MANAGING SYMPTOMS( continued)
Swallowing Adapting to Swallowing Problems
Progressive supranuclear palsy( PSP), corticobasal degeneration( CBD), and multiple system atrophy( MSA) are progressive neurodegenerative diseases dominated by motor symptoms. Changes in swallowing and communication are hallmarks of PSP, CBD, and MSA. These changes often occur early in the disease progression, which may help to distinguish them from Parkinson’ s disease. The intent of this section is to serve as a guide, providing information and strategies to enhance swallowing and communication abilities specific to PSP, CBD, and MSA. Management of swallowing and speech problems requires changing intervention strategies as the disease progresses. Consultations with your physician and speech pathologist are recommended to tailor a program to your specific needs.
PSP, CBD, and MSA are neurodegenerative disorders that develop swallowing difficulties. The primary causes of death are infection and pulmonary complications in the setting of immobility, feeding dependence, and swallowing difficulties. It is important that aggressive efforts are pursued to evaluate and manage these symptoms in an attempt to minimize complications such as malnutrition, dehydration, and aspiration pneumonia. A plan should be developed that will be useful through all stages, including late stages of the disease.
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Why should I be concerned about swallowing?
Self-feeding and swallowing problems are very common in PSP, CBD, and MSA. Dysphagia is the medical term for disordered swallowing. Dysphagia can lead to aspiration, meaning food, liquids, saliva, or stomach contents go down the wrong way into the trachea and toward the lungs instead of toward the stomach. This can lead to the development of aspiration pneumonia, an infection that develops in the lungs. Management of swallowing difficulties should promote swallowing safely and easily, along with maintaining adequate intake of fluids and calories.
There are many reasons for self-feeding and swallowing difficulties in PSP, CBD, and MSA. In PSP, there is impairment of self-feeding, including bilateral supranuclear gaze palsy resulting in difficulty looking down. This limits the ability to see the plate during meals. Behavioral changes such as disinhibition can cause rapid drinking or mouth-stuffing. Stiffness can also occur, which interferes with self-feeding. The control and timing of the swallowing mechanism may be affected by an extended head and neck posture, which alters the proportional relations of the mouth and throat. The swallow mechanism may also be affected by cognitive changes or by lack of awareness of deficits. Cough ability may also be impaired across diagnoses.
Slow and incomplete chewing as well as swallowing apraxia are observed in CBD. Apraxia is the inability to perform purposeful movements, so that foods are held in the mouth and not swallowed. Apraxia can also affect the hands and interfere with the ability to manipulate the plate and utensils.
In MSA, there may be difficulty sitting upright at mealtimes and a tendency toward holding foods or liquids in the mouth.
What is normal swallowing?
To manage swallowing difficulties, it is helpful to understand some of the basics of the normal swallowing mechanism. Swallowing is a complex sequence of events that occurs in three phases: the oral, pharyngeal, and esophageal phases. The oral phase involves the placement and manipulation of food or liquid in the mouth and moving it from the front to the back of the mouth. The pharyngeal phase is more automatic and