Drooling is a common—and frustrating—problem for many speech therapy patients.
In this article, you’ll find evidence-based tips for how to assess and treat drooling in Parkinson’s disease.
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How To Assess Drooling in Parkinson’s Disease
As you may not actually observe drooling during a speech therapy assessment—or be aware of how much it impacts the patient’s daily life—consider adding a drooling screen.
Consider also if your patient is a good candidate for the treatment. For example, do they have the appropriate motivation, cognition, motor skills, etc.?
The Radboud Oral Motor Inventory for Parkinson’s disease (ROMP) was developed specifically for Parkinson’s disease. The ROMP is a patient-rated assessment with a ‘Saliva’ subsection. Research has found it to be reliable and valid (Kalf, J. G. et al., 2011).
The ROMP is available for clinicians to use with their patients. You can access it in the Guidelines for Speech-Language Therapy in Parkinson’s Disease (scroll down the document to the Appendix).
The Guidelines were commissioned by the Dutch Association of Logopedics and Phoniatrics, with the English translation funded by the National Parkinson Foundation.
What Causes Drooling in Parkinson’s Disease?
Current research points to decreased swallow frequency and oropharyngeal bradykinesia (slowness of movement) as the cause of excess pooling of saliva in the mouth.
Then, a stooped, open-mouthed posture leads to drooling of this excess saliva.
While helpful, speech therapy treatment for drooling in Parkinson’s disease is limited. Research has shown that speech therapy works to decrease drooling, although only in the short term.
But, that doesn’t mean it can’t make a big difference in your patients’ quality of life, right now!
(Issacson, J. et al., 2020)
How To Treat Drooling in Parkinson’s Disease
Again, assess whether your patient has the cognitive skills, motor skills, motivation, and/or family support for the following interventions to be successful.
1. Cues To Swallow
Cue the patient to swallow frequently.
Speech-language pathologist Alisha Kleindel, MA, CCC-SLP cues her patients to: “Gather your saliva, close your lips tight, and swallow.”
Ideally, they will get this cue every two minutes, mimicking a non-impaired, spontaneous swallowing rate.
Patients can use an app called Swallow Prompt to remind them to do this every few minutes.
You can also cue based on the patient’s specific needs. For instance, if they drool when speaking, cue them to swallow before they speak. If they drool when focusing on a cognitive task or when relaxing, have them set Swallow Prompt before starting the activity.
Patients with Parkinson’s disease may present with a stooped, forward-leaning posture, which can increase drooling.
Show them how to maintain an upright, head-neutral posture.
Refer to physical therapy as appropriate to improve postural stability and strength and/or for a wheelchair assessment (i.e. adding neck support).
3. Chew Gum
A 2010 study found that chewing gum increased swallow frequency and reduced drooling in some patients with Parkinson’s disease (South, A.R. et al).
Again, assess whether your patient can safely manage the bolus before recommending this treatment.
4. Refer to Physician
If these interventions aren’t effective or your patient needs more support, refer to their physician.
There are pharmacological interventions to manage drooling, including Botox, drops, patches, sprays, and other medications. Unfortunately, these can come with significant side effects, depending on the drug.
5. Consider Lip Closure Exercises
A small recent study found that expiratory muscle strength training (EMST) decreased drooling in patients with Parkinson’s disease (Cocks, N. et al. 2022). If your patient struggles to maintain adequate lip closure due to decreased strength and is a good candidate, consider EMST or other strengthening exercises.
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- Cocks, N. et al. (2022). Expiratory Muscle Strength Training for Drooling in Adults with Parkinson’s Disease. Dysphagia, 37(6), 1525–1531. https://doi.org/10.1007/s00455-022-10408-6
- 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
- Kalf, J. G. et al. (2011). Reproducibility and validity of patient-rated assessment of speech, swallowing, and saliva control in Parkinson’s disease. Archives of physical medicine and rehabilitation, 92(7), 1152–1158. https://doi.org/10.1016/j.apmr.2011.02.011
- Isaacson, J. et al. (2020). Sialorrhea in Parkinson’s Disease. Toxins, 12(11), 691. https://doi.org/10.3390/toxins12110691
- Nascimento, D. et al. (2021). Drooling rating scales in Parkinson’s disease: A systematic review. Parkinsonism & Related Disorders, 91, 173-180. https://doi.org/10.1016/j.parkreldis.2021.09.012
- South, A. R. et al. (2010). Gum chewing improves swallow frequency and latency in Parkinson patients: a preliminary study. Neurology, 74(15), 1198–1202. https://doi.org/10.1212/WNL.0b013e3181d9002b
- Varley, L. P. et al. (2019). A systematic review of noninvasive and invasive sialorrhoea management. Journal of clinical nursing, 28(23-24), 4190–4206. https://doi.org/10.1111/jocn.15009