Swallowing therapy is individually prescribed following assessment by a speech pathologist.
Swallowing and chewing difficulties (dysphagia) can significantly impact the lives of people with Parkinson’s and their care partners. An estimated four out of five people with Parkinson’s may experience chewing and swallowing difficulties. The good news is a speech pathologist can help.
Importance of early detection
Swallowing changes may occur as Parkinson’s progresses, so being proactive in preserving swallowing strength and managing symptoms is a great strategy to maintain quality of life.
- Early assessment by a speech pathologist can help identify potential swallowing issues before they become severe, allowing for proactive management.
- Recognise the role of care partners in managing swallowing difficulties. Speech pathologists are great at providing resources and support for care partners which can help them assist effectively and reduce their own stress.
- Address the psychological impact of swallowing difficulties, such as anxiety or depression, and the importance of seeking support from mental health professionals if needed.
- Emphasis should be placed on the importance of a balanced diet and any modifications needed to maintain overall health and manage Parkinson’s symptoms effectively. You can speak to your dietitian about strategies and a diet plan.
- Regular follow-up assessments with your care team to monitor changes in swallowing ability and adjust treatment plans are necessary.
- In case of choking or other swallowing-related emergencies, be sure to have any carers with you learn basic first aid tips and when to seek immediate medical attention.
Tips for safe eating & drinking
There is no single national swallowing “program” for Parkinson’s. Instead, swallowing-specific therapy is individually prescribed following assessment by a speech pathologist. Management may include posture strategies, texture modification, mealtime routines, and exercises tailored to Parkinson’s‑related swallowing changes. These services are delivered across hospital, community, aged care, online and private settings.
Using these tips, you can feel safe and comfortable while eating and reduce the risk of swallowing difficulties:
- See a multidisciplinary care team as mentioned above, and bring your care partner or a friend along so they understand the issues that affect your swallowing.
- Stay hydrated. Dehydration can exacerbate swallowing difficulties and other health issues.
- Be mindful when chewing, eating and swallowing.
- Adjust your seated posture and head position when eating or drinking.
- Take smaller bites, cut food into smaller pieces and eat more slowly.
- Seek dietary advice from an accredited dietitian.
- Make smoothies to incorporate green, leafy vegetables and fruits easily.
- Limit dairy if advised, as it may increase mucous production.
- Perform your prescribed swallowing exercises regularly for best results.
- Set goals with your care team and review them regularly.
- Chew gum or suck on sweets to encourage regular swallowing.
- Ask about medications and surgical treatments that can help with dry mouth and saliva production.
See also Communication & Parkinson’s and Dental Health & Parkinson’s information sheets.
Seeking professional help
If you experience problems with eating or swallowing, consult your GP as soon as possible. They may refer you to specialists who can help, including a speech pathologist, who is best placed to assist you in any swallowing or speech-related issues. They assess swallowing and develop management plans. They examine your lips, tongue, soft palate, and voice box, and observe how you eat, drink, and swallow medication. They can also teach exercises and provide tips for safe chewing and swallowing actions and saliva control techniques. Speech pathologists make recommendations regarding modification of diet and appropriate foods related to safe swallowing. There is not a ‘swallowing’ program, however, several speech therapy programs exist in Australia including the Parkinson Voice Project‘s SPEAK OUT!® and LOUD Crowd® programs. LSVT LOUD® (Lee Silverman Voice Treatment) is an intensive, evidence-based voice therapy focused on increasing vocal loudness and speech clarity. These programs are delivered by certified speech pathologists across Australia and may also help as part of your swallowing treatments.
Other health professionals that would be helpful to consult with about swallowing may include:
- ENT Specialists and Gastroenterologists: Assess and rule out any internal structural problems.
- Dietitians: Can ensure your nutritional and food modification needs are being met.
- Occupational Therapists: Help you find the best way of sitting for meals and recommend suitable cutlery aids and equipment.
- Physiotherapists: Assist with optimal sitting positions for meals and provide chest physiotherapy to clear airways.
- Dentists: Monitor oral health and address any teeth problems arising from these symptoms.
Speech pathology for Parkinson’s can be accessed through:
- Medicare Chronic Disease Management plans
- NDIS (for eligible people under 65)
- Home Care Packages and CHSP
- Private services and telehealth
Early referral improves outcomes for both communication and swallowing.
Health & safety risks
Without help from you care team’s speech pathologist and dietitian, chewing and swallowing difficulties can interfere with your ability to eat a balanced diet and meet your nutritional needs. These issues can also affect the effectiveness of your Parkinson’s medications. Other health and safety risks include:
- Reduced enjoyment of meals, appetite loss, embarrassment, and increased stress and anxiety.
- Weight loss, which is common in Parkinson’s but can be exacerbated by swallowing difficulties.
- Dehydration, affecting kidney, bladder, and bowel functions, skin health, saliva control, energy levels, and general wellbeing.
- Difficulty eating green, leafy vegetables or grains, potentially leading to constipation.
- Aspiration pneumonia or recurring chest infections from food or drinks going down the wrong way into the lungs.
- Choking, while rare, can occur if swallowing problems are not addressed.
Recognising swallowing difficulties
A speech pathologist is a great person to have on your care team. People with Parkinson’s may exhibit slow movements, difficulty initiating movements, and reduced range of movement, which can also affect the muscles of the mouth, tongue and throat. Rapid coordination of movements is needed during swallowing. Symptoms such as mood changes, fatigue, and poor posture can further impact these movements. Eating, drinking, and swallowing are automatic skills, but they may be affected when focusing on other tasks like talking, reading, or watching TV.
Some early warning signs of dysphagia include:
- Wet, gurgling voice after eating or drinking
- Coughing during or after eating or drinking
- Difficulty swallowing medication
- Feeling like food is stuck in the throat
- Difficulty shifting food from mouth to throat
- Ineffective chewing
- Bits of food left in the mouth after meals
- Poor saliva control, dribbling, or drooling
- Coughing up saliva or phlegm
- Difficulty initiating a swallow
- Slow, difficult eating and drinking
- Difficulty breathing during meals
- Throat or chest discomfort during meals
- Recurring chest infections.
I want to be encouraging and say, Learning simple exercises with a speech pathologist makes a HUGE improvement in swallowing, talking, etc.
I speak from personal experience. I personally highly recommend finding a Speech Pathologist who is trained in SPEAK OUT. Four sessions later I have a permanent program and incredible improvement that’s stable. ~Liz Shrimpton
Infosheet kindly reviewed by Speech Pathology Australia
Speech Pathology Australia is the national peak body for the speech pathology profession in Australia. You can locate a speech pathologist by using the ‘Find a Speech Pathologist’ search function on the Speech Pathology Australia website.
References
Arboleda-Montealegre, G. Y., Cano-de-la-Cuerda, R., Fernández-de-Las-Peñas, C., Sanchez-Camarero, C., & Ortega-Santiago, R. (2021). Drooling, swallowing difficulties and health related quality of life in Parkinson’s disease patients. International Journal of Environmental Research and Public Health, 18(15), 8138.
Gandhi, P., & Steele, C. M. (2022). Effectiveness of interventions for dysphagia in Parkinson disease: a systematic review. American Journal of Speech-Language Pathology, 31(1), 463-485.
Kim, J. Y., & Kim, H. (2023). Effects of behavioural swallowing therapy in patients with Parkinson’s disease: A systematic review. International Journal of Speech-Language Pathology, 25(2), 269-280.
Panebianco M, Marchese-Ragona R, Masiero S, Restivo DA. Dysphagia in neurological diseases: a literature review. Neurol Sci. 2020 Nov;41(11):3067-3073. doi: 10.1007/s10072-020-04495-2. Epub 2020 Jun 7. PMID: 32506360; PMCID: PMC7567719.
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