PSP and Swallow

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Speech and Swallow

Speech, language, voice and swallow are interconnected. Speech problems can lead to swallow problems later.  The tubes we use for breathing and to swallow lie close together. They are separated only by a flap (epiglottis) so it is very easy for food to get into the lungs and cause problems such as chest infections or aspiration pneumonia. A lack of sensitivity in the nerves and muscles can result in leaking into the lungs in Progressive Supranuclear Palsy and Corticobasal Degeneration, referred to as silent aspiration. Frequent coughing is a good indicator that food is going down the wrong way.

Symptoms such as drooling, coughing, difficulties chewing and swallowing, changes in speech or voice require an early referral to a Speech and Language Therapist. Discuss all difficulties or changes as they occur. A programme of exercises specific to need will be prescribed. It is very important to do the exercises regularly.


  • Get a referral to a dietician for advice on diet.
  • Do not drink liquids with food. Take them separately.
  • Do not over fill the mouth.
  • Take small amounts, chew well, pause then remind yourself to swallow.

What happens when eating and swallow issues become a problem?

A doctor will refer you to a dietician for advice. Diet changes may be required if eating becomes more difficult .The type of foods eaten will depend on the level of difficulty  e.g. selecting softer foods,  using mashed or pureed food such as blended fruit or vegetables. Thickeners are added to water, drinks etc. to make swallowing easier. It may be necessary to take extra nutrients. Don’t be put off by the changes, find tastes that suit you and enjoy mealtimes.


When the voice gets weak the person themselves may not always be aware that they are not speaking loud enough to be heard. They will hear themselves clearly but the listener may not.  As a patient you will need to take note if you find that people frequently strain to hear you, ask you to speak up or ask you to repeat what you have just said. Worries about not being heard can add to the stress levels experienced and can aggravate speech difficulties.  It is important to see a Speech and Language Therapist who will recommend a course of regular very effective exercises that will help with loss of voice and volume. This is called the Lee Silverman Technique.

What can I do?

  • Sing Often.
  • Sing scales from high to low.
  • Sing scales from low to high.
  • Think Loud and you will Speak Loud.
  • Do regular breathing exercises.
  • Do regular physical exercise.

Drooling and Dry Mouth

It is normal to produce 1-2 litres of saliva per day. This is important to the health of your mouth, to facilitate talking, eating and swallowing. A build up of saliva or lack of saliva can lead to oral health issues, drooling or a dry mouth. If you are having problems tell your doctor or your consultant at your next visit.