Many people with PSP report double vision, which can look like two images of one object or the images may overlap. This can be an early symptom of PSP.
People with PSP can experience abnormal eyelid movement. One such problem is called blepharospasm, which can take the form either of forceful involuntary closing of the eyes for a few seconds or minutes at a time, or of difficulty opening the eyes, even though the lids seem to be relaxed. The person may try to use the muscles of the forehead, or even the fingers, in an effort to open the eyelids(“ apraxia of lid opening”). Others may have trouble closing the eyes and blink very little. While about 15 to 25 blinks per minute are normal, people with PSP blink, on average, only about three or four times per minute. This can allow the eyes to become dry. Dry eyes can lead to blurred vision, production of extra tears, or a sensitivity to light called photophobia.
Not everyone with PSP gets all of these visual symptoms. Symptoms vary from person to person and in severity. If you experience changes to your vision, especially if they interfere with your daily functioning and quality of life, you can be assessed by a neuro-ophthalmologist. There may be treatment options and management techniques that can help, depending on the nature and severity of the vision symptoms, such as artificial tears for dry eyes, prism glasses or prism stickers for double vision, and Botox injections or eyelid crutches for forced eyelid closure. Occupational therapists can also provide recommendations for adaptations related to vision that can make daily life easier and the home environment safer.
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How does PSP impact speech? The same general area of the brain that controls eye movement also controls movements of the mouth, tongue, and throat, and these movements also weaken in PSP. In Parkinson’ s disease, the primary speech problem is characterized by soft volume. While this can occur in PSP, PSP can also cause the speech to have an irregular, explosive, or rubber band quality( called spastic speech) or a slurred, drunken quality( ataxic speech). These changes to speech and voice can be coupled with difficulty getting out thoughts or finding words, making communication quite challenging for many people with PSP. It can be helpful to work with a speech-language pathologist, especially one who is specialized in Parkinson’ s disease and related disorders, to learn exercises and compensatory strategies to help people with PSP continue to communicate as much as possible.
Does PSP cause difficulty with swallowing? Unfortunately, swallowing problems are common with PSP and are a leading cause of complications. PSP can cause weakness and incoordination of throat muscles, making it more difficult to swallow. This issue increases the risk of food or liquids going into the lungs, which is called aspiration, and can lead to pneumonia.
Changes to swallowing function, which can occur early in PSP, may include coughing on thin liquids or more particulate foods, such as salads or dry cereal. Other signs of swallowing dysfunction can include the sensation of food being caught in the throat, frequent runny nose, watery-sounding voice, occurrences of choking, and recurrent lung infections. Additionally, sometimes people with PSP can eat more impulsively, including large bites or very quickly, which can increase risk with swallowing.
Your doctor may recommend regular examinations of your swallowing function to make sure food and liquid are going down the right way. Additionally, speech-language pathologists can help assess swallowing function as well as provide recommendations for diet and lifestyle modifications and exercises for the throat in order to make swallowing easier and safer.