Exercise program may alleviate swallowing problems in Parkinson’s

MDTP was first developed for people recovering from stroke

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by Mary Chapman |

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A pathologist at the University of Texas Health Science Center at San Antonio (UTHSA) is studying whether a treatment developed to aid in recovery from a stroke can be used as a preventive intervention for dysphagia in early Parkinson’s disease.

Giselle Carnaby, who is also a public health scientist, is studying the McNeill Dysphagia Therapy Program (MDTP) at UTHSA’s Swallowing and Upper Aerodigestive Research Laboratory, which she founded.

Dysphagia may affect some 20 million adults in the U.S., and up to 80% of Parkinson’s disease patients over the course of the disease. The condition is a common Parkinson’s symptom and can lead to malnutrition, dehydration, choking, and aspiration pneumonia, a potentially life-threatening infection caused by food or liquids being inhaled into the lungs instead of being swallowed.

Dysphagia often doesn’t improve with available Parkinson’s therapies. While behavioral changes, such as diet texture modifications and posture adjustment, can help, some patients can’t adhere to them properly or stick with them.

Carnaby is from Australia and joined UTHSA two years ago, where she directs the PhD program in health sciences. She has studied swallowing and related disorders in clinical practice for 35 years.

“I can’t think of anything more socially isolating than not being able to eat or drink anything,” Carnaby, PhD, MPH, said in a university press release. “Some of our patients can’t even swallow their own saliva.”

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Swallowing problems may be due to poorer sensation in the airways

Improving swallowing ability in Parkinson’s

MDTP is an evidence-based, high-energy exercise therapy program for adults with swallowing issues. It combines motor control so that function changes as patients build strength. Patients practice at home and their families are trained so they can assist with the methods as needed.

At Empowered Voice Rehabilitation, which serves Florida and nearby areas, MDTP participants have their swallow function evaluated and undergo a modified barium swallow study. There are 16 one-on-one sessions lasting 40 to 60 minutes, four times a week. During a session, the participant and a speech-language pathologist work through a number of food and liquid textures and consistencies in conjunction with swallowing exercises and techniques. Daily home exercises are also part of the program.

In a 2008 comparative study that Carnaby co-led, six adults with chronic pharyngeal dysphagia who hadn’t benefited from other therapies underwent 15 sessions of the standardized protocol of swallowing exercises, now the main component of MDTP, with adjunctive neuromuscular electrical stimulation (NMES), which for swallowing complications uses an electrical current to stimulate the muscles involved in swallowing.

Using adjunctive NMES as part of the therapy improved clinical swallowing ability and functional oral intake without significant weight loss or complications, the study found.

Carnaby, who collaborated with a multidisciplinary team of university scientists in the fields of respiratory therapy, medical imaging, neurology, and movement disorders, said the program could reduce hospitalizations and stress in Parkinson’s patients and potentially save lives.

“If we can show a difference in pre- and post-intervention in early Parkinson’s patients who do not have obvious difficulties with swallowing, then the conceptual background is that it should be more beneficial in patients with more serious issues,” she said. “…Teach it up front and then maybe we will extend the period of time where their swallowing is normal and easy for them.”