How is your father-in-law? Progressive bulbar palsy involves the brain stem which is important in swallowing, speaking, chewing, and other functions. Symptoms include pharyngeal muscle weakness involved with swallowing, weak jaw and facial muscles, progressive loss of speech, and tongue muscle atrophy. Limb weakness is almost always evident but less prominent. Individuals are at increased risk of choking and aspiration pneumonia that is why a percutaneous endoscopic gastrostomy (PEG) is often requested. A PEG is a safe and effective way to provide food, liquids and medications directly into the stomach. This procedure is done for patients who are having difficulty swallowing. It is best that you discuss the management plan with his attending physician for proper evaluation. Hope this helps. Take care and do keep us posted.