Department of Neurology with Institute of Translational Neurology, University Hospital of Muenster, Muenster, Germany.
Institute for Biomagnetism and Biosignal Analysis, University Hospital Muenster, Muenster, Germany.
Mov Disord. 2021 Aug;36(8):1815-1824. doi: 10.1002/mds.28552. Epub 2021 Mar 2.
Pharyngeal dysphagia in Parkinson's disease (PD) is a common and clinically relevant symptom associated with poor nutrition intake, reduced quality of life, and aspiration pneumonia. Despite this, effective behavioral treatment approaches are rare.
The objective of this study was to verify if 4 week of expiratory muscle strength training can improve pharyngeal dysphagia in the short and long term and is able to induce neuroplastic changes in cortical swallowing processing.
In this double-blind, randomized, controlled trial, 50 patients with hypokinetic pharyngeal dysphagia, as confirmed by flexible endoscopic evaluation of swallowing, performed a 4-week expiratory muscle strength training. Twenty-five participants used a calibrated ("active") device, 25 used a sham handheld device. Swallowing function was evaluated directly before and after the training period, as well as after a period of 3 month using flexible endoscopic evaluation of swallowing. Swallowing-related cortical activation was measured in 22 participants (active:sham; 11:11) using whole-head magnetencephalography.
The active group showed significant improvement in the flexible endoscopic evaluation of swallowing-based dysphagia score after 4 weeks and after 3 months, whereas in the sham group no significant changes from baseline were observed. Especially, clear reduction in pharyngeal residues was found. Regarding the cortical swallowing network before and after training, no statistically significant differences were found by magnetencephalography examination.
Four-week expiratory muscle strength training significantly reduces overall dysphagia severity in PD patients, with a sustained effect after 3 months compared with sham training. This was mainly achieved by improving swallowing efficiency. The treatment effect is probably caused by peripheral mechanisms, as no changes in the cortical swallowing network were identified. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
帕金森病（PD）患者的咽期吞咽障碍是一种常见且具有临床相关性的症状，与营养摄入不良、生活质量下降和吸入性肺炎有关。尽管如此，有效的行为治疗方法却很少见。
本研究旨在验证为期 4 周的呼气肌力量训练是否能在短期和长期内改善咽期吞咽障碍，并能诱导皮质吞咽处理的神经可塑性变化。
在这项双盲、随机、对照试验中，50 例运动迟缓性咽期吞咽障碍患者（经软性内镜吞咽评估证实）进行了为期 4 周的呼气肌力量训练。25 名参与者使用校准（“主动”）装置，25 名参与者使用假手持装置。在训练期前后以及 3 个月后使用软性内镜吞咽评估直接评估吞咽功能。使用全头磁脑图测量 22 名参与者（主动：假；11：11）的吞咽相关皮质激活。
主动组在 4 周和 3 个月后，在软性内镜吞咽评估基础上的吞咽障碍评分均显著改善，而假组从基线开始则无显著变化。特别是咽残留明显减少。关于训练前后的皮质吞咽网络，通过磁脑图检查未发现统计学上的显著差异。
为期 4 周的呼气肌力量训练可显著降低 PD 患者整体吞咽障碍严重程度，与假训练相比，3 个月后仍有持续效果。这主要是通过提高吞咽效率来实现的。治疗效果可能是由外周机制引起的，因为皮质吞咽网络没有发生变化。
