Swallowing

While there are common signs of difficulty swallowing, it is important to remember that people with PD may not always show (or be aware of) these signs. PD can negatively affect the cough response, a natural reflex that protects the airway during eating, drinking, or swallowing saliva. A speech-language pathologist can conduct an X-ray of your swallowing (i.e., a modified barium swallow study, also called a video fluoroscopic swallow study), or a fiberoptic endoscopic exam of your swallowing. This allows the speech pathologist to examine your throat during swallowing using a flexible tube with a camera on the end to assess swallowing problems.

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Common symptoms of swallowing problems include:

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• Slowness in eating

• A sensation that food is caught in the throat

• Coughing, throat clearing, or choking while eating or drinking

• Difficulty swallowing pills and drooling

• Food sticking in the mouth or difficulty chewing

• A sensation that swallowing takes effort and a feeling of fatigue when eating

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Treatment options include therapies specific to PD, including LSVT BIG Therapy or SPEAK OUT programs.

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Some tips to help improve eating, chewing, and swallowing, includes:

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• Always sit upright (preferably in a chair when eating, drinking, and taking pills. If you are able, sit upright for 30 -60 minutes after eating. Try to sit at a 90-degree angle.

• Tilt your head slightly forward while eating. Keep your chin slightly down or at least parallel to the table. When the chin is raised, there is an increased risk of fluid getting into the lungs.

• Sit with your elbows on the table, which forces your spine, neck, and chin upward

• Chew small amounts of food well and swallow it all before eating more. Intentionally eat slowly.

• Put your fork down between bites to slow yourself down.

• If food feels stuck, swallow multiple times (at least twice) after every bite

• Take small sips when drinking. Take one sip at a time. Do not gulp or tip your head backward when drinking. 

• Be wary of straws. Straws are useful when someone has severe tremors or dyskinesias, but can put too much liquid, too far back into the mouth, too quickly before the airway has a chance to close. Try to keep the straw only at the front of your tongue.

• You can increase saliva production and swallowing frequency by sucking on popsicles, ice chips, lemon ice, or lemon-flavored water.

• Don't talk with your mouth full of food. Minimize distractions during meals.

• Consider eating several small meals during the day.

• Be aware of food sticking in your mouth.

• Choose soft, moist foods and avoid dry or crumbly foods

• Swap thin liquids for thick ones (eat cream soup instead of broth) as thin liquids may make you cough. You can also thicken liquids on your own by adding a liquid thickener. Your speech therapist can recommend one for you.

• Ask your doctor about crushing your pills and mixing them with applesauce or pudding. But DO NOT do this without consulting with your doctor or pharmacist. While this may help with swallowing, crushing pills can alter how the medication works.

• You may be able to take your carbidopa/levodopa in the form of Parcopa, which dissolves in your mouth. Check with your doctor.

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A speech-language pathologist can develop a treatment plan for eating and swallowing challenges that is consistent with your quality-of-life-goals. Diet modifications may include changing the consistency of foods and liquids to make them easier to chew and safer to swallow.

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Sometimes swallowing problems can be limited to taking pills. In some cases, medications can be taken in liquid format or crushed and added to apple sauce, yogurt, or pudding to ease swallowing. Learning how to reinforce your head while eating can also aid in improved swallowing techniques from a therapist.