Original article
Skill Training for Swallowing Rehabilitation in Patients With Parkinson's Disease

Presented to the Dysphagia Research Society, March 14, 2013, Seattle, WA.
https://doi.org/10.1016/j.apmr.2014.03.001Get rights and content

Abstract

Objective

To examine the effects of skill training on swallowing in individuals with dysphagia secondary to Parkinson's disease (PD) and to explore skill retention after treatment termination.

Design

Within-subject pilot study with follow-up after 2 weeks of treatment and after a 2-week nontreatment period.

Setting

Clinic in a research institute.

Participants

Patients (N=10; mean age, 67.4y) included 3 women (mean Hoehn and Yahr score, 2.6) and 7 men (mean Hoehn and Yahr score, 2.4).

Intervention

Patients underwent 10 daily sessions of skill training therapy focused on increasing precision in muscle contraction during swallowing using visual feedback.

Main Outcome Measures

Data from the timed water swallow test, Test of Mastication and Swallowing Solids, surface electromyography (sEMG) of submental muscles, and swallowing-related quality of life questionnaire were collected at 2 baseline sessions (conducted 2wk apart) at the end of treatment and after 2 nontreatment weeks to assess skill retention.

Results

Immediately after posttreatment, the swallowing rate for liquids (P=.034), sEMG durational parameters of premotor time (P=.003), and preswallow time (P<.001) improved. A functional carryover effect was seen from dry to water swallows (P=.009). Additionally, swallowing-related quality of life improved (P=.018). Reassessment at 2 weeks after treatment termination revealed short-term retention of treatment effects.

Conclusions

A skill-based training approach produced functional, biomechanical, and swallowing-related quality of life improvements in this cohort indicating compelling evidence for the effectiveness of this novel approach for dysphagia rehabilitation in PD.

Section snippets

Participants

Ten patients were recruited from 4 PD outpatient movement disorders clinics. Selection criteria included the following: diagnosis of PD by a neurologist, self-identified dysphagia of ≥3 months' duration using the Eating Assessment Tool,22 and dysphagic presentation on clinical swallowing evaluation. The primary researcher conducted the clinical swallowing evaluation for all the patients. This consisted of a detailed case history, cranial nerve examination, inhalation cough challenge, oral

Results

Intrarater reliabilities across all outcome measurements were .94 to 1 (single-measure intraclass correlation coefficient), and interrater reliabilities for all parameters were .80 to .99; all were considered to indicate “almost” perfect agreement.26, 27

Discussion

This study evaluated a uniquely designed skill training approach for dysphagia rehabilitation in patients with PD. Despite the small sample size, there were significant effects of treatment in many of the outcome measures providing compelling evidence for the efficacy of this novel treatment approach.

As expected, during the nontreatment baseline phase, all outcome measures remained unchanged, apart from the SWAL-QOL. This indicates that the group as a whole was physiologically stable,

Conclusions

Skill training provided functional, biomechanical, and SWAL-QOL improvements in this cohort of dysphagic patients secondary to PD. Despite the small sample size, this study provides evidence for the viability and efficacy of this novel approach for dysphagia rehabilitation. Findings suggest that skill training may have increased the neuromuscular coordination, timing, speed of reaction, and planning of movement of orolingual structures in this sample. Additionally, heightened cortical awareness

Suppliers

  • a.

    Arnott's Biscuit Ltd, 24 George St, North Strathfield, NSW 2137 Australia.

  • b.

    Model 7120; KayPentax, 2 Bridgewater Ln, Lincoln Park, NJ 07035.

  • c.

    Model ES65; Samsung, Dongguan, China, 523000.

  • d.

    Thought Technology Ltd, 8205 Montreal/Toronto Blvd, Ste 223, Montreal West, QC, Canada, H4X1N1.

  • e.

    Myopace, Model NE-1; Niche Technology Ltd, Christchurch, 8011, New Zealand.

  • f.

    SPSS Inc, 233 S Wacker Dr, 11th Fl, Chicago, IL 60606.

Acknowledgments

We thank Ben Han for his contribution to the design and development of the BiSSkiT software.

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