BSN PSP/CBD Conference – Megan DePuy


Speech, Language, and Swallowing Treatment for PSP & CBD

Megan DePuy, SLP, private practice, San Mateo

  • Why speech therapy?
    • Swallowing (dysphagia) speech (dysarthria, dysphonia) language (aphasia)
  • If you are going to go see a speech therapist…
    • Do some research and make sure they have a background in neurological disorders
  • Swallowing
    • Symptoms and challenges
      • Head and neck stiffness can make looking down at a plate challenging
      • Portion control – eating and drinking too quickly, tremor or stiffness interfere with self-feeding
      • Restricted head and neck posture
      • Delayed pharyngeal swallow onset
      • Poor cough
      • Occasional difficulty opening the mouth
      • Swallowing management
      • Evaluation should include both subjective and objective measures
      • Observation of client during a meal
      • Caregiver input about feeding habits and challenges
      • Evaluation techniques
        • Modified barium swallow
        • Fiber optic endoscopic evaluation of swallowing (FEES)

Many people have poor function, and don’t know if food or drink are stuck in the wrong place

    • Prevention is the easiest treatment – go and see a speech therapist before you even consider you may have difficulty swallowing.

Some slight differences with PSP/CBD

    • CBD is unilateral, so sometimes there are strategies a speech therapist can give. If food or liquid is swallowed and there’s a unilateral weakness, sometimes say turn head or tuck head to the weak side
  • Management
    • Medical management
      • Medications to control motor symptoms
    • Modified Barium swallow/FEES
      • MBE – one is an x-ray of your swallow
      • FEES – looking with a small camera into your vocal chord/throat
      • Both can tell if someone aspirates or penetrates
      • Not always able to prevent
  • Aspiration is not always obvious; the most severe aspiration is often silent.
  • Speech Challenges – PSP affects muscle strength and coordination
  • Decreased muscle strength and coordination of the face mouth, tongue and throat can result in:
    • Speech deficits – hypokinetic dysarthria – quiet voice and quick pace. Stutter can result from quick pace of speech. Voice quality can become breathy.
    • Spastic dysarthria – quiet and destrained voice quality with bursts of loud voice caused by stiff muscles.
  • Motor speech symptoms
    • Characterized by hypokinetic and spastic dysarthria, as well as progressive apraxia of speech and oral apraxia
    • Progressive non-fluent aphasia
    • MSA-A: often ataxic or hypokinetic dysarthria, but may be mixed with spastic
    • MSA-C ataxic dysarthria is most often expected, or in combination with spastic
  • Exercises for swallowing voice and speech
    • Tongue
      • Stick tongue out as far as you can. 10 repetitions
      • Move tongue from one corner of your mouth to the other, slowly and in a controlled manner. 10 repetitions
      • Move tongue up and down, touching your top teeth and then bottom teeth. 10 repetitions
      • Touch the roof of your mouth with the tip of your tongue without moving your lower jaw
      • Close your mouth and push your tongue out against the inside of your cheek. Provide resistance with your hand if it is easy. 5 repetitions on each side
      • Move tongue in clockwise motion around upper and then lower teeth keeping your mouth closed. 10 times around. Switch directions.