Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, 10027, USA.
Dysphagia. 2020 Jun;35(3):460-470. doi: 10.1007/s00455-019-10050-9. Epub 2019 Aug 22.
Respiratory-swallow coordination (RSC) is important for swallowing safety. Atypical RSC is common in Parkinson's disease (PD) and is associated with the presence of dysphagia and aspiration. Verbal cueing is known to affect RSC in healthy adults, yet an understanding of its effect on RSC in PD is unknown. Therefore, the aims of this study were to: (1) assess the effects of verbal cueing on respiratory-swallow patterning, lung volume initiation, and swallow apnea duration in PD; and (2) determine when during tidal breathing verbal cues should be given in order to increase the likelihood of eliciting optimal RSC. People with PD were prospectively recruited for respiratory-swallowing assessments during cued and non-cued swallowing conditions. Non-cued trials consisted of swallowing in an unprompted fashion, while cued trials consisted of swallowing only once participants were verbally instructed. Verbal cues were given at four specific points during tidal breathing. Nonparametric tests were used to compare differences in patterning, lung volume, and swallow apnea duration between the cued and non-cued swallows. Twenty-five people with PD were enrolled, yielding an analysis of 375 swallows. Verbal cueing significantly affected respiratory-swallow patterning (p < 0.0005), lung volume initiation (p < 0.0005), and swallow apnea duration (p < 0.0005). The effects of verbal cueing on RSC differed significantly depending on when during tidal breathing verbal cues were given. Cues given at high tidal inhalation were most likely to elicit optimal RSC, while cues given at low tidal exhalation were the least likely to elicit optimal RSC. The results of this study demonstrate that verbal cueing significantly affects RSC in PD. Depending on when verbal cues are given during tidal breathing, RSC can become more safe and coordinated or more atypical and risky. Clinicians should be cognizant of these effects by avoiding verbal cues if attempting to evaluate normal RSC during swallowing evaluations and cueing for swallows at the time of high tidal inhalation when targeting more optimal RSC in PD.
呼吸-吞咽协调（RSC）对于吞咽安全很重要。非典型的 RSC 在帕金森病（PD）中很常见，与吞咽困难和误吸有关。已知口头提示会影响健康成年人的 RSC，但对其在 PD 中对 RSC 的影响知之甚少。因此，本研究的目的是：（1）评估口头提示对 PD 患者呼吸-吞咽模式、肺容量起始和吞咽暂停时间的影响；（2）确定在潮式呼吸过程中何时给予口头提示，以增加诱发最佳 RSC 的可能性。前瞻性招募 PD 患者进行有提示和无提示吞咽时的呼吸-吞咽评估。无提示试验包括以非提示方式吞咽，而有提示试验仅在参与者被口头指示时进行一次吞咽。口头提示在潮式呼吸的四个特定点给出。使用非参数检验比较有提示和无提示吞咽之间的模式、肺容量和吞咽暂停时间的差异。共纳入 25 名 PD 患者，共分析 375 次吞咽。口头提示显著影响呼吸-吞咽模式（p<0.0005）、肺容量起始（p<0.0005）和吞咽暂停时间（p<0.0005）。口头提示对 RSC 的影响取决于在潮式呼吸过程中何时给予口头提示而显著不同。在高潮式吸气时给予提示最有可能诱发最佳 RSC，而在低潮式呼气时给予提示最不可能诱发最佳 RSC。本研究的结果表明，口头提示显著影响 PD 患者的 RSC。取决于在潮式呼吸过程中何时给予口头提示，RSC 可以变得更安全和协调，或者更不典型和更具风险。如果在吞咽评估期间试图评估正常的 RSC 或在目标是 PD 中更理想的 RSC 时在高潮式吸气时提示吞咽，则临床医生应注意这些影响并避免口头提示。
