Swallowing and Voice Issues Speaker Notes

Speech and Language Pathologist, Matt McKeon visited our group for our January 6 meeting via Zoom. He began his visit with a discussion of how all health professionals, not only speech pathologists, ask people with Parkinson’s to go out of their comfort zone. In doing so, we learn more about ourselves: our insecurities and self-doubts, what holds us back, and what our capabilities are. Learning to ask for help when we need it empowers us to be stronger. 

Matt asks people with Parkinson’s to swallow and eat differently. In addition to individual treatment and therapy, he leads weekly Communication Club practice groups of about five people each post-treatment. He believes all his clients are capable of doing more and better, and pushes them to do so.

Matt asked us to think about how we use our ability to talk every day, who we talk to and what we talk about, in order to recognize the value of talking. Because the strength of our voices plays into our ability to swallow, it is important to keep our voices strong to try and prevent swallowing issues. Physical therapy and occupational therapy are often the paramount therapies that doctors prescribe for Parkinson’s. Matt recommends adding speech therapy to our care repertoire and asking our doctors for a referral if they don’t suggest it. Statistics indicate that 94% of people with Parkinson’s will need speech therapy.

Matt is both a Speech Pathologist and a Voice Therapist. In addition to treating with the LSVT-Loud program, Matt can also treat other voice issues and disorders. Voice issues are not necessarily Parkinson’s-specific. For example, coughing during exercise is a voice issue. He also checks for acid reflex—generally indicated when someone feels something in their throat that they cannot clear (which can result from inflammation of the larynx).

Speech therapy is usually covered by insurance. Medicare should cover as long as you are maintaining function and not getting worse (you do not need to improve) and the treatment must be “medically necessary.” Matt says since speech is necessary to maintain social relationships, it meets the medical necessity requirement. 

Those with the strongest voices tend to have the least problems swallowing. A strong voice ensures strong voice support. There is a difference between a loud and a strong voice. To test your voice strength, take in a big breath and hold a vowel for as long as you can—without discomfort and without the volume or the pitch changing. If you can do this for sixteen seconds, Matt considers that pretty good.

Strengthening the voice makes swallowing issues go away or get better. This is best accomplished by working with a speech pathologist on an individual basis. Matt begins by assessing someone’s ability to cough loud and clear the throat loud in order to develop an individual treatment plan for each of his clients. Matt stressed that being able to cough hard and being able to clear your throat well are essential in preventing swallowing issues. Both require you to take deep breaths and produce strong breathing while doing them. 

How do you know you need speech therapy? Symptoms to look for that could indicate a swallowing disorder (which you may or may not be aware of on your own) or that someone close to you may notice that indicate you need help:

  1. Drooling from your mouth (and down your face).
  2. Coughing during the day in the absence of eating (saliva may be dripping down your throat rather than being swallowed).
  3. Coughing while eating (the vocal folds—the entry to our airways—are very sensitive to something hitting them while we are eating, drinking, and swallowing).
  4. Having a weak and soft voice (vocal cords may not close off the airway when you clear your throat, so it becomes difficult to clear residues of food that do not go down all the way).

Self-help Suggestions:

  1. Take the LSVT-Loud program. Ask your doctor for a referral to a skilled, certified speech therapist.
  2. Keep hydrated throughout the day by drinking lots of water. Being poorly hydrated can make your voice hoarser.
  3. Maintain good oral hygiene. Brush your teeth in the morning and after meals. Good oral hygiene also helps prevent aspiration pneumonia by removing the bacteria from your mouth that could potentially get into your lungs with water.
  4. Practice breathing exercises often, like the ones learned from LSVT-Loud classes. A strong voice is the basis to a good breathing foundation. 

Matt McKeon can be contacted at vocalizemckeon@gmail.com
or 215-292-6674

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