Journal
NEUROLOGY
Volume 75, Issue 21, Pages 1912-1919Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1212/WNL.0b013e3181fef115
Keywords
-
Categories
Funding
- VA Rehab RD [B3721R]
- Michael J. Fox Foundation [00056150]
- National Parkinson Foundation Center of Excellence
- Medtronic, Inc.
- NIH [PI R21NS072897, PI R34MH080764, NIDCHD HD046903-01A112/0 [PI]]
- University of Florida Foundation
- Parkinson Alliance
- Michael J. Fox Foundation
- National Parkinson Foundation
- AstraZeneca
- Forest Laboratories, Inc.
- Novartis
- Solvay Pharmaceuticals, Inc.
- Teva Pharmaceutical Industries Ltd.
- NIH/NINDS [U10 NS53381-01 [PI]]
- Huntington Study Group
- Movement Disorders Society
- Parkinson Study Group
- Society of Progressive Supranuclear Palsy
- Merz Pharmaceuticals, LLC
- Ipsen
- US Veterans Administraion
- CurePSP
- Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Rehabilitation Research and Development Service
Ask authors/readers for more resources
Objective: Dysphagia is the main cause of aspiration pneumonia and death in Parkinson disease (PD) with no established restorative behavioral treatment to date. Reduced swallow safety may be related to decreased elevation and excursion of the hyolaryngeal complex. Increased submental muscle force generation has been associated with expiratory muscle strength training (EMST) and subsequent increases in hyolaryngeal complex movement provide a strong rationale for its use as a dysphagia treatment. The current study's objective was to test the treatment outcome of a 4-week device-driven EMST program on swallow safety and define the physiologic mechanisms through measures of swallow timing and hyoid displacement. Methods: This was a randomized, blinded, sham-controlled EMST trial performed at an academic center. Sixty participants with PD completed EMST, 4 weeks, 5 days per week, for 20 minutes per day, using a calibrated or sham, handheld device. Measures of swallow function including judgments of swallow safety (penetration-aspiration [PA] scale scores), swallow timing, and hyoid movement were made from videofluoroscopic images. Results: No pretreatment group differences existed. The active treatment (EMST) group demonstrated improved swallow safety compared to the sham group as evidenced by improved PA scores. The EMST group demonstrated improvement of hyolaryngeal function during swallowing, findings not evident for the sham group. Conclusions: EMST may be a restorative treatment for dysphagia in those with PD. The mechanism may be explained by improved hyolaryngeal complex movement. Classification of evidence: This intervention study provides Class I evidence that swallow safety as defined by PA score improved post EMST. Neurology (R) 2010;75:1912-1919
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available