Aspiration and swallowing in Parkinson disease and rehabilitation with EMST

Abstract

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.

Differential effects of targeted tongue exercise and treadmill running on aging tongue muscle structure and contractile properties

“…Specific motor exercises that include the swallow and have been shown clinically to improve behavioral aspects of the swallow are the Mendelsohn Maneuver, the effortful swallow, and the Masako Maneuver (5,8,62). However, motor exercises that do not include a swallow such as progressive resistance tongue exercise with the Iowa Oral Pressure Instrument, expiratory muscle strength training, and the Shaker Head Lift have also led to improvements in strength and swallowing function (5,8,53,62,65,79). Therefore, we included aspects of learning and specificity in our study to further investigate their effects on the tongue musculature.…”

Efeitos do exercício muscular respiratório na biomecânica da deglutição de indivíduos normais

“…Troche et al 5 reported that the airway protection was improved and the risk of penetration/aspiration were not found in the literature, which limited the theoretical study and discussion of this study. Thus, we suggest further studies addressing the use of IS related to the biomechanics of swallowing.…”

“…Steele et al 4 presented correlations between vertical and horizontal movement of this complex during swallowing and the predictive value for biomechanical of swallowing disorders. In this context, Troche et al 5 carried out a study in which they demonstrated the importance of respiratory muscle training, through the use of expiratory spirometry for the dysphagia rehabilitation in Parkinson patients. They verified that there was an improvement in the function of swallowing, being it attributed to the improvement of the hyolaryngeal complex function, resulting in an increased airway protection during swallowing.…”

“…Such structures may present improved mobility and function, from the respiratory muscle training with the use of incentive spirometry 5 .…”

Respiratory training in an individual with amyotrophic lateral sclerosis

“…This training protocol is based on a previous trial in individuals with Parkinson's disease with an extended training length 12. Training occurred in the patient's home, with nose clips in place to avoid nasal air emissions.…”