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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Awareness of dysphagia in Parkinson’s disease

Bayés-Rusiñol À; Forjaz MJ; Ayala A; Crespo Mde L; Prats A; Valles E; Petit C; Casanovas M; Garolera-Freixa M

Rev Neurol;53(11):664-72, 2011 Dec 1.

INTRODUCTION AND AIM: In order to be able to assess the level of awareness of swallowing disorders in Parkinson’s disease (PD), a specific questionnaire was designed and validated: the Dysphapark questionnaire. PATIENTS AND METHODS: A total of 470 persons with PD were asked whether they believe they have problems swallowing or not, and then they filled in a self-administered questionnaire that evaluates the effectiveness and safety of swallowing. The Dysphapark questionnaire was validated by means of Rasch analysis and classical psychometric methods. RESULTS: The safety and effectiveness dimensions of the Dysphapark fit the Rasch model well. The efficacy dimension showed significant differences for gender, length of the illness, awareness of dysphagia and length of meals. Significant differences were also found in the safety dimension for length and severity of illness, awareness of dysphagia, speech therapy and knowledge of thickening agents. Despite the fact that 90% of patients had problems concerning effectiveness and safety in swallowing, 79.45% were not aware that they suffered from dysphagia. CONCLUSIONS: The Dysphapark questionnaire is a suitable measure of dysphagia in PD, according to the Rasch analysis. A high proportion of patients with PD have dysphagia, although it has been observed that they have a low level of awareness of the condition, of the consequences it may have and of the possibility of using thickening agents. Given that some of the swallowing disorders in PD are asymptomatic and that the level of awareness of the disorder is low, we recommend including specific questionnaires as well as clinical and instrumental evaluation of dysphagia in clinical practice.

 

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Analysis of oropharyngeal dysphagia through fibroendoscopy evaluation of swallowing in patients with Parkinson’s disease

Correa-Flores M; Arch-Tirado E; Villeda-Miranda A; Rocha-Cacho KE; Verduzco-Mendoza A; Hernández-López X

Cir Cir;80(1):31-7, 2012 Jan-Feb.

BACKGROUND: Parkinson’s disease (PD) has a high incidence in Mexico and is estimated at approximately 500,000 patients. One of the main clinical manifestations of PD is dysphagia, which is the difficult passage of food from the mouth to the stomach. The aim of this study was to assess oropharyngeal dysphagia through fibroendoscopy evaluation of swallowing in patients with PD. METHODS: We conducted a census sample of patients with PD: 17 males and 10 females, aged >49 years. Clinical history, physical examination and neurological evaluation of swallowing fibroendoscopy were carried out. RESULTS: Of the symptomatic patients, 16 patients (59.25%) reported dysphagia. Fibroendoscopic evaluation demonstrated swallowing disorders in 25 patients (92.59%). The main findings were poor bolus control in 19 patients (70.37%), deficits in bolus propulsion in 25 patients (92.59%), impaired swallowing in 14 patients (51.85%), fractional swallowing in 11 patients (40.74%), reduced epiglottic tilting in 11 patients (48.14%), food residue in vallecula in 24 patients (88.88%) and piriform sinus in 19 patients (70.37%). There was no correlation between duration of PD and degree of involvement of oropharyngeal dysphagia. CONCLUSIONS: Oropharyngeal dysphagia in patients with PD is a common symptom and can range from the oral cavity to the upper esophageal sphincter. Early onset of severe dysphagia is exceptional in this disease and should alert the clinician to the diagnostic possibility of parkinsonism.

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Neuromuscular electrical stimulation versus traditional therapy in patients with Parkinson’s disease and oropharyngeal Dysphagia: effects on quality of life

Heijnen BJ; Speyer R; Baijens LW; Bogaardt HC

Dysphagia; 27(3): 336-45, 2012 Sep

ABSTRACT:

This study compares the effects of traditional logopedic dysphagia treatment with those of neuromuscular electrical stimulation (NMES) as adjunct to therapy on the quality of life in patients with Parkinson’s disease and oropharyngeal dysphagia. Eighty-eight patients were randomized over three treatment groups. Traditional logopedic dysphagia treatment and traditional logopedic dysphagia treatment combined with NMES at sensor or motor level stimulation were compared. At three times (pretreatment, post-treatment, and 3 months following treatment), two quality-of-life questionnaires (SWAL-QOL and MD Anderson Dysphagia Inventory) and a single-item Dysphagia Severity Scale were scored. The Functional Oral Intake Scale was used to assess the dietary intake. After therapy, all groups showed significant improvement on the Dysphagia Severity Scale and restricted positive effects on quality of life. Minimal group differences were found. These effects remained unchanged 3 months following treatment. No significant correlations were found between dietary intake and quality of life. Logopedic dysphagia treatment results in a restricted increased quality of life in patients with Parkinson’s disease. In this randomized controlled trial, all groups showed significant therapy effects on the Dysphagia Severity Scale and restricted improvements on the SWAL-QOL and the MDADI. However, only slight nonsignificant differences between groups were found.

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Aspectos fonaudiológicos na doença de Parkinson

Palermo, Simone; Tavares, Eloíza Fernandes; Bastos, Izabel Cristina Constantino; Mendes, Maria Filomena X.

Rev. bras. neurol; 43(1): 33-39, jan.-mar. 2007.

Resumo

A doença de Parkinson se caracteriza por alteração da motilidade involuntária que pode levar ao comportamento da articulação da palavra da voz e da deglutição em alguma fase da doença. O objetivo é relacionar o atendimento fonoaudiológico de acordo com o estágio da doença, aplicando técnicas fonoaudiológicas tradicionais possibilitando a intervenção na mobilidade e na flexibilidade oromuscular para a articulação dos sons, coordenação das estruturas da fala, controle e aumento da capacidade respiratória e dos distúrbios específicos da deglutição, visando aplicabilidade de técnicas fonoaudiológicas compatíveis com a doença de Parkinson, além de verificar se a alteração olfatória referida e constatada em avaliação fonoaudiológica, tem relação com possível déficit cognitivo (memória olfatória) ou faz parte do processo de senilidade. Foram selecionados 47 pacientes do ambulatório de distúrbios do movimento do INDC/UFRJ, com diagnóstico de doença de Parkinson, avaliados segundo a escala de Hoehn & Yahr, com queixas relativas à articulação da palavra, da fonação e da deglutição e encaminhados ao setor de fonoaudiologia. Dos 47 pacientes, selecionou-se 23 no estágio II da referida escala, visando aplicação mensal do exame TMF (tempo máximo fonatório) por um período de um ano e três meses, avaliando coaptação de pregas vocais, dinâmica respiratória, equilíbrio de força aerodinâmica rouca (85%), articulação disártrica (74%), anosmia (72%), tremor de língua (70%), disfagia (49%), sialismo presente (49%), ATM com deslocamento (47%), reflexo protetivo de tosse e pigarreio ausentes (28%) ritmo de fala bradilálico (23%), tremor da mandíbula (15%). No TMF, o maior percentual de alteração foi em eficiência glótica (34%) e o menor em hipercontração de pregas vocais (17%). A aplicação de técnicas fonoaudiológicas relativas aos distúrbios da comunicação oral e deglutição do paciente com doença de Parkinson no ambulatório de fonoaudiologia no INDC/UFRJ vem … Parkinson.

Assuntos

Humanos Doença de Parkinson/complicações Fonoaudiologia Distúrbios da Voz

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Disfagia do idoso: estudo videofluoroscópico de idosos com e sem doença de Parkinson

Bigal, Alessandra; Harumi, Daniela; Luz, Mislene; De Luccia, Gabriela; Bilton, Tereza.

Distúrb. comun; 19(2): 213-223, 2007.

Resumo

Objetivo: descrever as alterações nas fases oral, farínfea e esofágica da deglutição de pacientes idosos com doença de Parkinson (DP) avaliados pela videofluoroscopia, comparando com as queixas relatadas pelos mesmos; comparar as alterações entre pacientes com doença de Parkinson e um grupo de idosos com mais de 60 anos sem alterações neurológicas (grupo controle). Método: foram levantadas as principais queixas quanto à deglutição e avaliados pela videofluoroscopia 25 pacientes com doença de Parkinson (DP), sendo 19 do sexo masculino e 6 do sexo feminino entre o II e IV estágio da doença, segundo a escala modificada de Hoehn e Yahr. Os pacientes foram avaliados em todas as consistências alimentares. Os achados foram comparados com o grupo controle. Resultados: na fase oral, as alterações mais comuns foram: dificuldade no movimento de preparo e organização do bolo alimentar, fechamento labial inadequado, tremor da língua em repouso e durante a mastigação e permanência do meio de contraste em cavidade oral. Na fase faríngea foi observada estase em valéculas, recessos piriformes e esfíncter esofágico superior, necessidade de múltiplas deglutições para limpeza e aspiração laringo-traqueal. Na fase esofágica, presença de contrações terciárias, diminuição do peristaltismo, presença de refluxo gastroesofágico. Conclusão: pacientes com doença de Parkinson podem apresentar alterações nas fases oral, faríngea e esofágica da deglutição mais freqüentes do que em idosos sem alterações neurológicas .

Assuntos

Humanos Masculino Feminino Idoso Idoso de 80 Anos ou mais Deglutição Doença de Parkinson Idoso FluoroscopiaEstudos de Casos

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