None listed
Conditions
Brief summary
The aim of the study is to investigate the effects of an intensive home practice program of Expiratory Muscle Strength Training (EMST) versus the Effortful Swallow, a traditional dysphagia rehabilitation exercise, in a population of people with dysphagia secondary to Parkinson's disease (PD). The aims of this research are: 1. Does completion of an intensive home practice program using EMST or traditional dysphagia therapy improve swallow function in individuals with Parkinson's disease in the community setting? 2. Does EMST and traditional dysphagia rehabilitation change the force generation of the sub mental muscle group involved in swallowing for people with PD and dysphagia? 3. Are EMST and traditional dysphagia rehabilitation exercises practical swallowing intervention options in the community setting for clients with Parkinson’s disease? 4. Does participating in a rehabilitation program for dysphagia due to Parkinson’s disease improve quality of life?
Interventions
Expiratory Muscle Strength Training (EMST) uses an innovative hand-held treatment device titled the EMST 150 device that has been scientifically tested for its ability to improve muscle strength involved in swallowing. Expiratory muscle strength training intervention uses short duration, isometric contractions of the expiratory muscles to generate the maximum pressure to open the pressure release valve the handheld respiratory pressure threshold device. As the person progresses through the train
Expiratory Muscle Strength Training (EMST) uses an innovative hand-held treatment device titled the EMST 150 device that has been scientifically tested for its ability to improve muscle strength involved in swallowing. Expiratory muscle strength training intervention uses short duration, isometric contractions of the expiratory muscles to generate the maximum pressure to open the pressure release valve the handheld respiratory pressure threshold device. As the person progresses through the training program the pressure threshold device is adjusted incrementally, to increase the progressive load or effort. The resistance load is determined via measurement of the individuals’ maximum expiratory pressure (MEP) using a manometer, and setting the device to a percentage of this to ensure the intensity is close to the maximal loading of the muscle for strengthening. The intervention will involve a home practice program of 5 sets of 5 breaths (25 breaths) per session, completed seven days per week for six weeks. Participants are demonstrated how to use the device. Participants are provided with an instruction manual which include written and visual information regarding the intervention and maintenance program and will be asked to maintain a diary to record compliance with the regime, The participants just need to tick off when they have completed the daily session, or write down if they have missed a session. The diary and an instruction manual on how to complete the exercise will be provided by the researchers at the beginning of the training. Participants will attend the Community Therapy Services clinic once per week to be reviewed by a Speech Pathologist. The Community Therapy Services is the outpatient allied health rehabilitation service at Northern Health. During this weekly review session the EMST device we be calibrated each week to 75% of the participants Maximum Expiratory Pressure (MEP) and completion of the exercise will be reviewed. At the end of the 6 week program, A maintenance program will be recommended after this period for 4 weeks to maintain conditioning and prevent detraining. The maintenance program is not considered part of the intervention that is being measured in this project however is recommended to prevent de-training The maintenance program will involve a graded reduction with the exercises of 5 sets of 5 breaths (25 breaths) being completed 5 days per week for the first 2 weeks, and 3 days per week for the last 2 weeks. During the maintenance program the particpant will not visit the CTS but will be telephoned by the researcher each to week to monitor their status.
Sponsors
Northern Health Foundation
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
55 Years to 88 Years
Healthy volunteers
No
Inclusion criteria
- Have a formal diagnosis of idiopathic Parkinson’s disease - Able to provide informed consent. Consent may also be provided by a person who has legal authority to do so (e.g. carer, Next of Kin). - Report some degree of swallowing impairment (e.g. reports coughing during eating a and drinking, food getting stuck in throat, increased eating duration) - Age between 55 and 88 - Mini Mental Score > 24 or Mini Mental Score 22-23 with carer support. - Preference for the participant to remain on the same Parkinson’s disease medications for the duration of the study - Nil residual deficits from other neurological disorders, gastrointestinal disease, gastro-oesophageal surgery, head and neck cancer, history of respiratory disorders, untreated hypertension or heart disease It is the preference of the researchers that participants will not change their medications relating to PD during the research trial as this may influence results. However, if this is necessary, participants will be asked to inform the researchers of any changes. They are also restricted from participating in any other Speech Pathology rehabilitative treatment during the study.
Exclusion criteria
- MMSE < 24 and unable to complete daily home practice regime due to cognition/ nil carer support - residual deficits from other neurological disorders, gastrointestinal disease, gastro-oesophageal surgery, head and neck cancer, history of respiratory disorders, untreated hypertension or heart disease - nil dysphagia
Outcome results
None listed