD share a common etiology there may still be heterogeneity within the population regarding the cause of swallow problems.  There are a number of reasons why swallowing can be "difficult" for a person with PD and it is important for the health care team to understand these issues.  Appropriate treatment techniques to address swallowing disorders in PD need to address the motor and sensory components.  Common treatment approaches for swallowing deficits in PD include:

  • Modifying bolus flow with postures
  • Maneuvers to improve airway protection or airway clearance
  • Alterations in diet consistency
  • Sensory stimulation
  • Exercises to improve swallow function
  • Alterations in feeding environment

I recommend that you get a referral for a swallowing evaluation with a speech-language pathologist to learn what can be done to maximize swallow safety and oral intake in addition to consulting about specific diet recommendations.




Leslie Mahler, PhD, CCC-SLP

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