Swallowing Treatment Strategies
• Optimize oral hygiene
• Supervision at mealtimes
• Use less affected side for self-feeding
• Maintain head in a chin-tucked position
• Avoid highly textured, particulate foods
• Blend multiple consistency foods
• Proceed with caution with thin liquids
• Alternate food and liquid swallows
• Provide medications with pureed food
• Use mealtime adaptive devices including cups, plates and utensils to assist with self-feeding
• Consider smaller, more frequent meals to shorten duration of mealtimes
• Ask the neurologist about the role of anticholinergic drugs or botulinum toxin for management of secretions
Speech Problems
• Characterized by hypokinetic and spastic dysarthria, as well as progressive apraxia of speech and oral apraxia
• Progressive nonfluent aphasia may be strongly associated with this diagnosis
• Speech is hesitant and halting, with strained voice and slower speech production
• Initially may have intact written language
• Frontotemporal dementia may be present
• Progresses to anarthria
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Patient Speaking Strategies
• Speech must become a conscious effort
• Use compensatory strategies to enhance intelligibility
• Use short phrases and simpler language because of increased errors with increased rate of speech, number of syllables and complexity of language
• Optimize use of written language
• Use of gestures may be limited by apraxia
• Be alert to“ yes / no” confusion
• Investigate assistive forms of communication such as a communication board or speech generating device to supplement natural speech, depending on patients’ cognitive and motor limitations
• Simple augmentative communication will be required in later stages
Listener Strategies
• Eliminate distractions to reduce background noise
• Face the speaker with CBD
• 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...?”