Most birds drink some water every day, but they don’t drink the way we humans do. Their anatomy is obviously quite different from ours, and that includes not having cheeks and lips.
With a few exceptions, birds lack the ability to suction liquid into their throats, instead, most birds drink water by filling their bill with the liquid—often from morning dew on leaves—then tilting their head back, using gravity to send the liquid into their digestive tract. (Source: Bird Watcher’s Digest)
Unlike our bird friends, tilting our head back when swallowing is considered an unsafe posture and may mis-direct the liquid into our airway. So, unlike birds, we prepare to swallow using our cheeks, lips, and tongue to control and propel the liquid into our throat safely and efficiently. Tongue, lips, and cheek movements are closely related, and work synergistically in the oral stage of swallowing and apply appropriate pressure forces to the food or liquid we swallow.
Loss of strength and/or normal movement of the oral musculature because of a stroke, surgery, or a neurodegenerative disease like Parkinson’s can make chewing and swallowing not only difficult but even perilous if food or liquid is constantly falling into the airway (aspiration).
But even healthy older people may have age related changes to the swallowing musculature, referred to as presbyphagia, and these age-related changes can also impact the safety and efficiency of chewing and swallowing. Loss of muscle mass, sarcopenia, which alters strength of the skeletal muscles can also change the way the oral musculature functions. Dysphagia (swallowing) researchers are increasingly investigating not only the effect of muscle weakness on swallowing function, but also the effect of strength training exercises for the oral musculature and their impact on improving swallowing function and efficiency.
Low skeletal muscle mass and/or low muscle strength (e.g., handgrip) is an easy measure used by physicians and physical therapists and when combined with walking speed measures may help identify patients at risk for sarcopenia, falls, and other health-related symptoms.
Speech-language pathologist use instrumentation to visualize swallowing physiology (e.g., Modified Barium Swallow Study/MBS or Fiberoptic Endoscopic Evaluation Swallowing/FEES), and they may also incorporate instrumentation and biofeedback tools to assess and strengthen the muscles involved in the oral-pharyngeal phase of swallowing. Based on clinical and instrumental findings you may be prescribed tongue, lip, or jaw strengthening exercise as a part of your dysphagia treatment.
(Baby bird image courtesy of: aylmer, gatineau, qc, canada on Unsplash)
Do You Have a Swallowing Problem?
Would you be surprised to know that many people with Parkinson’s disease under-report swallowing problems? This may be because they fail to recognize dysphagia symptoms which can include coughing when eating or drinking, drooling, or a wet sounding voice. Sensory changes in the swallowing mechanism, may also reduce awareness of a swallowing problem, and silent aspiration (food or liquid falling into the upper airway without a cough response) may only be identified when observed on an instrumental exam.
The incidence of swallowing dysfunction in PD has been reported to be 80% and up to 90 to 100% of individuals with advanced disease stages of PD develop swallowing dysfunction, and yet, dysphagia is often overlooked until swallowing difficulties reach an advanced phase.
If you drool, it’s important for you to know that 86% of people with drooling have oral-pharyngeal dysphagia and day- time drooling is associated with silent aspiration. (Nóbrega A C, Rodrigues B & Melo A 2008). Botulinum injections can be an effective way to reduce severe drooling, but have no known affect on improving swallowing physiology which over time may worsen.
If you have a Parkinson’s diagnosis and suspect you may have a swallowing problem, request a referral to a speech-language pathologist.
Let’s Talk About Swallowing September 20, 2021 3-4pm ET Movers and Shakers PD Support Group sponsored by Neuro Challenge
If you would like to learn more about Parkinson’s related dysphagia, join me and my colleague, Debra Tarakofsky for an hour- long discussion about swallowing and Parkinson’s. Debra is an Adjunct Instructor with Nova Southeastern University and Owner of Swallowing Diagnostics a mobile company which has been conducting instrumental swallowing assessments throughout south Florida for 20 years. Debra will discuss and demonstrate through video presentations, the physiology of a normal swallowing and Parkinson’s associated dysphagia.
I will discuss some of the treatment options available, including strength training devices and swallowing exercises. There will be time for your questions, and an opportunity to submit questions in advance of the presentation. To register for the program on September 20, 2021, click the link below:
My Mission: To enlist individuals in their treatment, and help them express their personality & spirit through voice. To educate and empower. Mary Spremulli, MA, CCC-SLP * FiTOUR® Group Exercise Instructor * Voice Aerobics® A Whole Body Approach to Voice Practice
Voice Aerobics the heART and Science of Voice Practice