Objective: This pilot study tested the effectiveness of a novel motor learning and exercise principle-based dysphagia treatment approach in PD.

Background: Dysphagia occurs in 90% percent of individuals with PD. Aspiration pneumonia, a complication associated with dysphagia, is the leading cause of death in PD.

One of the dysphagia symptoms that leads to aspiration pneumonia is the post-swallow pooling in the piriform sinuses due to reduced tongue base pressure.  Based on motor-learning and exercise principles, the Masako maneuver was delivered with high-frequency and high-intensity to improve reduced tongue base pressure. It was hypothesized that swallow function would improve as a result of improved tongue base pressure evidenced by reduced post-swallow pooling in piriform sinuses following the intensive treatment.

Method: Ten patients with H&Y stage 3 IPD and swallowing complaints participated in the study.  All patients signed the Informed Consent Form approved by the Rush University IRB.

All patient received pre-treatment testing, 4-week treatment, and post-treatment testing. During the treatment phase, each patient carried out 120 Masako swallows (6 sessions of 2 sets of 10 Masako swallows) daily throughout the day. There were no aspiration risks as Masako swallows involved only patients’ own saliva.  The effectiveness of the treatment was assessed by three primary outcome measures: duration of contact between the base of the tongue and posterior pharyngeal wall, duration of pharyngeal transit time, and pharyngeal residue, obtained from the videofluoroscopic swallow studies (VFSS) using the MBSimP protocol, as well as six secondary outcome measures for changes in quality of life.

Results: The protocol was well-tolerated by all patients. The results showed improved MBSimP scores of the three primary outcome measures accompanied by varying degrees of the secondary outcome measures. Together, the results demonstrated an overall improved swallow function and insight related to the quality of life associated with this novel treatment protocol in this pilot study of ten patients with stage-III PD.

Conclusion: The results from the comparison between pre- and post-treatment primary and secondary measurements support the hypothesis that the swallow function improved as a result of improved tongue base pressure following the 4-week intensive Masako treatment protocol. Limitations of the study and future directions were discussed.

References: Hammer, M. J., Jones, C. A., Mielens, J. D., Kim, C. H., & Mcculloch, T. M. (2014). Evaluating the tongue-hold maneuver using high-resolution manometry and electromyography. Dysphagia, 29(5), 564-570. doi:10.1007/s00455-014-9545-6 z
Jankovic, J. (2007). Parkinson’s disease: Clinical features and diagnosis. Journal of Neurology, Neurosurgery, and Psychiatry, 79, 368-367.
Kalf, J. G., De Swart, B. J., Bloem, B. R., & Munneke, M. (2012). Prevalence of oropharyngeal dysphagia in Parkinson’s disease: A meta-analysis. Parkinsonism & Related Disorders, 18(4), 311-315. doi:10.1016/j.parkreldis.2011.11.006
Mehanna, R., & Jankovic, J. (2010). Respiratory problems in neurologic movement disorders. Parkinsonism & Related Disorders, 16(10), 628-638. doi:10.1016/j.parkreldis.2010.07.004

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-novel-motor-learning-based-dysphagia-treatment-approach-in-parkinsons-disease/