Parkinson's disease is a neurodegenerative disorder caused by degeneration (dysfunction and death) of dopamine-producing nerve cells in the brainstem, which are nerve cells that control the muscles.
This will more often than not impair one or more of the person’s general motor skills, speech, posture and other functions as well as loss of confidence and prestige.
We will attempt to offer practical positive advice based on actual case studies.
Because there are so many levels and types of functions that may have been impaired, it is advisable to read through the various points and then pick up on any that may be relevant in your instance. The information is far from extensive, but rather specific and with patience, can be provided by family and/or care-givers with good results.
Patience and a slow but sure improvement in even the most trivial skills can be very significant, which in turn promotes a sense of confidence and determination by the sufferer to keep up with the challenges.
These unfortunate sufferers were invariably proud and active citizens. They have lost that pride and it is up to all those involved in their welfare to try and restore as much of that past glory as possible.
What are some of the usual physical problems of a Parkinson's sufferer?
- Difficulty in swallowing and eating
- Poor posture whilst seated with chin drooped in to the chest
- A sudden seizure whilst walking and staying rooted to a spot
- Stooped posture and walking with a shuffle
- Arms hanging at sides whilst walking
- Difficulty standing up from a chair
- Unable to write or if able, in very small lettering
- Sallow facial expression
- Minimal activities
- Postural instability and slouching
- Difficulty turning in bed or not able to at all
- Speak very softly
- Cramps in the legs and feet
Drooling or dribbling is a common problem experienced by people with Parkinson’s. There is a delayed transmission of signals from the brain to the skeletal muscles due to diminished dopamine. By doing regular simple facial movements and exercises, this problem can be reduced dramatically.
Drooling does not occur because more saliva is produced but because, without realizing it, the natural tendency to swallow every now and again (even when not eating) is slowed down. This, combined with stooped, poor posture and an inability to close the lips as normal, affects the control of the saliva in and from the mouth.
As a result saliva tends to accumulate in the mouth, and rather than being swallowed it can overflow. Many people have poor lip closure due to their Parkinson’s and a flow of saliva from the mouth will occur if the lips do not seal tightly. There is also a tendency for the head to be bent forwards so that the chin points downwards in to the chest. This will make the drooling worse as swallowing is impaired by the tucked-in chin. Try for yourself. It is very difficult to swallow if your chin is tucked well in to your upper chest.
In some cases, simply improving posture can alleviate the problem.
Try these simple exercises at home in front of the mirror.
The rigidity of Parkinson`s affects the muscles involved in the voluntary and involuntary swallowing processes. This will create a build-up, followed by an overflow and acute embarrassment.
We all swallow more than 500 times a day and usually clear our mouths subconsciously but the rigidity and slowness of movement that people with Parkinson’s experience will reduce this considerably. As a result a pooling of saliva occurs which can cause a soreness and rawness of the skin on the chin; clothes can become stained and many people suffer from a stale breath as a result.
There are risks associated with swallowing problems. Some of these are:
Research has shown that these issues are not always recognized to the person with Parkinson's Disease. This can lead to food entering the airway and flowing into the lungs without any of the usual signs of coughing or choking.
Swallowing and eating problems can have a tremendous impact upon a person’s quality of life at home and on their social life. People with these problems can become anxious about swallowing anything for fear of choking.
Their family and friends may also worry about the person choking and what to do if they do choke. They are anxious about the mess that they make when eating so that all the fun of eating together can disappear.
Many people with swallowing problems will understandably eat less than normal and weight loss will occur. They cannot enjoy eating, feel embarrassed, and become tense and apprehensive which can lead to them experiencing panic or anxiety attacks before mealtimes. Since eating and drinking are such essential parts of life and are so tied in with the socializing aspects of life, they must be given all the help possible with these critical eating problems.
The muscles of the jaw, face and tongue may have been weakened by the Parkinson's, which in turn affects the control a person may have over their bite. Opening and closing lips becomes a difficulty.
After all, try this experiment on yourself – Open your mouth and try to swallow. Not easy, comfortable or even possible. Got the idea? This is what the Parkinson's sufferer has to go through 24/7. The weakened muscles and loss of control of the function of the muscles is the reason.
So it is important to understand that everyone has difficulty swallowing if they cannot close their lips.
If a person cannot chew their food adequately – due to loss of muscle control or poor dentures - it will cause problems. Some particles of food are swallowed easily but some may remain in the mouth. They are unaware that they have more food to swallow and as a result could choke. Food remaining in the mouth can be the cause of many other problems.
Often the tongue bunches up in Parkinson’s disease and this can cause food to be pushed out through or stick behind the teeth instead of passing down to the next stage of the digestive process. Take small mouthfuls!
Parkinson’s may also affect the numerous other muscles that are involved so naturally in the swallowing process. Naturally that is, for a non-sufferer.
It could give the impression that the sufferer has had sufficient. In this case, his unfinished food may be removed and / or he may not have eaten enough.
The length of time taken to eat makes hot tasty food change its taste and appearance, neither of which is appetizing.
Indications that a person may have a swallowing problem include:
- loss of appetite
- weight loss
- inability to clear mouth of food
- food sticking in the throat
- gurgled voice
- coughing when eating or drinking
- choking on food, liquids or saliva
- difficulty in swallowing medication
- pain when swallowing
- discomfort in the chest or throat
- heartburn or reflux
- repeated chest infections.
Following an appropriate assessment to identify the particular problems, treatment may be suggested. This might include:
- making the person with Parkinson’s and their family more aware of their particular swallowing difficulties
- adjustments to the person’s posture when eating or drinking
- exercises to strengthen the lip, tongue and throat muscles
- modifications to the diet to make foods and liquids easier and safer to swallow such as avoiding hard, dry or crumbly foods
- liaising with the medical team to ensure timing of medications allows optimal swallow function at mealtimes
- improving breathing techniques.
Sometimes eating and drinking problems are not to do with the physical aspects of swallowing, but are more to do with the practicalities of eating and drinking. These may include difficulties in getting the food up to the mouth or balancing a cup to drink. Tiredness at mealtimes is also common.
Stretching – Refer to the link “Seated Stretching Exercises” and try to do whatever you are able to achieve as a start. Have patience. Repetitions of the movements a few times a day will get you there.
Posture & Standing – Feet shoulder width apart – Very Important. Do NOT stand with the feet together and DO NOT WALK with the feet close together. THINK TALL & WALK TALL & SIT TALL. Let your care-giver prop you up with some cushions until you are able to sit upright with your head and chin in a relaxed normal position. Remember that no one can swallow if their chin is tucked in to their chest.
Standing from a sitting position – You must lean forward with the upper body to give leverage to the movement. It is impossible to stand up from sitting without leaning forward. You must then learn to squeeze the abdominal muscles – which is like putting a car in to gear – and then stand upright. This is also an excellent exercise for you to practice daily.
Walking – Walking practice on the Spot. Take a step Forward, then a step Backwards, then step to One side then to the other side. Lift the knee as high as possible off the ground for each step. You must keep your feet shoulder width apart at all times – whether sitting, standing or walking. When walking or turning on the spot – lift the knees to take the foot out of the way.
Using a Walker – Walk upright and don’t LEAN on the walker. This adds too much pressure on the handgrips and wheels and acts as a brake on the walker. The walker is there to provide comfort, protection, balance and a feeling of security.
Seated Leg Extension Exercises.
Seated Leg Raise Exercises.
Standing Alternate Leg Lifts.
Hand and Finger exercises using Rubber Ball.
Using a Tissue – Always place tissues either in your shirt pocket or in the sleeve of your shirt, for ease of use. When they are in your trousers, the pocket needs to be pried open before the tissue can be placed in to it or retrieved which is very difficult. You will need to lift your top or whatever and then pry open the trouser pocket before trying to put the tissue in or to remove it.
Saliva – See the information above on “Saliva”. It is very difficult to swallow if and when the head is bent forward and the chin is tucked into the chest. THINK TALL at all times – whether sitting or standing or walking. Try to keep the lips dry by swallowing more frequently. But remember that swallowing is only possible if the lips and teeth are shut closed. If the mouth is open, no one is able to swallow. Inhale frequently through the nose with steady big breaths. Use a large "bib". This will help to collect the saliva and keep the saliva from spoiling the clothing. Use an adjustable book rest when working at your desk or reading and writing. This will allow you to sit more upright, which will make swallowing easier and place less strain on the shoulder/neck areas.
Eating Habits – Take small mouthfuls and chew / masticate the food well before swallowing. Again, use a large "bib".
Sit on the Bed - Turn the upper body and the arms from one side to the other. Then as an advanced movement lie flat on the bed. Slowly move the arms over to one side and if possible turn the upper body as well. Then follow this by moving the arms to the other side with as much of the upper body as possible. This is an advanced exercise. You will need assistance. Do not extend further than is comfortable.
Writing – Try to write as much as possible. Use lined paper so as to write in between the lines with as large letters as possible. At the outset this may be illegible scribble. Don’t be put off. Persevere and you will be surprised how quickly your writing talents will return. Make notes of reminders lest you forget. This is a good habit for everyone. Have writing materials handy.
Please remember that these are not easy movements by any means. So go easy. Don’t force the movement and do not get frustrated.
Practice, Patience, Encouragement and even pictures to register progress are all very important elements to a steady advancement.