HD:

Speech & Swallowing

Speech Characteristics & Communication Therapy in HD:

Variable rate & rhythm, irregular breathing and vocal arrests, vocal interference: gasps, grunts, clicks, and kisses
Ask for feedback from person, take extra time to listen, teach person to slow down, ask to repeat main word for person, try to rephrase main idea for person, never pretend to understand!

Dysphagia in HD

Cognitive loss -> mouth-stuffing and food retention
Loss of tongue control -> poor bolus formation
Loss of respiratory control ->inhaling before swallowing

 

Dysphagia is the most common cause of death in HD, either directly from suffocation or aspiration, or indirectly from starvation.


Patients require 4000-6000 calories
lower body mass index associated with more rapid disease progression
high caloric intake is imperative

HD Swallowing & Feeding Problems

Swallowing process: oral preparatory phase, oral phase, pharyngeal phase, esophageal phase. HD affects first two phases more than last two.
Difficulties: hyperkinetic feeding behavior (tachyphagia, lingual chorea, uninhibited swallow initiation, impaired respiratory inhibition during deglutition.

Swallowing Therapy in HD

Sit upright with chin tucked down
Use sturdy straight-back chair with arms
Choose a calm, quiet, and familiar setting
Try ankle weights for truncal stability
Chew slowly and completely
Clear mouth between bites
Eat one food texture or item at a time
Try straw for thickened liquids

Physical Therapy for Eating in HD

firm back and seat support
torso slightly flexed
seated close to table
ease of chair movement
Adapted Utensils: weighted handles & cups, plates on adherent mats, high edged plates and bowls

 

Treatment of Dysphagia in HD

( Learn to do the Heimlich Maneuver)
1. Food should be high caloric - 6000 calories
Pudding-like consistency
Thicken with potato flakes or corn starch
Nutritional supplement
2. Meals limited to 25-30 minutes
5-6 meals per day
3. Upright position for meals and 45 minutes after
Straight back chair with arms
Ankle weights and seat belts
4. Medications that are anticholinergic dry the mouth
Start with liquid that is nectar like consistency
5. Coughing should be encouraged
Lemon sherbert may reset the swallow
6. Occupation Therapy
Weighted utensils
Weighted cups
Non-slip plates
One-way straws
Mid-chest height table