Effects of an Intensive Exercise-Based Swallowing Program for Persons With Parkinson's Disease and Complex Medical History: A Single-Case Experiment.

Purpose Dysphagia treatments to address the deterioration of oropharyngeal and respiratory functions in Parkinson's disease (PD) are few and rarely researched in persons with complex medical histories. This research note explored the effects of an intensive exercise-based swallowing program (ISP) that incorporated lingual and respiratory exercises for persons with PD and complex medical history. Method A single-case experiment was conducted across a 4-week ISP of lingual training and expiratory muscle strengthening for 2 participants (67-year-old man and 61-year-old woman). Probes included tongue strength and maximum expiratory pressure. Generalization measures included the Mann Assessment of Swallowing Ability (Mann, 2002), Timed Water Test (Hughes & Wiles, 1996), Repetitive Saliva Swallow Test (Oguchi et al., 2000), Functional Oral Intake Scale (Crary, Carnaby Mann, & Groher, 2005), and Swallowing Quality of Life questionnaire (McHorney et al., 2002). Results Gains occurred in tongue strength and maximum expiratory pressure (p ≤ .002) with large effect sizes (d ≥ 1.3) as well as Mann Assessment of Swallowing Ability and Timed Water Test performance. Repetitive Saliva Swallow Test performance and Functional Oral Intake Scale improved for 1 participant, whereas the other maintained function. Swallowing Quality of Life questionnaire remained largely unchanged; however, participants indicated they became more aware of their swallowing difficulties at posttreatment. Conclusions Persons with PD and complex medical history demonstrated increased lingual and expiratory muscle strength following a brief intensive program, which further generalized to select clinical swallowing measures. Findings suggest an overall positive and potentially additive or synergistic effect of an ISP. Future research may refine optimal candidacy and regimens for ISPs, which may help to maximize clinically meaningful returns, especially considering the increased demands of an intensive program.