Study Rationale:
Aspiration pneumonia is a leading cause of death in persons with Parkinson's disease (PD). One of the main reasons people with PD develop aspiration pneumonia is that they often have both swallowing dysfunction (dysphagia) and cough dysfunction (dystussia). If food or liquid enters the airway, a cough is not elicited and the material remains in the airway (silent aspiration). It is then possible for the material to enter the lungs, resulting in an infection called aspiration pneumonia. Currently, there are no tested treatment approaches that specifically target silent aspiration.
Hypothesis:
The goal of this study is to determine how well two different rehabilitation treatments, expiratory muscle strength training (EMST) and sensorimotor treatment for airway protection (smTAP), work to improve cough and swallowing function in persons with PD and dysphagia.
Study Design:
This study will include two participant groups; one group will receive EMST and the other will receive smTAP. There will be initial baseline testing of swallowing, coughing, respiratory and laryngeal function. We will also measure their perception of their cough and swallowing problem. Then, participants will be randomly assigned to either the EMST or smTAP training groups. They will be further randomized to receive immediate training or delayed training where there is a five-week wait to start with a second baseline performed at the end of the five-week delay. Once training is complete they will once again complete measures of swallowing, coughing, respiratory and laryngeal function.
Impact on Diagnosis/Treatment of Parkinson's Disease:
We anticipate that this study will help us better understand what treatments work best to improve swallowing and cough in people with PD, resulting in an immediate shift in the clinical management of swallowing and cough dysfunction in PD. We also believe that participants will have improvements in their own swallowing and cough function, therefore, reducing the risk of aspiration pneumonia.
Next Steps for Development:
This clinical trial will help us determine if one of the two treatments is best for treating these sorts of swallowing and cough problems in people with PD. We will then follow up by testing the long-term impact of these treatments on health and quality of life.