Quiz: Difficult to swallow

Manuel, aged 67, has Parkinson’s disease. His dysphagia has recently worsened.

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For Manuel, an enteral formula avoiding excess protein is chosen with adequate fibre and fluid to prevent constipation.

The daytime tube-feeding regimen is altered to allow levodopa dosing to be given half an hour before each oral meal.

This maximises his swallowing muscle control at mealtimes to enjoy his food.

His wife helps him with meals and monitors his swallowing to ensure that he clears his mouth and has no signs of aspiration.

In between meals, he keeps his mouth moist with regular swabs. Regular re