My World of Parkinsonian Delights

Consulting the Family Speech Pathologist

My genius nephew, Tommy, of whom we all love and his sainted mother would be so proud, had a thing or two to say about the video I posted here earlier today.  He’s a grad student, a future speech pathologist.

I just had 4 different speech paths look at your MBS. We all agree your epiglottis is indeed very naughty!

MBS means “modified barium swallow.”  I asked him to elaborate.

I saw penetration with the thin and thick liquid, but no aspiration. (Although the movie is very fast…. most of the time we watch it slowed down) But that makes sense. It sounds like you have more trouble with liquids. Liquids move very fast, so if you have weak muscles the epiglottis will not close off in time for the liquids to pass. I would be interested to see the report. Did the speech path recommend a chin tuck when you drink liquids? That will make it so your epiglottis doesn’t have to travel as far.

I had to look it up to see what he was talking about.

The delineation between ‘laryngeal penetration’ and ‘aspiration’ has been better agreed upon recently, with the term ‘laryngeal penetration’ reserved for entry of materials into the laryngeal vestibule but not below the true vocal folds and ‘aspiration’ for when material passes below the vocal folds…

So, it’s like the epiglottis doesn’t keep the slop from getting into the TOP of the airway, but during the act of swallowing, that slop gets stripped out of the vestibule and down the hatch… as it were.

Tommy further elaborated that “swallowing” is “gross” and that he prefers to work with communication.  But without “swallowing,” Thomas, how will one have the nutrition with which to communicate?  Hmm?


Here are two videos, slowed considerably.  The first is the thin liquid swallow, the second is the thick liquid.

I’m no genius, but I think I see what he’s talking about.

If you look carefully, you can see the contrast (barium) pass over the epiglottis and poke into the upper part of the larynx before being swallowed completely down the esophagus.

I did some MORE looking up.  This from my friends at Viartis.

Silent Laryngeal Penetration is when material enters the top of the airway and is subsequently removed during the swallowing. People with Parkinson’s Disease who produced excessive saliva during the day were evaluated. Of those in which Silent laryngeal penetration or silent aspiration (SLP/SA) was observed, most developed respiratory infection. Some of them died of it. The authors claim that the results suggest that patients with Parkinson’s disease with diurnal sialorrhea (excessive saliva during the day) and SLP/SA have an increased risk of respiratory infections, which is the main cause of death in Parkinson’s Disease patients.

Oh, well.  Gotta die of sumthin’.

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