In its early stages, the symptoms on PSP can resemble those of Parkinson’s disease or other neurological disease so it can be hard to diagnose. PSP is caused by nerve cells in certain areas of the brain become damaged by a build up of protein (tau). This can lead to difficulties with balance, movement, vision, speech and swallowing.
Speech changes are common in PSP. Speech can become slurred or speech rate can become too fast, leading to difficulties being understood. Changes in voice quality can also occur: strained or harsh voice, or quiet and breathy voice. Cognitive (thinking) skills can also be affected and this can impact ability to communicate. Many people find that facial expression becomes reduced and difficulties with eye movement also affect non-verbal communication.
Speech therapists assess all aspects of communication and suggest strategies for keeping communication effective. They may offer to work with friends and family, as well as the person with PSP. You may be offered therapy to improve voice quality and improve intelligibility of speech, for example, by controlling speech rate effectively. Some people with a quiet voice benefit from use of a voice amplifier.
In cases where speech has become very unclear, support materials can be developed with a speech therapist such as communication charts, books, or electronic aids can be used (such as tablets with communication software installed). The speech therapist can advise on what is likely to be most helpful.
Swallowing difficulties are also common in PSP. These include:
- Coughing or choking on food or drink
- Wet voice quality when eating or drinking
- Taste changes – people may develop a preference for sweet food
- Eating too fast or putting too much food in the mouth
- Because PSP can cause difficulties with downward eye movement, it can be difficult to see food and bring it to your mouth. This means that some people require assistance with eating
Difficulties with eating or drinking can lead to weight loss, repeated chest infections (through small amounts of food and drink being aspirated into the lungs) and increased risk of choking. The following is some general advice:
- Sit upright, facing forwards, chin level or down slightly
- Avoid distractions, e.g. turn off the TV and try not to talk during a meal
- Take small mouthfuls of food
- Take your time, don’t rush
- Chew carefully and finish each mouthful before you take the next
- When drinking take single sips of fluids slowly, rather than gulping mouthfuls
- Avoid mixing fluids and solids e.g. soup with bits in, cornflakes with milk
- Avoid dry crumbly foods, moist foods may be easier
- Sit upright for 20 minutes after eating and drinking
A Speech Therapist can help with these difficulties by providing a full assessment and advice on strategies, equipment, modified food and drink textures, and/or swallowing exercises. If swallowing deteriorates to the point where it is no longer safe, some people choose to have a gastrostomy, where nutrition and hydration is given by tube directly into the stomach through a small tube.