Swallowing Treatment Strategies
• Optimize oral hygiene
• Supervise mealtimes
• Offer moist, soft, tender and well-lubricated foods; avoid dry, particulate, textured foods
• Keep the plate in the line of vision
• Maintain head in a chin-tucked position
• Restrict liquid and food bolus volumes
• Make sure food is swallowed before taking more
• Put cup and utensils down between bites and sips
• Look for mealtime adaptive devices including cups, plates and utensils to assist with self-feeding
• Give medications with a pureed food
• Ask the neurologist about anticholinergic drugs or botulinum toxin for management of secretions
Speech Problems Mixed dysarthria, typically including hypokinetic and spastic dysarthria; ataxic features are less common
• Strained voice, impaired speech fluency with slow rate of speech and palilalia( the compulsive repetition of utterances in context of increasing rate and decreasing loudness), and emotional lability
• Language and cognitive deficits including frontotemporal dementia and progressive nonfluent aphasia have been observed and can interfere with therapy efforts
• Progresses to anarthria
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Speaking Strategies Speaking must become a conscious effort and to enhance intelligibility, patients must use compensatory strategies including:
• Breathing first and speaking loudly and slowly
• Keep sentences short
• Repeat entire sentence when necessary instead of isolated words
• Say one sentence at a time without immediate repetition
• Establish the context
• Use gestures
• LSVT techniques emphasizing increased phonatory effort may be of benefit but difficult to habituate
• Investigate assistive forms of communication such as a communication board or speech-generating device to supplement natural speech, depending on an individual’ s visual, cognitive and motor limitations
• Simple augmentative communication will be required in later stages
• Consider personal portable amplifiers
Listener Strategies
• Keep comments and questions brief
• Stick with familiar topics, and one topic at a time
• Use“ yes / no” question format
• Ask for clarification,“ Did you say...?”
• Provide choices to ease decision making