Strengthening swallowing muscles to prevent choking and improve quality of life

Exploring the efficacy of the Effortful Swallow maneuver for improving swallowing safety and efficiency in people with Parkinson Disease

Pooja Gandhi
PhD candidate
University Health Network
Graduate Student Award
Funded in Partnership with Parkinson Society of British Columbia
$20,000 over 2 years

Eating and drinking without choking or aspirating food are among the pleasures of life denied to some people with Parkinson’s who have swallowing difficulties.

The most common strategy used to alleviate these problems is to thicken liquids and puree solids – an unsatisfactory solution for anyone who enjoys good food and drink.

But not altering diet may result in food and liquids entering the airway and lungs, rather than the food pipe and stomach. This problem, called aspiration, increases the risk of choking, pneumonia, dehydration, and malnutrition.

At Toronto’s University Health Network, Pooja Gandhi, a speech-language pathologist and PhD candidate, wants to use an exercise-based therapy called “effortful swallowing” to prevent these negative outcomes.

“Effortful swallowing involves training the swallowing muscles in your throat to become stronger, to be able to protect your airways better and to clear residue or food or liquid left behind in your throat,” Gandhi says.

The effortful swallowing technique is a well-established method in rehabilitation therapy for stroke patients. Gandhi’s research will help determine if effortful swallowing can also help people living with Parkinson’s.

Gandhi will first x-ray people’s throats as they are swallowing to see what physiological impairments are occurring. Then Gandhi will put participants through an intensive four-week course, training them to strengthen their throat muscles and increase their tongue pressure while swallowing.

These exercises are easy to learn once people understand what muscle groups are involved and, once learned, people can practise it at home, Gandhi says.

After the four-week course, she will take another x-ray of people swallowing to see what has changed.

If effortful swallowing is as effective as Gandhi hopes, it will help to prevent choking and aspiration, enabling people to eat and drink normally and enjoy social functions.

Gandhi watched her late grandfather Suresh Gandhi struggle to eat and drink as his Parkinson’s progressed.

“For an individual who had been independent his whole life, having food cut up and look different from everyone else’s food, and not being able to eat affected his self-esteem and quality of life,” she says.

As a speech-language pathologist, seeing her clients with swallowing problems worsen as their Parkinson’s progressed also spurred Gandhi’s desire to work in the field.

“You could prevent deterioration and delay the need for modified foods by using this technique,” she says.

Gandhi hopes her research will address a major clinical gap, especially for clinicians and therapists working in hospitals and long-term care.

How your support made this research project possible

The increasing prevalence of Parkinson's in our aging population makes it more urgent than ever to devote money to researching interventions that can make an immediate difference in people's lives, Gandhi says.

"The money that is invested now is helping us to find these optimal diagnostic, preventative, and therapeutic pathways," she says.

"Once we have all three of those in place, we are no longer as clinicians guessing at the bedside. We have research to back up what we are doing, whether it is diagnosing or providing them with treatment."

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