Arquivo da categoria: Parkinson’s disease

Swallowing disorders in Parkinson’s disease: impact of lingual pumping

Int J Lang Commun Disord. 2015 Feb 4. doi: 10.1111/1460-6984.12158. [Epub ahead of print]

Abstract

BACKGROUND:

Lingual pumping (LP) is a repetitive, involuntary, anteroposterior movement of the tongue on the soft palate that is executed prior to transferring the food bolus to the pharynx, but we also observed LP when multiple swallows were taken. LP may be associated with rigidity and bradykinesia in patients with Parkinson’s disease (PD). This phenomenon tends to be more prevalent in dysphagic PD patients, and its impact on swallowing dynamics remains poorly understood.

OBJECTIVE:

To evaluate how LP interferes with the oral and pharyngeal phases of the swallowing of foods of different consistencies and volumes.

METHODS:

We used videofluoroscopy to study the swallowing of 69 PD patients performing 10 swallows of barium mixed with foods of different consistencies and volumes.

RESULTS:

LP was associated with the unstable intra-oral organization of the bolus, the loss of bolus control, the pharyngeal retention of food and food entering the airway. This abnormal movement was also associated with a shorter oral transit time and was found to be more prevalent with food of thicker consistencies.

CONCLUSIONS:

LP is associated with swallowing incoordination and with food entering the airway. Preventive measures to minimise the pulmonary or nutritional consequences of this behaviour are necessary.

© 2015 Royal College of Speech and Language Therapists.

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Swallowing impairment and pulmonary dysfunction in Parkinson’s disease: the silent threats.

J Neurol Sci. 2014 Apr 15;339(1-2):149-52. doi: 10.1016/j.jns.2014.02.004. Epub 2014 Feb 14.

Abstract

INTRODUCTION:

Swallowing disorders and respiratory impairment are frequent in Parkinson‘s disease (PD) patients, and aspiration pneumonia remains the leading cause of death among these subjects.

OBJECTIVE:

The objective of this study was to investigate whether there is an association between pulmonary impairment and swallowing dysfunction in PD patients.

METHODS:

A cross-sectional study with a comparison group was conducted with PD patients. Subjects were submitted to demographic questionnaires and underwent spirometric and videofluorographic assessments. Significance level was considered at 95% (p<0.05).

RESULTS:

Among 35 PD patients, 40% presented with swallowing complaints. However, 22% of the clinically asymptomatic patients presented airway food penetration when submitted to videofluoroscopy. In 20% of PD patients material entered the airways and there was contact with the vocal folds in 7%. However, there was an efficient cleaning with residue deglutition in almost all patients. No penetration/aspiration was detected among the controls. Respiratory parameters were below the normal predicted values in PD patients when compared to the healthy controls.

CONCLUSION:

These data suggest an association between pulmonary dysfunction and swallowing impairment in PD patients; even in patients without swallowing complaints, impaired pulmonary function can be detected.

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Wet Voice as a Sign of Penetration/Aspiration in Parkinson’s Disease: Does Testing Material Matter?

Sampaio M, Argolo N, Melo A, Nóbrega AC.

October 2014Volume 29Issue 5pp 610-615

Abstract

Wet voice is a perceptual vocal quality that is commonly used as an indicator of penetration and/or aspiration in clinical swallowing assessments and bedside screening tests. Our aim was to describe the clinimetric characteristics of this clinical sign using various fluid materials and one solid food in the Parkinson’s disease (PD) population. Consecutive PD individuals were submitted for simultaneous fiberoptic endoscopic evaluation of swallowing (FEES) and voice recording. Speech therapists rated the presence or absence of wetness and other voice abnormalities. Two binary endpoints of FEES were selected for comparison with an index test: low penetration (LP) and low penetration and/or aspiration (LP/ASP). The accuracy of wet voice changed according to the testing material in PD patients. Overall, the specificity of this indicator was better than its sensitivity, and the wafer cookie and yogurt drink yielded the best indices. Our data show that wet voice is clearly indicative of LP or LP/ASP in PD patients in case of positive test. However, in the case of a negative result, the wet voice test should be repeated or combined with other clinical tests to include or exclude the risk of LP or LP/ASP.

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PARKINSON

Do swallowing exercises improve swallowing dynamic and quality of life in Parkinson’s disease?

lingua
NeuroRehabilitation. 2013 Jan 1;32(4):949-55. doi: 10.3233/NRE-130918.

Source

Division of Neurology and Epidemiology, Federal University of Bahia, Salvador, Brazil.

Abstract

OBJECTIVE:

To investigate the effect of motor swallowing exercises on swallowing dynamic, quality of life and swallowing complaints in Parkinson’s disease (PD).

DESIGN:

A before-after trial.

SETTING:

University Medical Center.

PARTICIPANTS:

Parkinson’s disease patients with dysphagia complaints.

INTERVENTIONS:

Motor swallowing exercises designed to increase the strength and range of motion of the mouth, larynx and pharyngeal structures, coordination between breathing and swallowing, and airway protection. Patients should perform the exercises twice a day, five days a week, for five weeks.

MAIN OUTCOME MEASURE(S):

The primary outcome was the difference before and after the intervention in number of swallowing videofluoroscopic events (Swallowing Score). The secondary outcomes were quality of life (QOL) and swallowing complaints.

RESULTS:

Fifteen patients concluded the study (10 man/5 woman; mean age 59.2 ± 9.17). The videofluoroscopic events with greater improvement were loss of bolus control (P < 0.03), piecemeal swallow (P = 0.05) and residue on the tongue (P < 0.01), valleculae (P = 0.01) and pyriform sinuses (P = 0.05). Lingual pumping and dental absence were interfering factors associated with treatment failure (beta standardized coefficient = -16.6, 26.2; P = 0.02, 0.002, respectively). The domains with greater improvements in QOL were fear (P = 0.02) and symptom frequency (P = 0.05). Regarding swallowing complaints, patients reported to have reduced mainly their difficulty in moving food in the mouth when chewing (P = 0.02). Reduction in swallowing disorders was not related with QOL improvement (cor = 0.13, [95% CI, 0.6-0.4], P = 0.63).

CONCLUSIONS:

Motor swallowing exercises may reduce swallowing disorders in PD patients without lingual pumping and dental absence and impact positively QOL and swallowing complaints in individuals with PD.

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Surface electrical stimulation in dysphagic parkinson patients: A randomized clinical trial

Baijens LW, Speyer R, Passos VL, Pilz W, van der Kruis J, Haarmans S, Desjardins-Rombouts C.

Laryngoscope. 2013 Apr 17.

Abstract

OBJECTIVES/HYPOTHESIS:

A new treatment for oropharyngeal dysphagia in Parkinson’s disease was evaluated in the present study.

STUDY DESIGN:

Prospective randomized controlled trial.

METHODS:

The study describes the effects of surface electrical stimulation (SES) of the neck (submental region) in dysphagic Parkinson patients using different intensities of electrical current. Quasi-random allocation was performed when assigning patients to treatment groups. Three groups consisting of dysphagic patients with idiopathic Parkinson’s disease (N = 90) received daily treatment for 15 days with periods of no treatment during the weekend. All three received traditional logopedic dysphagia treatment. In addition, two groups received SES, either motor-level or sensory-level stimulation. A standardized measurement protocol, including fiber optic endoscopic evaluation of swallowing (FEES) and videofluoroscopy of swallowing (VFS), was performed before and after therapy. A team of experienced raters was blinded to the treatment group and to the moment of measurement. Intrarater and interrater reliability were calculated.

RESULTS:

Using proportional odds models (POMs), some of the visuoperceptual ordinal outcome variables showed significant improvement in all groups following treatment. Following 15 days of SES of the submental region, few significant effects were found, suggesting a therapy effect of traditional logopedic dysphagia treatment without any additional influence of SES.

CONCLUSIONS:

On the grounds of this study, it is concluded that further research is needed on the exact mechanism of SES and its effects on the neural pathways involved in swallowing.

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Respiratory-swallowing coordination and swallowing safety in patients with Parkinson’s disease

Troche MS; Huebner I; Rosenbek JC; Okun MS; Sapienza CM

Dysphagia;26(3):218-24, 2011 Sep.

The purpose of this study was to determine if individuals with Parkinson’s disease (PD) demonstrate abnormal respiratory events when swallowing thin liquids. In addition, this study sought to define associations between respiratory events, swallowing apnea duration, and penetration-aspiration (P-A) scale scores. Thirty-nine individuals with PD were administered ten trials of a 5-ml thin liquid bolus. P-A scale score quantified the presence of penetration and aspiration during the swallowing of a 3-oz sequential bolus. Participants were divided into two groups based on swallowing safety judged during the 3-oz sequential swallowing: Group 1 = P-A â‰¤ 2; Group 2 = P-A â‰¥ 3. Swallows were examined using videofluoroscopy coupled with a nasal cannula to record respiratory signals during the event(s). Findings indicated that expiration was the predominant respiratory event before and after swallowing apnea. The data revealed no differences in our cohort versus the percentages of post-swallowing events reported in the literature for healthy adults. In addition, individuals with decreased swallowing safety, as measured by the P-A scale, were more likely to inspire after swallows and to have shorter swallowing apnea duration. Individuals who inspired before swallow also had longer swallowing apnea duration. The occurrence of inspiratory events after a swallow and the occurrence of shorter swallowing apnea durations may serve as important indicators during clinical swallowing assessments in patients at risk for penetration or aspiration with PD.

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Impaired food transportation in Parkinson’s disease related to lingual bradykinesia

Umemoto G; Tsuboi Y; Kitashima A; Furuya H; Kikuta T

Dysphagia;26(3):250-5, 2011 Sep.

This study aimed to analyze quantitatively videofluoroscopic (VF) images of patients with Parkinson’s disease (PD), to evaluate if the predicted factors of the oral phase of swallowing deteriorated with PD progression, and to demonstrate a relationship between the abnormal movements of the tongue and food transportation. Thirty PD patients were recruited and divided into mild/moderate (Hoehn & Yahr stages II and III) and advanced (stages IV and V) groups. They underwent measurement of tongue strength and VF using 5 ml of barium gelatin jelly as a test food. We measured the speed of bolus movement and the range of tongue and mandible movements during oropharyngeal transit time. The maximum tongue pressure of the mild/moderate group was significantly larger than that of advanced group (p = 0.047). The oropharyngeal transit time of the mild/moderate group was significantly shorter than that of the advanced group (p = 0.045). There was a significant negative correlation between the speed of tongue movement and the oropharyngeal transit time (p = 0.003, R = -0.527). Prolonged mealtimes and the ejection of insufficiently masticated food from the oral cavity into oropharynx were associated with PD progression. These results indicate the importance of the oral phase of swallowing in PD patients.

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