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Neurology. 2010 Nov 23;75(21):1912-9. doi: 10.1212/WNL.0b013e3181fef115.
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.
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.
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.
EMST may be a restorative treatment for dysphagia in those with PD. The mechanism may be explained by improved hyolaryngeal complex movement.
This intervention study provides Class I evidence that swallow safety as defined by PA score improved post EMST.
吞咽困难是帕金森病（PD）患者发生吸入性肺炎和死亡的主要原因，但目前尚无针对该疾病的恢复性行为治疗方法。吞咽安全性降低可能与舌骨喉复合体的上提和移动减少有关。颏下肌肌力的增加与呼气肌力量训练（EMST）有关，随后舌骨喉复合体运动的增加为其作为吞咽困难治疗方法提供了强有力的依据。本研究的目的是测试为期 4 周的设备驱动 EMST 方案对吞咽安全性的治疗效果，并通过吞咽时程和舌骨位移的测量来确定其生理机制。
这是一项在学术中心进行的、随机、双盲、假对照 EMST 试验。60 名 PD 患者完成了 EMST，每周 5 天，每天 20 分钟，使用校准或假手设备，持续 4 周。吞咽功能的测量包括吞咽安全性的判断（渗透-吸入[PA]量表评分）、吞咽时程和舌骨运动，均来自荧光透视图像。
治疗前无组间差异。与假治疗组相比，主动治疗（EMST）组的吞咽安全性明显改善，表现为 PA 评分的改善。EMST 组在吞咽过程中显示出了更好的舌骨喉复合体功能，而假治疗组则没有。
EMST 可能是 PD 患者吞咽困难的一种恢复性治疗方法。其机制可能是通过改善舌骨喉复合体的运动来解释。
这项干预研究提供了 I 级证据，证明 EMST 后 PA 评分的吞咽安全性得到了改善。
