I am fascinated by swallowing dirty jokes aside it’s really quite amazing
jokes aside it’s really quite amazing
jokes aside it’s really quite amazing how he can perform such a complex task
how he can perform such a complex task
how he can perform such a complex task with such little thoughts to move a
with such little thoughts to move a
with such little thoughts to move a piece of watermelon the 15 centimeters
piece of watermelon the 15 centimeters
piece of watermelon the 15 centimeters or so from our lips to our esophagus
or so from our lips to our esophagus
or so from our lips to our esophagus we need to precisely coordinate the
we need to precisely coordinate the
we need to precisely coordinate the contraction of 31 pairs of muscles with
contraction of 31 pairs of muscles with
contraction of 31 pairs of muscles with sensory and motor information traveling
sensory and motor information traveling
sensory and motor information traveling along six of the 12 cranial nerves after
along six of the 12 cranial nerves after
along six of the 12 cranial nerves after biting manipulating and chewing we’ve
biting manipulating and chewing we’ve
biting manipulating and chewing we’ve propelled the watermelon to the back of
propelled the watermelon to the back of
propelled the watermelon to the back of the mouth using the tongue we close off
the mouth using the tongue we close off
the mouth using the tongue we close off the nasal cavity
the nasal cavity
the nasal cavity don’t want any watermelon juice getting
don’t want any watermelon juice getting
don’t want any watermelon juice getting up the nose we valve off the opening to
up the nose we valve off the opening to
up the nose we valve off the opening to the airway release the sphincter at the
the airway release the sphincter at the
the airway release the sphincter at the top of the esophagus and drive the
top of the esophagus and drive the
top of the esophagus and drive the watermelon down the throat using the
watermelon down the throat using the
watermelon down the throat using the squeeze from the back of the tongue
squeeze from the back of the tongue
squeeze from the back of the tongue against the throat walls and all that
against the throat walls and all that
against the throat walls and all that happens in 800 milliseconds while we’re
happens in 800 milliseconds while we’re
happens in 800 milliseconds while we’re trying to remember when the firework
trying to remember when the firework
trying to remember when the firework starts swallowing is one of those
starts swallowing is one of those
starts swallowing is one of those critical life functions requiring urgent
critical life functions requiring urgent
critical life functions requiring urgent medical care if something goes wrong
medical care if something goes wrong
medical care if something goes wrong it’s one of the few motor acts that we
it’s one of the few motor acts that we
it’s one of the few motor acts that we need to be able to be able to perform at
need to be able to be able to perform at
need to be able to be able to perform at birth
birth
birth on day one in order to survive and we
on day one in order to survive and we
on day one in order to survive and we actually practice swallowing a wall in
actually practice swallowing a wall in
actually practice swallowing a wall in the womb if at any point in our lifetime
the womb if at any point in our lifetime
the womb if at any point in our lifetime something goes wrong with our swallowing
something goes wrong with our swallowing
something goes wrong with our swallowing the effects range further than just
the effects range further than just
the effects range further than just figuring out how to get nutrition and
figuring out how to get nutrition and
figuring out how to get nutrition and hydration imagine sitting at the
hydration imagine sitting at the
hydration imagine sitting at the Thanksgiving table seeing the gorgeous
Thanksgiving table seeing the gorgeous
Thanksgiving table seeing the gorgeous spread smelling the rich aroma is being
spread smelling the rich aroma is being
spread smelling the rich aroma is being able to enjoy your favorite dish or to
able to enjoy your favorite dish or to
able to enjoy your favorite dish or to participate in the debate about who
participate in the debate about who
participate in the debate about who makes a better pumpkin pie imagine not
makes a better pumpkin pie imagine not
makes a better pumpkin pie imagine not being able to take a cool drink of water
being able to take a cool drink of water
being able to take a cool drink of water into a parched throat or sip on that
into a parched throat or sip on that
into a parched throat or sip on that glorious first cup of coffee in the
glorious first cup of coffee in the
glorious first cup of coffee in the morning so treating a swallowing
morning so treating a swallowing
morning so treating a swallowing disorder is more than just figuring out
disorder is more than just figuring out
disorder is more than just figuring out the safest way to provide nutrition and
the safest way to provide nutrition and
the safest way to provide nutrition and hydration for people we want to be able
hydration for people we want to be able
hydration for people we want to be able to provide the comfort that comes along
to provide the comfort that comes along
to provide the comfort that comes along with eating and drinking and
with eating and drinking and
with eating and drinking and provide an individual the ability to
provide an individual the ability to
provide an individual the ability to participate in the many show social
participate in the many show social
participate in the many show social events that center around food and drink
events that center around food and drink
events that center around food and drink so what happens if something goes wrong
so what happens if something goes wrong
so what happens if something goes wrong with swallowing people with swallowing
with swallowing people with swallowing
with swallowing people with swallowing complaints are often seen by a
complaints are often seen by a
complaints are often seen by a speech-language pathologists such as
speech-language pathologists such as
speech-language pathologists such as myself and the most common way that we
myself and the most common way that we
myself and the most common way that we take a look at the swallow is to do a
take a look at the swallow is to do a
take a look at the swallow is to do a video x-ray so here we’re looking at the
video x-ray so here we’re looking at the
video x-ray so here we’re looking at the side of the neck we can see the mouth
side of the neck we can see the mouth
side of the neck we can see the mouth jaw and soft palate the little dangly
jaw and soft palate the little dangly
jaw and soft palate the little dangly guy in the back here throat in the upper
guy in the back here throat in the upper
guy in the back here throat in the upper left as well as the spine esophagus and
left as well as the spine esophagus and
left as well as the spine esophagus and airway in the middle of the screen
airway in the middle of the screen
airway in the middle of the screen during this evaluation the person will
during this evaluation the person will
during this evaluation the person will eat and drink food liquid with a barium
eat and drink food liquid with a barium
eat and drink food liquid with a barium contrast in it and that appears on the
contrast in it and that appears on the
contrast in it and that appears on the x-ray video is black in a healthy person
x-ray video is black in a healthy person
x-ray video is black in a healthy person we can see the material moving quickly
we can see the material moving quickly
we can see the material moving quickly through the mouth and throat all of the
through the mouth and throat all of the
through the mouth and throat all of the material is going into the esophagus the
material is going into the esophagus the
material is going into the esophagus the structures and the throat have a good
structures and the throat have a good
structures and the throat have a good range of motion none of that materials
range of motion none of that materials
range of motion none of that materials getting into the airway and there’s
getting into the airway and there’s
getting into the airway and there’s nothing left in the throat after the
nothing left in the throat after the
nothing left in the throat after the swallow
swallow
swallow isn’t that cool so this is a healthy
isn’t that cool so this is a healthy
isn’t that cool so this is a healthy swallow or what might someone look like
swallow or what might someone look like
swallow or what might someone look like with a severe swallowing disorder well
with a severe swallowing disorder well
with a severe swallowing disorder well we can already see that this person has
we can already see that this person has
we can already see that this person has some black material in the throat left
some black material in the throat left
some black material in the throat left over from a previous swallow and they’re
over from a previous swallow and they’re
over from a previous swallow and they’re having difficulty moving this lip of
having difficulty moving this lip of
having difficulty moving this lip of liquid to the back of the mouth this
liquid to the back of the mouth this
liquid to the back of the mouth this person needs multiple swallows to get
person needs multiple swallows to get
person needs multiple swallows to get that liquid down some of the liquid is
that liquid down some of the liquid is
that liquid down some of the liquid is getting into the airway but despite
getting into the airway but despite
getting into the airway but despite efforts to cop it out and there’s quite
efforts to cop it out and there’s quite
efforts to cop it out and there’s quite a bit of residue left over in the throat
a bit of residue left over in the throat
a bit of residue left over in the throat after this swallow so this is a
after this swallow so this is a
after this swallow so this is a gentleman in the late stages of
gentleman in the late stages of
gentleman in the late stages of Parkinson disease which is a
Parkinson disease which is a
Parkinson disease which is a neurodegenerative neurodegenerative
neurodegenerative neurodegenerative
neurodegenerative neurodegenerative disease which is the second most common
disease which is the second most common
disease which is the second most common in the United States after Alzheimer’s
in the United States after Alzheimer’s
in the United States after Alzheimer’s disease Parkinson disease is
disease Parkinson disease is
disease Parkinson disease is characterized by a loss of brain cells
characterized by a loss of brain cells
characterized by a loss of brain cells in a region called the substantia nigra
in a region called the substantia nigra
in a region called the substantia nigra and these brain cells produce dopamine
and these brain cells produce dopamine
and these brain cells produce dopamine which is one of the main
which is one of the main
which is one of the main neurotransmitters required for movement
neurotransmitters required for movement
neurotransmitters required for movement control classic signs of Parkinson
control classic signs of Parkinson
control classic signs of Parkinson disease include a tremor
disease include a tremor
disease include a tremor rest small slow and stiff movements and
rest small slow and stiff movements and
rest small slow and stiff movements and the limbs and stooped posture with a
the limbs and stooped posture with a
the limbs and stooped posture with a shuffling walking pattern however as we
shuffling walking pattern however as we
shuffling walking pattern however as we just saw swallowing disorders can happen
just saw swallowing disorders can happen
just saw swallowing disorders can happen in people with Parkinson disease as well
in people with Parkinson disease as well
in people with Parkinson disease as well and although swallowing disorders are a
and although swallowing disorders are a
and although swallowing disorders are a lot less visible than the classic
lot less visible than the classic
lot less visible than the classic science I mean we need an x-ray to even
science I mean we need an x-ray to even
science I mean we need an x-ray to even see in there that can pose a big problem
see in there that can pose a big problem
see in there that can pose a big problem for these patients
for these patients
for these patients Budhan liquid getting into the airway is
Budhan liquid getting into the airway is
Budhan liquid getting into the airway is a risk factor for what we call
a risk factor for what we call
a risk factor for what we call aspiration pneumonia and that’s the
aspiration pneumonia and that’s the
aspiration pneumonia and that’s the leading cause of death for people with
leading cause of death for people with
leading cause of death for people with Parkinson disease and currently there’s
Parkinson disease and currently there’s
Parkinson disease and currently there’s no cure for Parkinson’s disease so our
no cure for Parkinson’s disease so our
no cure for Parkinson’s disease so our treatments are focused around decreasing
treatments are focused around decreasing
treatments are focused around decreasing the science and symptoms and
the science and symptoms and
the science and symptoms and unfortunately the main medications and
unfortunately the main medications and
unfortunately the main medications and surgeries that improve motor function in
surgeries that improve motor function in
surgeries that improve motor function in the limbs in patients with Parkinson
the limbs in patients with Parkinson
the limbs in patients with Parkinson disease do not meaningfully improve
disease do not meaningfully improve
disease do not meaningfully improve swallowing function so these people are
swallowing function so these people are
swallowing function so these people are left to behavioral treatments such as
left to behavioral treatments such as
left to behavioral treatments such as exercise in order to improve their
exercise in order to improve their
exercise in order to improve their swallowing so what can we do to improve
swallowing so what can we do to improve
swallowing so what can we do to improve a condition that could potentially
a condition that could potentially
a condition that could potentially shorten the life span of a person with
shorten the life span of a person with
shorten the life span of a person with Parkinson disease well let’s look at a
Parkinson disease well let’s look at a
Parkinson disease well let’s look at a progression about how how this might go
progression about how how this might go
progression about how how this might go for someone surely after or after the
for someone surely after or after the
for someone surely after or after the diagnosis of Parkinson disease typically
diagnosis of Parkinson disease typically
diagnosis of Parkinson disease typically some time passes before the person or
some time passes before the person or
some time passes before the person or their family members start to realize
their family members start to realize
their family members start to realize changes to swallowing so this might be
changes to swallowing so this might be
changes to swallowing so this might be something like coughing after taking a
something like coughing after taking a
something like coughing after taking a sip of liquid these changes progress to
sip of liquid these changes progress to
sip of liquid these changes progress to a problematic point such as that would
a problematic point such as that would
a problematic point such as that would warrant a report to the primary care
warrant a report to the primary care
warrant a report to the primary care provider who would then generate a
provider who would then generate a
provider who would then generate a referral to a speech-language
referral to a speech-language
referral to a speech-language pathologist who had been performance
pathologist who had been performance
pathologist who had been performance objective swallowing evaluation such as
objective swallowing evaluation such as
objective swallowing evaluation such as the x-ray videos that we saw and from
the x-ray videos that we saw and from
the x-ray videos that we saw and from what was seen in those x-ray videos
what was seen in those x-ray videos
what was seen in those x-ray videos speech pathologists would recommend a
speech pathologists would recommend a
speech pathologists would recommend a treatment program that’s reactive to the
treatment program that’s reactive to the
treatment program that’s reactive to the science and symptoms so something like I
science and symptoms so something like I
science and symptoms so something like I noticed this structure in the throats
noticed this structure in the throats
noticed this structure in the throats not moving as much as it should so I’m
not moving as much as it should so I’m
not moving as much as it should so I’m going to strengthen the muscles that are
going to strengthen the muscles that are
going to strengthen the muscles that are responsible for moving that structure
responsible for moving that structure
responsible for moving that structure this reactive treatment paradigm can
this reactive treatment paradigm can
this reactive treatment paradigm can lead to variable outcomes for these
lead to variable outcomes for these
lead to variable outcomes for these patients most
patients most
patients most because by the time it takes to get
because by the time it takes to get
because by the time it takes to get through this pipeline the progression of
through this pipeline the progression of
through this pipeline the progression of the disease may have passed an ideal
the disease may have passed an ideal
the disease may have passed an ideal point for behavioral swallowing
point for behavioral swallowing
point for behavioral swallowing treatment and a person may have
treatment and a person may have
treatment and a person may have difficulty returning to a desired level
difficulty returning to a desired level
difficulty returning to a desired level of function say having a steak dinner
of function say having a steak dinner
of function say having a steak dinner and having a glass of wine so then why
and having a glass of wine so then why
and having a glass of wine so then why don’t speech-language pathologists see
don’t speech-language pathologists see
don’t speech-language pathologists see people suturing the progression of the
people suturing the progression of the
people suturing the progression of the disease of Parkinson’s well let’s take a
disease of Parkinson’s well let’s take a
disease of Parkinson’s well let’s take a look at a swallowing video from someone
look at a swallowing video from someone
look at a swallowing video from someone in the early stages so we can notice the
in the early stages so we can notice the
in the early stages so we can notice the liquid is moving quickly through the
liquid is moving quickly through the
liquid is moving quickly through the throat structures have good range of
throat structures have good range of
throat structures have good range of motion no materials getting into the
motion no materials getting into the
motion no materials getting into the airway and there’s no residue left over
airway and there’s no residue left over
airway and there’s no residue left over after the swallow this is a beautiful
after the swallow this is a beautiful
after the swallow this is a beautiful swallow but as a clinician I have
swallow but as a clinician I have
swallow but as a clinician I have nothing to react to in this swallow from
nothing to react to in this swallow from
nothing to react to in this swallow from what I see there are no therapy therapy
what I see there are no therapy therapy
what I see there are no therapy therapy items that that would improve the
items that that would improve the
items that that would improve the swallow because it’s already a good
swallow because it’s already a good
swallow because it’s already a good swallow and of the problem in order to
swallow and of the problem in order to
swallow and of the problem in order to start a rehabilitation plan as a
start a rehabilitation plan as a
start a rehabilitation plan as a therapist I need to be able to document
therapist I need to be able to document
therapist I need to be able to document a change in function from a typical
a change in function from a typical
a change in function from a typical person it might be that at this point in
person it might be that at this point in
person it might be that at this point in the progression of the disease the
the progression of the disease the
the progression of the disease the muscles nerves and brain regions
muscles nerves and brain regions
muscles nerves and brain regions responsible for swallowing aren’t yet
responsible for swallowing aren’t yet
responsible for swallowing aren’t yet affected or it could be that a
affected or it could be that a
affected or it could be that a swallowing evaluation such as this x-ray
swallowing evaluation such as this x-ray
swallowing evaluation such as this x-ray is not sensitive enough to detect very
is not sensitive enough to detect very
is not sensitive enough to detect very subtle deviations and motor controls for
subtle deviations and motor controls for
subtle deviations and motor controls for swallowing so you may have noticed these
swallowing so you may have noticed these
swallowing so you may have noticed these black rectangles in this person’s throat
black rectangles in this person’s throat
black rectangles in this person’s throat you haven’t seen those on the other
you haven’t seen those on the other
you haven’t seen those on the other x-rays these are high resolution
x-rays these are high resolution
x-rays these are high resolution pressure sensors and we can now
pressure sensors and we can now
pressure sensors and we can now objectively measure swallowing pressures
objectively measure swallowing pressures
objectively measure swallowing pressures from all along the throat and as I said
from all along the throat and as I said
from all along the throat and as I said before when we swallow food and liquid
before when we swallow food and liquid
before when we swallow food and liquid doesn’t just magically glide down our
doesn’t just magically glide down our
doesn’t just magically glide down our throat we have to actively contract
throat we have to actively contract
throat we have to actively contract muscle groups in the mouth and throat to
muscle groups in the mouth and throat to
muscle groups in the mouth and throat to push it down and we can measure the
push it down and we can measure the
push it down and we can measure the pressures as a result of those muscle
pressures as a result of those muscle
pressures as a result of those muscle contractions and a fine scale and get a
contractions and a fine scale and get a
contractions and a fine scale and get a wealth of objective data about the
wealth of objective data about the
wealth of objective data about the swallow great so then what do swallowing
swallow great so then what do swallowing
swallow great so then what do swallowing pressures look like in patients in the
pressures look like in patients in the
pressures look like in patients in the early stages of Parkinson disease well
early stages of Parkinson disease well
early stages of Parkinson disease well that’s just narrow our focus to one
that’s just narrow our focus to one
that’s just narrow our focus to one region of the throat so we’ll look at
region of the throat so we’ll look at
region of the throat so we’ll look at the region where the back of the
the region where the back of the
the region where the back of the presses up against the walls of the
presses up against the walls of the
presses up against the walls of the throat and we can compare swallowing
throat and we can compare swallowing
throat and we can compare swallowing pressure waves from a healthy individual
pressure waves from a healthy individual
pressure waves from a healthy individual as you’ll see on the left and someone in
as you’ll see on the left and someone in
as you’ll see on the left and someone in the early stages of Parkinson disease on
the early stages of Parkinson disease on
the early stages of Parkinson disease on the right and we can look at a single
the right and we can look at a single
the right and we can look at a single swallow but we really start to see more
swallow but we really start to see more
swallow but we really start to see more interesting things if we look at
interesting things if we look at
interesting things if we look at multiple swallows from the same person
multiple swallows from the same person
multiple swallows from the same person if we overlay multiple swallowing
if we overlay multiple swallowing
if we overlay multiple swallowing pressure waves at the same level in the
pressure waves at the same level in the
pressure waves at the same level in the throat over multiple swallows of the
throat over multiple swallows of the
throat over multiple swallows of the same amount of liquid we can see an
same amount of liquid we can see an
same amount of liquid we can see an interesting phenomenon namely the person
interesting phenomenon namely the person
interesting phenomenon namely the person with Parkinson disease is generating a
with Parkinson disease is generating a
with Parkinson disease is generating a swallowing pressure pattern that is more
swallowing pressure pattern that is more
swallowing pressure pattern that is more variable than the healthy person and we
variable than the healthy person and we
variable than the healthy person and we can objectively measure the degree to
can objectively measure the degree to
can objectively measure the degree to this variability this within individual
this variability this within individual
this variability this within individual variability in motor movement is not
variability in motor movement is not
variability in motor movement is not limited to swallowing in Parkinson
limited to swallowing in Parkinson
limited to swallowing in Parkinson disease it’s also seen in other motor
disease it’s also seen in other motor
disease it’s also seen in other motor systems such as fine motor control in
systems such as fine motor control in
systems such as fine motor control in the hand and in the walking pattern and
the hand and in the walking pattern and
the hand and in the walking pattern and this variability in swallowing motor
this variability in swallowing motor
this variability in swallowing motor control would not be able to be seen
control would not be able to be seen
control would not be able to be seen without an objective evaluation such as
without an objective evaluation such as
without an objective evaluation such as the swallowing pressure evaluation so
the swallowing pressure evaluation so
the swallowing pressure evaluation so great we have something to now
great we have something to now
great we have something to now objectively document a change in typical
objectively document a change in typical
objectively document a change in typical function in these patients in the early
function in these patients in the early
function in these patients in the early stages of swallowing disorders and the
stages of swallowing disorders and the
stages of swallowing disorders and the patients that we’ve seen in the lab that
patients that we’ve seen in the lab that
patients that we’ve seen in the lab that I work in this variability happens more
I work in this variability happens more
I work in this variability happens more or less throughout the throat and even
or less throughout the throat and even
or less throughout the throat and even in the absence of changes seen on an
in the absence of changes seen on an
in the absence of changes seen on an x-ray swallowing study so it seems to
x-ray swallowing study so it seems to
x-ray swallowing study so it seems to better suit these patients to move from
better suit these patients to move from
better suit these patients to move from a reactive treatment model waiting for
a reactive treatment model waiting for
a reactive treatment model waiting for science and symptoms of a swallowing
science and symptoms of a swallowing
science and symptoms of a swallowing dysfunction to occur and then trying to
dysfunction to occur and then trying to
dysfunction to occur and then trying to go in and rehabilitate a disordered
go in and rehabilitate a disordered
go in and rehabilitate a disordered swallow to a more proactive treatment
swallow to a more proactive treatment
swallow to a more proactive treatment model where someone has seen or by
model where someone has seen or by
model where someone has seen or by speech-language pathologists soon after
speech-language pathologists soon after
speech-language pathologists soon after diagnosis undergoes an objective
diagnosis undergoes an objective
diagnosis undergoes an objective swallowing evaluation and then is put
swallowing evaluation and then is put
swallowing evaluation and then is put through a proactive treatment model
through a proactive treatment model
through a proactive treatment model where the goal is to preserve a high
where the goal is to preserve a high
where the goal is to preserve a high level of swallowing function for as long
level of swallowing function for as long
level of swallowing function for as long as possible if we can prolong the amount
as possible if we can prolong the amount
as possible if we can prolong the amount of time that a person with Parkinson
of time that a person with Parkinson
of time that a person with Parkinson disease is able to safely swallow we can
disease is able to safely swallow we can
disease is able to safely swallow we can be able to prolong not only the lifespan
be able to prolong not only the lifespan
be able to prolong not only the lifespan of that person but their quality of life
of that person but their quality of life
of that person but their quality of life and this model of swallowing
and this model of swallowing
and this model of swallowing Proactive treatment is not limited to
Proactive treatment is not limited to
Proactive treatment is not limited to swallowing and Parkinson disease with
swallowing and Parkinson disease with
swallowing and Parkinson disease with improvements in diagnostics health
improvements in diagnostics health
improvements in diagnostics health monitoring and big data and now is this
monitoring and big data and now is this
monitoring and big data and now is this we have the potential to widen the scope
we have the potential to widen the scope
we have the potential to widen the scope of proactive treatments across many
of proactive treatments across many
of proactive treatments across many different dysfunctions in different
different dysfunctions in different
different dysfunctions in different chronic and degenerative diseases if our
chronic and degenerative diseases if our
chronic and degenerative diseases if our goal is to preserve a good level of
goal is to preserve a good level of
goal is to preserve a good level of function the person will be better
function the person will be better
function the person will be better equipped as their disease progresses or
equipped as their disease progresses or
equipped as their disease progresses or even as they age and if we shift towards
even as they age and if we shift towards
even as they age and if we shift towards more objective evaluations in healthcare
more objective evaluations in healthcare
more objective evaluations in healthcare we cannot learn more we can not only
we cannot learn more we can not only
we cannot learn more we can not only learn more about a disease process but
learn more about a disease process but
learn more about a disease process but we can document evidence for treatment
we can document evidence for treatment
we can document evidence for treatment efficacy or non efficacy and we can get
efficacy or non efficacy and we can get
efficacy or non efficacy and we can get a clear understanding of rehabilitation
a clear understanding of rehabilitation
a clear understanding of rehabilitation in general so clearly there’s a lot of
in general so clearly there’s a lot of
in general so clearly there’s a lot of work left to be done here and there are
work left to be done here and there are
work left to be done here and there are a lot of unanswered questions but we
a lot of unanswered questions but we
a lot of unanswered questions but we move forward still because preserving a
move forward still because preserving a
move forward still because preserving a person’s ability to eat and to drink is
person’s ability to eat and to drink is
person’s ability to eat and to drink is not a trivial matter thank you and
not a trivial matter thank you and
not a trivial matter thank you and Cheers
Cheers
Cheers [Applause]
”
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