Reducing aspiration risk is always important for anyone with a known swallowing problem, but with today’s current health crisis, avoiding a trip to the hospital due to an aspiration pneumonia should be a top priority for people living with dysphagia.
Along with recommendations for swallowing exercise or compensatory/behavioral swallowing strategies that your speech-language pathologist may have instructed you to do, there are steps that YOU can take to reduce your overall risk of developing an aspiration pneumonia.
We know that oral care is an extremely important defense strategy for people with dysphagia. Our mouths contain hundreds of bacteria, some of it healthy and some of it contributing to disease. If someone is ill or oral hygiene is poor, the unhealthy bacteria can take over. If someone has a swallowing problem that incudes aspiration of saliva or food and liquid, bacteria can be carried into the lungs where eventually infection occurs. Aspiration pneumonia occurs when the lungs cannot defend against the onslaught of bacteria.
Under normal circumstances even healthy adults aspirate from time to time, including at nighttime when micro aspiration may occur due to our sleeping position, reflux, or medications. But a healthy immune system, mobility, and healthy lungs, allow our body to defend against the development of any infections associated with aspiration events.
So, an abundant amount of research supports the fact that good oral care can help to reduce risks associated with swallowing problems. Brushing your teeth after meals and before bedtime is important. For people with Parkinson’s who may have difficulty manipulating a toothbrush, an electric toothbrush is useful. Dentures also need to be cleaned in the same way you brush your natural dentition. Oral care is also important for people with feeding tubes and for individuals who may receive Botox injections for sialorrhea (drooling) or who may have xerostomia (dry mouth) from radiation or disease.
Pulmonary hygiene refers to strategies and exercises you can do to help clear your lungs and airway of secretions and mucus. Coughing is our body’s normal reflexive response to something threatening our airway and it is also the mechanism by which we clear mucus from our lungs if we have a cold or other respiratory infection. But, if a neuromuscular or neurodegenerative disease has reduced the strength and efficiency of your cough, this important defense mechanism will be weakened. A variety of handheld devices are available that can help mobilize secretions and some are designed to strengthen the respiratory muscles for improved cough effort. Devices that oscillate or vibrate provide a slight resistance on exhalation (the breath out) and help to loosen secretions for better clearance from the lungs. Respiratory muscle trainers that involve variable resistance act like mini weight machines and improve the strength of the muscles of inspiration and exhalation and thereby improve cough strength and also can help with better co-ordination of breathing and swallowing.
The Breather® is an inspiratory-expiratory device I have used in my practice for over 25 years helping to put the power of prevention in patient’s hands.
Voice Aerobics Offers Telepractice and Online Coaching for Continuity of Care
Telehealth/telepractice has been an option for provision of speech therapy for several years, however, CMS (Medicare) and commercial payers have been slow to broaden payment coverage to include our services, hence, patients are billed directly.
Under the emergency declaration and waivers related to the COVID 19 pandemic, several health plans (UHC, CIGNA, and Tricare) have authorized telehealth services for speech therapy, and we are hopeful that CMS will be soon to follow so that no one has to miss out on important treatment. It is recommended, however, that patients also check telehealth coverage with their insurance provider as regulations may be different from state to state.
Voice Aerobics has offered Online Coaching to patients for over 5 years and feels confident in serving patients using the telehealth model of service delivery.
My MissionTo enlist individuals in their treatment, and help them express their personality & spirit through voice. To educate and empower. Mary Spremulli, MA, CCC-SLP * FiTOUR® Group Exercise Instructor * Voice Aerobics® A Whole Body Approach to Voice Practice
Voice Aerobics the heART and Science of Voice Practice
Thank you, Pamela, for your feedback
Great article, well written! Thank you!