{"id":31791,"date":"2022-04-20T08:26:45","date_gmt":"2022-04-20T15:26:45","guid":{"rendered":"https:\/\/medfitnetwork.org\/public\/?p=31791"},"modified":"2022-04-27T07:14:58","modified_gmt":"2022-04-27T14:14:58","slug":"the-dark-side-of-parkinsons-disease-the-face-of-parkinsons-disease-part-2","status":"publish","type":"post","link":"https:\/\/medfitnetwork.org\/public\/all-mfn\/the-dark-side-of-parkinsons-disease-the-face-of-parkinsons-disease-part-2\/","title":{"rendered":"The Dark Side of Parkinson\u2019s Disease: The FACE of Parkinson\u2019s Disease, Part 2"},"content":{"rendered":"<p><em><span style=\"font-weight: 400;\"><a href=\"https:\/\/medfitnetwork.org\/public\/all-mfn\/the-dark-side-of-parkinsons-disease-the-face-of-parkinsons-disease\/\" target=\"_blank\" rel=\"noopener\">Click to read part 1<\/a> of this article, covering background on facial masking, swallowing, vocal issues for people with PD.<\/span><\/em><\/p>\n<p><span style=\"font-weight: 400;\">As a fitness professional, you can help. The key is is knowing how to appropriately apply facial, swallowing and vocal projections drills to private and group sessions.\u00a0 Below are some tips to utilize with your \u201cfighters\u201d.<\/span><\/p>\n<h4><b>Occupational Therapy Tips<\/b><\/h4>\n<p><b>Decreased facial expression<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400; padding-bottom: 10px;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Practice <\/span><span style=\"font-weight: 400;\">recognizing emotions in other people and creating appropriate responses. These responses may include facial expressions and verbal communication. Practicing these reactions to others can help support relationships.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400; padding-bottom: 10px;\" aria-level=\"2\"><span style=\"font-weight: 400;\">The word, \u201caffect\u201d refers to the appearance of emotion through facial expressions, voice tone, and body language or gestures. If you have trouble with facial expressions, try to express yourself more through adding gestures or body language when you communicate.<\/span><\/li>\n<li style=\"font-weight: 400; padding-bottom: 10px;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Communicate your situation! Try explaining your trouble with facial expressions and decreased voice volume to people who may not initially understand.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Facial exercises:\u00a0<\/span>\n<ul>\n<li style=\"font-weight: 400; font-size: 16px;\" aria-level=\"3\"><span style=\"font-weight: 400;\">look in the mirror and practice your facial expressions.<\/span><\/li>\n<li style=\"font-weight: 400; font-size: 16px;\" aria-level=\"3\"><span style=\"font-weight: 400;\">hold a smile, raise your eyebrows as high as you can, bring your eyebrows together to frown,\u00a0 open your mouth as wide to stretch your jaw, close your eyes tightly and open them wide, close your mouth and expand your cheeks, stick your tongue out and stretch it in each direction<\/span><\/li>\n<li style=\"font-weight: 400; font-size: 16px;\" aria-level=\"3\"><span style=\"font-weight: 400;\">Try to exaggerate your facial expressions and lip movements when you speak<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><b>Drooling<\/b><\/p>\n<p><span style=\"font-weight: 400;\">When eating:<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">Try to maintain good posture<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Focus on keeping your chin up and lips closed when eating<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Swallow often to limit saliva<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Avoid sugary foods that create more saliva<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Lip closure exercises:<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">Close lips tightly for 5 seconds and release (5 times)<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Close lips around tongue depressor and hold while trying to pull from mouth for 5 seconds (5x)<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Fill your cheeks with air and move the air from cheek to cheek (5&#215;5 times)<\/span><\/li>\n<\/ul>\n<h4><b>Dysphagia <\/b><span style=\"font-weight: 400;\">(Swallowing)<\/span><\/h4>\n<p><img fetchpriority=\"high\" decoding=\"async\" class=\"aligncenter size-full wp-image-31792\" src=\"https:\/\/medfitnetwork.org\/public\/wp-content\/uploads\/2022\/04\/Swallowing-Graphic.jpg\" alt=\"\" width=\"850\" height=\"450\" srcset=\"https:\/\/medfitnetwork.org\/public\/wp-content\/uploads\/2022\/04\/Swallowing-Graphic.jpg 850w, https:\/\/medfitnetwork.org\/public\/wp-content\/uploads\/2022\/04\/Swallowing-Graphic-300x159.jpg 300w, https:\/\/medfitnetwork.org\/public\/wp-content\/uploads\/2022\/04\/Swallowing-Graphic-768x407.jpg 768w\" sizes=\"(max-width: 850px) 100vw, 850px\" \/><\/p>\n<p><span style=\"font-weight: 400;\">Transferring food from a utensil to the mouth, chewing the food then swallowing and most likely socializing all at the same time without any problems is a task most people take for granted.\u00a0 According to Dr. Jose Vega MD, PhD, three phases must occur in order to swallow properly.<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400; padding-bottom: 10px;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The Oral Phase:<\/span><span style=\"font-weight: 400;\">\u00a0This phase begins when food is placed in the mouth and moistened with saliva. Moistened food is called a food bolus.<\/span><\/li>\n<li style=\"font-weight: 400; padding-bottom: 10px;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The Pharyngeal Phase: As the food bolus reaches the pharynx, special sensory nerves activate the involuntary phase of swallowing.<\/span><\/li>\n<li style=\"font-weight: 400; padding-bottom: 10px;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The Esophageal Phase: As food leaves the pharynx, it enters the esophagus, a tube-like muscular structure that leads food into the stomach due to its powerful coordinated muscular contractions. The passage of food through the esophagus during this phase requires the coordinated action of the vagus nerve, the glossopharyngeal nerve, and nerve fibers from the sympathetic nervous system.<\/span><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">Difficulty swallowing as it pertains to PD, reflects a deficiency of dopamine in the brain and often improves with medication and therapy\/exercises. Drooling is also a symptom and is caused by reduced reflexive swallowing not from an overproduction of saliva but tends to improve with dopamine replacement therapy.\u00a0 I have come to learn over the years that tremors and swallowing problems are usually the reason someone living with PD isolates themself.\u00a0 It is embarrassing to finally get food on your utensil only to get it to your mouth and realize it has scattered all over the place or fear of aspiration which by the way may not always be heard. <\/span><mark><b><i>Aspiration can be quiet and lead to aspiration pneumonia, the leading cause of death in PD.<\/i><\/b><\/mark><\/p>\n<p><span style=\"font-weight: 400;\">Care-partners and Fitness Professionals need to recognize the signs of aspiration as noted below.\u00a0<\/span><\/p>\n<p><strong>Coughing Before\/After Swallowing<\/strong><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Trouble chewing\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Pocketing food inside the cheek<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Gagging during a meal<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Crying or face turning red while eating<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Drooling especially during meals<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Clearing the throat before\/after and throughout the day<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Hoarse during and after the meal<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">For this reason, Coaches at Bridges For Parkinson\u2019s offers popsicles to our &#8220;fighters&#8221; at the end of class. And they love it! They can have a fun treat without the fear of dropping food and visit with others so it is a win-win! Plus, it allows us to make sure they are hydrated. Sneaky, sneaky!<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If a person living with Parkinson\u2019s Disease or their care-partner is not sure whether their loved one has a swallowing issue, the Parkinson\u2019s Foundation provides some great questions to help determine the answer:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Have I recently lost weight without trying?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Do I tend to avoid drinking liquids?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Do I get the sensation of food being stuck in my throat?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Do I drool?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Is food collecting around my gum line?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Do I cough or choke before, during or after eating or drinking?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Do I often have heartburn or a sore throat?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Do I have trouble keeping food or liquid in my mouth?\u00a0<\/span><\/li>\n<\/ul>\n<p><b>ORAL EXERCISES to help with strengthening and coordinating the LIPS<\/b><\/p>\n<ol>\n<li><span style=\"font-weight: 400;\">Pucker up and blow a \u201coooo\u201d then transition to an \u201cEEEEEE\u201d (SMILE BIG!)<\/span><\/li>\n<li><span style=\"font-weight: 400;\">\u201cMMMM\u201d press lips together as much as possible and take a deep breath in and hum.. \u00a0 \u00a0 \u00a0 \u00a0 good for the lungs too.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">\u201cBlowfish Hold\u201d and hand isometrically pushes into cheek<\/span><\/li>\n<\/ol>\n<p><b>TONGUE- ROM, Coordination and strength to help with eating and drinking<\/b><\/p>\n<ol>\n<li><span style=\"font-weight: 400;\">Stick tongue out as far as possible and hold it there (add SPOON FOR RESISTANCE)<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Stick tongue out and up and hold (ADD SPOON FOR RESISTANCE)<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Stick tongue into sides of cheek (helps with food deposits)<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Roll tongue back and press against roof of mouth<\/span><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">In addition to swallowing exercises, meal prep aids in reducing issues brought on by dysphagia and may lower the risk of aspiration. The APDA Organization recommends the following nutritional information:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Foods that don\u2019t require vigorous chewing. Avoid dry and crumbly foods.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Moderately textured wheat breads instead of very coarse, nutty breads or very soft, white breads.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Oatmeal, cream of wheat or moistened dry cereals instead of coarse, dry cereals.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Well-cooked, tender chicken\/turkey, well-cooked fish without bones, chopped and ground meats, instead of stringy, tough meats that require a lot of chewing.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Soft casseroles and poached or scrambled eggs<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Mashed potatoes or rice, moistened with gravy or margarine, instead of wild rice or French-fried potatoes.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Soft, cooked pasta elbows, instead of long spaghetti.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Soft, well-cooked vegetables, cut up or creamed, instead of raw vegetables or those with a hard texture.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Pureed or mashed fruits, fruit juices and fruit sauces, instead of fruits with seeds or hard outer skins. Avoid nuts, seeds or coconut.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Custard, yogurt, ice cream or other soft desserts<\/span><\/li>\n<\/ul>\n<h4><b>Speech<\/b><\/h4>\n<p><span style=\"font-weight: 400;\">The article begins with a story of a grandmother experiencing dysphagia, hypomimia and hypophonia (softness of voice).\u00a0 But people living with PD are not limited to hypophonia when it comes to speech problems.\u00a0 Dysarthria and tachyphemia are additional speech issues people living with PD may experience.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Hypophonia or softness of voice is a condition that the Davis Phinney Foundation states 90% of people living with PD will experience. Characteristics of hypophonia include raspy voice, low speech volume, breathy and\/or monotone speech.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Dysarthria is another speech issue related to PD. It is characterized by poor articulation, respiration and\/or phonation according to the National Aphasia Association.\u00a0 Speech will come across as slurred, effortful and can often be mistaken for inebriated.\u00a0 Doctors encourage people living with PD who are still driving to wear a bracelet to help law enforcement know they are not drunk.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Tachyphemia or acceleration of speech is also related to speech issues. A person struggling with tachyphemia will sound like all their words are jumbled together and often feel like their tongue is twisted.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">While these issues are troublesome and frustrating, there are some easy and even fun ways to combat low volume, slurred and accelerated speech.\u00a0\u00a0<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Music Therapy &#8211; <\/span><span style=\"font-weight: 400;\">t<\/span><span style=\"font-weight: 400;\">herapy defined broadly by the <\/span><a href=\"https:\/\/www.musictherapy.org\/about\/musictherapy\/\"><span style=\"font-weight: 400;\">American Music Therapy Association<\/span><\/a><span style=\"font-weight: 400;\"> as \u201ca treatment including creating, singing, moving to, and\/or listening to music [through which] clients\u2019 abilities are strengthened and transferred to other areas of their lives.\u201d <\/span>All over the country, Parkinson\u2019s Choirs are using singing to help improve respiration, Swallowing and enhanced volume and clarity of voice.<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Breathing Drills- Strong lungs reduces risk of pneumonia and allows the person to complete ADL\u2019s with little to no complications.\u00a0\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">LSVT LOUD:<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">an effective speech treatment for people with Parkinson&#8217;s disease (PD) and other neurological conditions. <\/span><span style=\"font-weight: 400;\">A study on hypophonia in PD reviewed the effectiveness of LSVT treatment for those with idiopathic PD and found that voice loudness significantly improved. Goals include: increased voice volume, improved articulation, increased confidence with communication, and changes in neural function related to speech (<\/span><a href=\"https:\/\/n.neurology.org\/content\/60\/3\/432\"><span style=\"font-weight: 400;\">https:\/\/n.neurology.org\/content\/60\/3\/432<\/span><\/a><span style=\"font-weight: 400;\">)<\/span><\/li>\n<li aria-level=\"1\"><span style=\"font-weight: 400;\"><a href=\"https:\/\/apps.apple.com\/app\/speak-up-for-parkinsons\/id784117908\" target=\"_blank\" rel=\"noopener\">Speak Up For Parkinson\u2019s App<\/a>: Yes, an app with exercises that also provides visual feedback on volume.\u00a0\u00a0<\/span><\/li>\n<\/ol>\n<p><b>Exercises<\/b><\/p>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Breathe in and exhale on a vowel for 5 seconds.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Hum for 3 seconds making sure to press the lips together then have the \u201cfighter\u201d say\u2026.<\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><span style=\"font-weight: 400;\">Their favorite food or movie or color.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Hum for 3 seconds then say the vowels, sliding the voice from one vowel to the next.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Recite a poem with various emotions.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Partner \u201cfighters\u201d and have them share jokes with each other. Whoever laughs the hardest wins!<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Close class or a session with a short song or team phrase .\u00a0<\/span><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">Fitness Professionals have the unique opportunity to incorporate exercises for the face, voice and swallowing while also performing strength and\/or cardio exercises. You do not have to separate the two. It is a great way to challenge the cognitive aspects and\u00a0 the physical, all while having fun! The best part is it creates a community moment which deepens their love and trust for you, the fitness professionals.\u00a0 You are making a difference!&#8217;<\/span><\/p>\n<p><a href=\"https:\/\/www.medfitclassroom.org\/product\/parkinsons-fitness-specialist\/\" target=\"_blank\" rel=\"noopener\"><img decoding=\"async\" class=\"aligncenter wp-image-30688 size-large\" src=\"https:\/\/medfitnetwork.org\/public\/wp-content\/uploads\/2021\/08\/PDFS_updated-1024x389.jpg\" sizes=\"(max-width: 1024px) 100vw, 1024px\" srcset=\"https:\/\/medfitnetwork.org\/public\/wp-content\/uploads\/2021\/08\/PDFS_updated-1024x389.jpg 1024w, https:\/\/medfitnetwork.org\/public\/wp-content\/uploads\/2021\/08\/PDFS_updated-300x114.jpg 300w, https:\/\/medfitnetwork.org\/public\/wp-content\/uploads\/2021\/08\/PDFS_updated-768x292.jpg 768w, https:\/\/medfitnetwork.org\/public\/wp-content\/uploads\/2021\/08\/PDFS_updated.jpg 1185w\" alt=\"\" width=\"1024\" height=\"389\" \/><\/a><\/p>\n<hr \/>\n<p><em>Co-authored by Colleen Bridges, M. Ed, NSCA-CPT; Renee Rouleau-B.S., PhD student, Jacobs School of Biomedical Sciences, University at Buffalo; Kristi Ramsey, OTD, OTR\/L.<\/em><\/p>\n<p>&nbsp;<\/p>\n<p><b>References<\/b><\/p>\n<ul>\n<li>ParkinsonsDisease.net (Emily Downward)<\/li>\n<li>Mayo Clinic<\/li>\n<li><a href=\"https:\/\/neurologicalsurgery.in\/top-facial-exercise-for-parkinsons-patient\/\">https:\/\/neurologicalsurgery.in\/top-facial-exercise-for-parkinsons-patient\/<\/a><\/li>\n<li><a href=\"https:\/\/www.mottchildren.org\/health-library\/hw81637\">https:\/\/www.mottchildren.org\/health-library\/hw81637<\/a><\/li>\n<li><a href=\"https:\/\/www.urmc.rochester.edu\/encyclopedia\/content.aspx?contenttypeid=135&amp;contentid=376\">https:\/\/www.urmc.rochester.edu\/encyclopedia\/content.aspx?contenttypeid=135&amp;contentid=376<\/a><\/li>\n<li><a href=\"https:\/\/n.neurology.org\/content\/60\/3\/432\">https:\/\/n.neurology.org\/content\/60\/3\/432<\/a><\/li>\n<li>Ricciardi, L., De Angelis, A., Marsili, L., Faiman, I., Pradhan, P., Pereira, E. A., Edwards, M. J., Morgante, F., &amp; Bologna, M. (2020). Hypomimia in Parkinson\u2019s disease: an axial sign responsive to levodopa. <i>European Journal of Neurology<\/i>,<i> 27<\/i>(12), 2422-2429.<a href=\"https:\/\/doi.org\/https:\/doi.org\/10.1111\/ene.14452\"> https:\/\/doi.org\/https:\/\/doi.org\/10.1111\/ene.14452<\/a><\/li>\n<li>M\u00e4kinen, E., Joutsa, J., Jaakkola, E., Noponen, T., Johansson, J., Pitkonen, M., Levo, R., Mertsalmi, T., Scheperjans, F., &amp; Kaasinen, V. (2019). Individual parkinsonian motor signs and striatal dopamine transporter deficiency: a study with [I-123]FP-CIT SPECT. Journal of neurology, 266(4), 826\u2013834. <a href=\"https:\/\/doi.org\/10.1007\/s00415-019-09202-6\">https:\/\/doi.org\/10.1007\/s00415-019-09202-6<\/a><\/li>\n<li>Adrienne Wootton, Nicola J. Starkey &amp; Carol C. Barber (2019) Unmoving and unmoved: experiences and consequences of impaired non-verbal expressivity in Parkinson\u2019s patients and their spouses, Disability and Rehabilitation, 41:21, 2516-2527, DOI: <a href=\"https:\/\/doi.org\/10.1080\/09638288.2018.1471166\">10.1080\/09638288.2018.1471166<\/a><\/li>\n<li>National Institute of Diabetes and Digestive and Kidney Diseases. <a href=\"https:\/\/www.niddk.nih.gov\/health-information\/digestive-diseases\/digestive-system-how-it-works\">Your digestive system &amp; how it works<\/a>.<\/li>\n<li>Finsterer J, Grisold W. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/labs\/pmc\/articles\/PMC4481793\/\">Disorders of the lower cranial nerves<\/a>. <i>J Neurosci Rural Pract<\/i>. 2015;6(3):377-391. doi:10.4103\/0976-3147.158768<\/li>\n<li>National Institute on Deafness and Other Communication Disorders. <a href=\"https:\/\/www.nidcd.nih.gov\/health\/dysphagia\">Dysphagia<\/a>.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Click to read part 1 of this article, covering background on facial masking, swallowing, vocal issues for people with PD. As a fitness professional, you can help. The key is is knowing how to appropriately apply facial, swallowing and vocal projections drills to private and group sessions.\u00a0 Below are some tips to utilize with your \u201cfighters\u201d. Occupational Therapy Tips Decreased facial expression Practice recognizing emotions in other people and creating appropriate responses. These responses may include facial expressions and verbal communication. Practicing these reactions to others can help support relationships.\u00a0 The word, \u201caffect\u201d refers to the appearance of emotion through facial expressions, voice tone, and body language or gestures. If you have trouble with facial expressions, try to express yourself more through adding gestures or body language when you communicate. Communicate your situation! Try explaining your trouble with facial expressions and decreased voice volume to people who may not initially understand. Facial exercises:\u00a0 look in the mirror and practice your facial expressions. hold a smile, raise your eyebrows as high as you can, bring your eyebrows together to frown,\u00a0 open your mouth as wide to stretch your jaw, close your eyes tightly and open them wide, close your mouth and [&hellip;]<\/p>\n","protected":false},"author":361,"featured_media":23290,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[1],"tags":[198,92],"class_list":["post-31791","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-all-mfn","tag-fitness-professionals","tag-parkinsons"],"jetpack_publicize_connections":[],"_links":{"self":[{"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/posts\/31791","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/users\/361"}],"replies":[{"embeddable":true,"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/comments?post=31791"}],"version-history":[{"count":6,"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/posts\/31791\/revisions"}],"predecessor-version":[{"id":31804,"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/posts\/31791\/revisions\/31804"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/media\/23290"}],"wp:attachment":[{"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/media?parent=31791"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/categories?post=31791"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/tags?post=31791"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}