In this article, you’ll find Parkinson’s disease dysphagia treatment ideas for your speech therapy patients. They’re based on recent evidence and include lists that you’re free to copy and paste to make your own patient handouts.
Looking to save time and stress in your practice? Check out the bestselling Adult Speech Therapy Starter Pack for premade patient handouts, worksheets, treatment guides, and much more.
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Dysphagia & Parkinson’s Disease
Dysphagia can be present in any stage of Parkinson’s disease. When assessing and making a plan of care for these patients, consider factors unique to this disease. These include:
- Lack of awareness and underreporting of swallowing issues
- Upper extremity weakness and tremor
- Gastrointestinal issues (leading to decreased appetite, constipation)
- Difficulty with multitasking
Read Speech Therapy Assessments for Parkinson’s Disease for a step-by-step guide.
Parkinson’s Disease Dysphagia Treatments
1. Swallowing Education
Educate patients and their caregivers to help them understand the difference between a normal and abnormal swallow. Use visuals (anatomical drawings) and videos to support their learning. Point out the structures involved and how and when they move.
See the Adult Speech Therapy Starter Pack for visuals to use during patient education.
2. Oral Hygiene
Encourage good oral hygiene to decrease the risk of aspiration pneumonia.
Oral hygiene tips:
- Use a clean toothbrush with soft bristles and toothpaste
- Brush your teeth and tongue once in the morning and once in the evening (some patients may need to brush more often)
- Perform oral care before eating or drinking to avoid bacteria entering the airway.
- Remove dentures to properly clean gums and palate. Properly clean dentures.
- Floss before you go to bed
- Use alcohol-free and sugar-free mouthwash, if you choose to use mouthwash
- Visit the dentist for a cleaning & check-up every 6 months
- Treat xerostomia (dry mouth) by sipping water throughout the day. Consider a mouthwash to reduce bacteria.
- For patients who are NPO, lean forward over the sink/basin to catch oral secretions.
- Avoid alcohol, caffeine, and sugary drinks
3. Compensatory Strategies
Recommend compensatory strategies based on each patient’s swallowing assessment results, goals, and preferences.
Compensatory strategies for dysphagia and Parkinson’s disease may include:
- Sit upright during and for 30 minutes after eating or drinking
- Small bites and sips
- Pacing (to slow down the rate of bites and sips)
- Sips between bites to clear residue
- Softer foods (less chewing, less bolus management)
- Chin-down posture maneuver (“put your chin to your chest”)
- Increased sensory input
- Add flavors (add honey, add salt, alternate sweet and salty while adhering to any dietary restrictions)
- Add temperatures (colder liquids, chilled pudding, alternate hot and cold)
- Add carbonation
(Kalf et al, 2011; Mansolillo, n.d.; Winiker and Kertscher 2023)
Expiratory muscle strength training (EMST) uses a handheld device to strengthen the swallowing and breathing muscles. A patient blows into the device until they generate enough pressure to open a one-way value.
There’s robust evidence supporting EMST as an effective Parkinson’s disease dysphagia treatment. Benefits include improved swallowing safety, expiratory pressure, cough, and hyolaryngeal function (Troche 2010, Winiker and Kertscher 2023).
You can learn more about Respiratory Muscle Strength Training (RMST) via online training programs.
5. Targeted Exercises
Evidence shows that targeted exercises can improve swallowing in patients who have Parkinson’s disease.
Promising exercises include:
- Effortful swallow
- Lingual range of motion & strengthening exercises
- Tongue press (against anterior hard palate)
- Tongue press using an IOPI device
- Lingual range of motion exercises (tongue out, tongue rolled back)
- Other lingual exercises
- A combination of swallowing & phonatory exercises
- Sustained phonation
- Laryngeal range of motion
- Posterior tongue to soft palate
- Swallow with anterior tongue sticking out
(Wang et al. 2018; Plaza et al. 2022; Argola et al. 2013; Winiker & Kertsche, 2023)
6. LSVT LOUD
While primarily a voice treatment, Lee Silverman Voice Treatment (LSVT) is also an evidence-based dysphagia treatment for patients who have Parkinson’s disease.
LSVT has been shown to improve dysphagia symptoms and increase coughing effectiveness.
Other voice-loading therapies, including VCST and ParkinSong, have shown improvements in some dysphagia measures.
Read LSVT LOUD vs SPEAK OUT! vs PLVT to learn more about voice-loading therapies.
7. Thickened Liquids
Research suggests that thickening liquids may improve swallow safety and reduce the incidence of aspiration in some patients who have Parkinson’s disease.
However, thickened liquids also increased tongue pumps and oral transit times in these patients. In addition, it’s important to be aware of the increased risk of dehydration and urinary tract infections for patients on thickened liquids (Winiker & Kertsche, 2023; Mansolillo, n.d.)
8. Electrical stimulation
While mixed, recent research suggests that electrical stimulation can improve dysphagia symptoms in patients who have Parkinson’s disease (Miller et al, 2022).
For example, a 2018 randomized controlled trial found that neuromuscular electrical stimulation (NMES) combined with effortful swallow increased hyoid bone movement and reduced aspiration in this population (Park et al, 2018).
Read NMES for Adult Speech Therapy to learn more.
9. Refer Out!
While you have many tools in your dysphagia toolkit, there’s only so much one person (or even one discipline!) can do.
- Dietician (adequate nutrition and hydration, unintentional weight loss)
- Occupational therapy (upper extremity weakness and tremors, difficulty using utensils)
- Physical therapy (improved posture for safe eating and drinking)
- Neurology (increased symptoms, apparent change in the effectiveness of carbidopa-levodopa)
- Argolo, N., et al. (2013). Do swallowing exercises improve swallowing dynamic and quality of life in Parkinson’s disease?. NeuroRehabilitation, 32(4), 949–955. https://doi.org/10.3233/NRE-130918
- Ayres, A., et al. (2017). Benefit from the Chin-Down Maneuver in the Swallowing Performance and Self-Perception of Parkinson’s Disease Patients. Parkinson’s Disease, 2017. https://doi.org/10.1155/2017/7460343
- Kalf, J. G. et al. (2011). Guidelines for Speech-Language Therapy in Parkinson’s Disease. ParkinsonNet. Retrieved September 6, 2023, from https://www.parkinsonnet.nl/app/uploads/sites/3/2019/11/dutch_slp_guidelines-final.pdf
- Mansolillo, A. (n.d.) The Essentials: Dysphagia and Parkinson’s Disease. Medbridge. https://www.medbridge.com/courses/details/essentials-dysphagia-parkinsons-disease-angela-mansolillo
- Miller, S. et al. (2022). Review of the effectiveness of neuromuscular electrical stimulation in the treatment of dysphagia – an update. German medical science : GMS e-journal, 20, Doc08. https://doi.org/10.3205/000310
- Park, J. S. et al. (2018). Effects of neuromuscular electrical stimulation in patients with Parkinson’s disease and dysphagia: A randomized, single-blind, placebo-controlled trial. NeuroRehabilitation, 42(4), 457–463. https://doi.org/10.3233/NRE-172306
- Plaza, E., et al. (2022). Effects of a tongue training program in Parkinson’s disease: Analysis of electrical activity and strength of suprahyoid muscles. Journal of Electromyography and Kinesiology, 63, 102642. https://doi.org/10.1016/j.jelekin.2022.102642
- Saleem, S. et al. (2023) A systematic review of behavioural therapies for improving swallow and cough function in Parkinson’s disease, International Journal of Speech-Language Pathology, DOI: 10.1080/17549507.2023.2215488
- Troche, M. S., et al. (2010). Aspiration and swallowing in Parkinson disease and rehabilitation with EMST A randomized trial. Neurology, 75(21). https://doi.org/10.1212/WNL.0b013e3181fef115
- Wang, C., et al. (2018). Home-Based Orolingual Exercise Improves the Coordination of Swallowing and Respiration in Early Parkinson Disease: A Quasi-Experimental Before-and-After Exercise Program Study. Frontiers in Neurology, 9, 382976. https://doi.org/10.3389/fneur.2018.00624
- Winiker, K., & Kertscher, B. (2023). Behavioural interventions for swallowing in subjects with Parkinson’s disease: A mixed methods systematic review. International Journal of Language & Communication Disorders, 58(4), 1375-1404. https://doi.org/10.1111/1460-6984.12865