Dysphagia Grand Rounds 4

The fourth Dysphagia Grand Rounds (DGR 4) research article being reviewed in April 2017 is posted below. This study's objective was to test the treatment outcome of a 4-week expiratory muscle strength training (EMST) program on swallowing safety in patients with Parkinson's Disease. Does the use of EMST improve hyoid elevation? Does it decrease dysphagia severity and minimize the risks of aspiration? Be sure to read the article below to find answers to some of these questions and watch the DGR 4 webinar to maximize your learning experience. 

Article
Aspiration and Swallowing in Parkinson Disease and Rehabilitation with EMST: A Randomized Trial

Authors: M.S. Troche, M.S. Okun, J.C. Rosenbek, N. Musson, H.H. Fernandez, R. Rodriguez, J. Romrell, T. Pitts, K.M. Wheeler-Hegland, and C.M. Sapienza
Journal:  Neurology. 2010;75(21):1912-1919.

Download DGR 4 article herehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2995389/

Download DGR 4 webinar here: http://dysphagiagrandrounds.yondo.com/playlist/dgr-4-april-2017/251

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.

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.