The disturbances in muscle motility present in Parkinson's disease also involve the swallowing and swallowing mechanisms. This involvement usually occurs at a more advanced stage of the disease. The bee is more difficult to understand because it is slower and weaker than usual. In severe cases, the bee turns into a whisper because the Parkinson's patient has difficulty exhaling, that is, compressing the air through the trachea to raise his voice. Can this situation be improved? The answer is positive. Two recent studies in the United States have demonstrated that certain methods (specific techniques) of practice used by speech therapists can improve the pitch of the sound produced. However, it is not enough to learn to raise your voice and you need to combine this with basic exercises to improve your pronunciation so that the words are clear.

Breathing and voice exercises
 
Please perform each exercise 10 times, about 3 times a day for about fifteen minutes each time
1. Expressing a very strong explosive sound, puff out the cheeks with a closed mouth and say "P" with the five vowels: פַּ, פּע, פִּי, po, poo - it is important to repeat each movement 5 times.

 
2. Exhalation with the wheel "Sh", when measuring the duration of the exhalation. It is important to repeat the exhalation exercise 10 times. During the exhalation with the production of the sound "shh" it is important that the stomach is gradually brought in all the way to the back.

 
3. Producing a sound with the vowel "a". when measuring the duration of exhalation. It is important to repeat an exercise 10 times, while exhaling with the production of the sound "a" it is important that the stomach is gradually brought in all the way to the back.

 
4. Counting with gradual introduction of the stomach to the back. At first count each digit separately, continue with 2 digits - 1,2, 3, then XNUMX digits until the number of digits that are able to be counted in one sequence without interrupting the exhalation.

 
5. Say short sentences until you can speak freely, paying attention that when the stomach has been inserted all the way (up to the back) to stop - release the stomach and start again, as in reading aloud when there is a comma and a period.

 
6. Exercises for finding the pitch of the voice by pronouncing a prolonged "m". As soon as the pitch of the voice is found, one should continue from the "m" to words like: מ-לח, and sentences beginning with מלח put on the bread.

 
7. Application in free speech that needs to be in a very loud voice. It is important to stop after every word or two and start again with a new exhalation.

 
8. Counting continuously and in a very loud voice, up to a hundred, when the stomach is inserted all the way in (to the back) during the counting and is released (comes out and sticks out) when you stop counting between the numbers
.
 
Exercises in the oral organs - to increase movement and sensation
Language exercises:
- Outside the mouth: lifting the tongue up and down. It is important to start from slow movement to fast movement and repeat each exercise 10 times.
- Inside the mouth: lift the tongue from the bottom of the mouth and bring it up to the upper jaw. It is important to start from slow movement to fast movement and repeat each exercise 10 times.
- Inside the mouth: in a circular motion, move the tongue from tooth to tooth - from the upper teeth on the left side and continue to the teeth on the right side and go down with the tongue to the lower teeth to the left side and come back up again. It is important to do 10 rounds at a time.
- From the outside between the lip and the teeth: a circular movement from tooth to tooth - one must pass the tongue from tooth to tooth - from the upper teeth on the left and continue to the teeth on the right and go down with the tongue to the lower teeth to the left side and come back up again. It is important to do 10 rounds at a time.
- Lateral movement: when the tongue rubs and pushes the cheek from side to side. It is important to repeat 10 times for each rubbing and pushing of the cheek.
- Biting the tongue hard, from the outer edge inwards and back outwards. It is important to repeat the tongue bites 10 times along the tongue from the tip inward and back.
- Pulling the tongue back as if swallowing it, when the tongue is flat on the floor of the mouth. The tongue pulling back exercise must be repeated 10 times.

Lip exercises:
- Strong contraction of the lips, inward as if saying "U" - it is important to repeat 10 times the contraction of the lips.
- Strong contraction, outward as if saying "O" - it is important to repeat 10 times the contraction of the lips.
- Pulling the lower lip between the teeth strongly. It is important to repeat the exercise 10 times.
- Pulling and biting the lower lip in between the teeth firmly - 10 times.
- Pulling the upper lip in between the teeth tightly - 10 times.
- Pulling and biting the upper lip in between the teeth firmly - 10 times.
- Pulling the lips in between the teeth strongly - 10 times.
- Pulling and biting the lips in between the teeth strongly - 10 times.

Life exercises:
- Inflating the cheeks. It is important to repeat the exercise 10 times.
- shrinking to life. It is important to repeat the exercise 10 times.
- While inflating, pass the air from cheek to cheek, without the air escaping - 10 times
- Contraction, swelling of the cheeks alternately. It is important to repeat the exercise 10 times.
– Biting the cheeks when they are compressed inwards. Each cheek separately and both together - 10 times.

Lower jaw exercises:
- Moving the jaw to the right and left, slowly and quickly. It is important to repeat the exercise 10 times.
- Stretching the jaw downwards when opening the mouth. It is important to repeat the exercise 10 times.

Face exercise:
– make faces to move the face.

Feeding for correct and safe ingestion
An instruction sheet for staff and families caring for children, sick adults who suffer from swallowing difficulties to prevent food from being sucked into the trachea - aspiration (aspiration)
After the communication clinician's assessment regarding the patient's or patient's ability to swallow, one must receive guidance from the clinician herself and use this instruction sheet, while feeding and/or when supervising people's eating so that eating and swallowing are safe and effective.

It is possible that during the evaluation in the department: the speech therapists will find:
Gag Reflex swallowing and vomiting are poor and/or delayed, which do not necessarily indicate an inability to swallow, but clearly indicate the possibility of disturbances in sensation or movement or disturbances in swallowing.

There may be dryness in the mouth because the saliva has seeped in and will be accompanied by coughing and snoring
The tongue may be oversized and loose.
There may be disturbances in sensation and/or movement in the oral organs: jaw, lips, cheeks, etc.
A recurrent cough may sometimes appear, but you will not be able to cough voluntarily

In the ward and upon discharge of the patient from the ward the recommendations are:

Therapeutic feeding only at first.
 
 
1. If the patients are not alert and exhausted, nutritional feeding should be considered through a nasal tube (probe) or intragastric - gastrostomy, due to the fear of very late swallowing and the need for a great deal of time, supervision, patience and strength until they swallow and eat a sufficient amount of thick mushy food containing at least 2000cc, In terms of calories and fluids.
 
2. You have to wait patiently and watch carefully until the patients have swallowed twice after each type of spoon.
 
 
3. The patients must be coughed up - that is: check, stimulate and request that they cough well and voluntarily after each
Once they swallowed several kinds of spoons. The ability of the patients to cough themselves, allows protection against
Remaining liquid, saliva and food in the trachea as well as cleaning the trachea.
 

 
4. It is important that patients reach the ability to expel phlegm and spit out with the head forward and tilted down.
 
 
5. Nutritional feeding through the mouth - only after the patients swallow immediately and are fully alert, immediately swallow what is in their mouth, and eat. Although if they eat continuously as a return and an internal drive (automatically instinctive) then it is possible to let very retarded children and adults who are vague in their knowledge to eat.
 
 
6. You can put your hand on the patient's chest and feel if there are crepitations in the chest and near the throat.
 
 
7. Swallowing can be stimulated by pressing with the finger under the glans in the neck in the throat area while the patients are trying to swallow
 
ways of feeding
It is better to eat and/or feed only with a long-handled ice cream scoop or using a small spoon.
 
1. When sitting upright only on a chair and not in bed - when the head is tilted forward and not stretched back. bias
The forward head is important for relaxing the throat and the house of swallowing and forces the flow of saliva or food out of the mouth, instead of permeating the pharynx and lungs.
 
2. It is forbidden to use water - for cleaning the mouth, for rinsing the mouth or for drinking. Water is a tasteless liquid and mixes and accumulates with the saliva, which penetrates the lungs and causes coughing and pneumonia when there is no re-swallowing.
 
3. You should give thick porridge food of the type: apple puree, fruit puree, gerber, you can make a blender of vegetables + potato puree and chicken or meat with a little chicken broth, Strauss yogurt that is gelatinous thick or gold ski cheese that are not floury (not for advertisement), jelly.
4. Soups and any food can be thickened with instant cornflour or Thick & Easy powder.
 
It is important to note that you should minimize dairy products, because they cause a lot of phlegm, and you can use milk and soy delicacies (not for advertising).
 
For the long-handled spoon - several functions during the entire feeding time

Medicines should be swallowed with porridge, paste, thick yogurt or cheese. Not jelly because it is not possible to inject the medicine in jelly.
Masked half-balls (not crushed) should be inserted inside 1/5 of the teaspoon and then the patient will swallow together with the food.
It is not worthwhile and dangerous to give medicine with jelly because it is impossible to wrap the ball with jelly, and the jelly may slip into the mouth without control and criticism.
Crushing the drugs may cause a bitter taste, the reaction to which can be vomiting or disgust and disapproval of continuing to take the drug and eat. Vomiting is very dangerous and may cause seepage and penetration of the vomit into the trachea and pneumonia/lungs - dangerous aspiration. Saliva can be dangerous if there is no automatic re-swallowing every half minute while awake and every minute while sleeping. A dry mouth does not indicate that saliva has been swallowed, but it is possible that the saliva permeates and penetrates the trachea and causes pneumonia/lungs - dangerous aspiration (aspiration).

Therefore, it is extremely important that the patients: a. They will remain sitting on the chair for about an hour after each oral intake. B. That the patients lie high on the bed with a high tilt (as sitting), even at night.

With an improvement in the patient's swallowing condition and after he starts eating properly, it is extremely important to adhere to the following recommendations:

A. Eat slowly and in small amounts, by the spoonful only. Each bite and each intake of food should be swallowed two to three times. It is important that they cough loudly after about 3 small spoonfuls, especially when they feel that their voice is very wet and watery or that they have no voice.

B. Eat only things with taste but not too sweet, which on the one hand stimulate swallowing, but on the other hand stimulate recurrent coughing.

third. After the porridge is well eaten and the patients are able to cough themselves well, you can try using the mini spoon to give tea or juice. and ask them to cough themselves up and if their voice is clear and they swallow well then you can continue slowly and gradually drinking from a straw very slowly and finally drinking very small sips - each sip separately.

d. As soon as there is an increase in temperature above 37 degrees, you must stop giving the drink and return to mushy food such as jelly, pudding and thick pastes saturated with liquids. It is allowed to return to drinking from a spoon or a straw, only after 4-5 days of no fever.