Immediate effects of thermal-tactile stimulation on timing of swallow in idiopathic Parkinson's disease.
Oropharyngeal dysphagia frequently presents in people with idiopathic Parkinson's disease (IPD). Clinical sequelae of dysphagia in this group include weight loss and aspiration pneumonia, the latter of which is the leading cause of hospital admissions and death in IPD. Thermal-tactile stimulation (TTS) is a sensory technique whereby stimulation is provided to the anterior faucial pillars to speed up the pharyngeal swallow. The effects of TTS on swallowing have not yet been investigated in IPD. The aim of this study was to investigate the immediate effects of TTS on the timing of swallow in a cohort of people with IPD and known oropharyngeal dysphagia. Thirteen participants with IPD and known dysphagia attended for videofluoroscopy during which standardised volumes of liquid barium and barium paste were administered preceding and immediately subsequent to TTS. The immediate effects of TTS on swallowing were examined using oral, pharyngeal, and total transit times and pharyngeal delay times as outcome measures. TTS significantly reduced median pharyngeal transit time on fluids (0.20 s, 95% CI = 0.12-0.28, p = 0.004) and on paste (0.3 s, 95% CI = 0.08-0.66, p = 0.01). Median total transit time was also reduced on fluids (0.48 s, 95% CI = 0.00-1.17, p = 0.049) and on paste (0.52 s, 95% CI = 0.08-1.46, p = 0.033). Median pharyngeal delay time was reduced on fluids (0.20 s, 95% CI = 0.12-0.34, p = 0.002). TTS did not significantly alter median oral transit time on either fluid or paste consistency. TTS significantly reduced temporal measures of the pharyngeal phase of swallowing in the IPD population. Significant results may be attributed to the role of sensory stimulation in improving motor function in IPD, with emphasis on the impaired glossopharyngeal and vagus nerves in this population. It is still unclear whether these findings will translate into a clinically beneficial effect.
Regan
Julie
J
SLT Department, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland. julie.regan@amnch.ie
Walshe
Margaret
M
Tobin
W Oliver
WO
D000368:Aged; D016001:Confidence Intervals; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D005471:Fluoroscopy; D006305:Health Status Indicators; D006358:Hot Temperature; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications* / Q000503:physiopathology; D015995:Prevalence; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric; D013997:Time Factors; D014110:Touch
Dysphagia. 2008 Sep;23(3):297-301
18483823
Neurology. 1997 Feb;48(2):373-6
9040724
Neurology. 1989 Oct;39(10):1309-14
2797454
Am J Med. 2000 Mar 6;108 Suppl 4a:8S-14S
10718445
Physiol Rev. 2001 Apr;81(2):929-69
11274347
J Speech Lang Hear Res. 2008 Feb;51(1):173-83
18230864
Dysphagia. 1998 Winter;13(1):1-9
9391220
Dysphagia. 1996 Spring;11(2):93-8
8721066
Ann Acad Med Singap. 1998 Nov;27(6):808-12
10101555
J Commun Disord. 2004 Sep-Oct;37(5):401-11
15231420
J Speech Hear Res. 1991 Dec;34(6):1257-68
1787707
Australas Ann Med. 1965 Feb;14:13-22
14271784
Am J Physiol Gastrointest Liver Physiol. 2004 Jan;286(1):G45-50
12946939
Acta Neurol Scand. 1998 Jan;97(1):27-35
9482675
Br J Radiol. 1970 Jul;43(511):456-7
5429083
Ann Intern Med. 2008 Apr 1;148(7):509-18
18378947
J Neurol. 2000 Apr;247 Suppl 2:II3-10
10991663
J Neurol Neurosurg Psychiatry. 1997 Nov;63(5):579-83
9408096
Dysphagia. 1994 Spring;9(2):83-7
8005011
N Engl J Med. 1999 May 13;340(19):1476-80
10320386
Gastroenterology. 1996 Feb;110(2):383-92
8566584
Am J Physiol. 1951 Jul;166(1):142-58
14857157
Dysphagia. 1998 Spring;13(2):95-100
9513304
Arch Phys Med Rehabil. 1993 Sep;74(9):973-6
8379846
Neurology. 1967 May;17(5):427-42
6067254
Am J Speech Lang Pathol. 2005 Feb;14(1):4-13
15962843
Brain. 1999 Aug;122 ( Pt 8):1437-48
10430830
Dysphagia. 2003 Winter;18(1):46-52
12497196
J Gerontol. 1975 May;30(3):299-303
1120891
Neurology. 1992 Apr;42(4 Suppl 4):27-31; discussion 41-8
1350072
Mov Disord. 2006 Nov;21(11):1824-30
16958133
Br J Radiol. 1991 Oct;64(766):890-3
1954529
Acta Neuropathol. 2000 May;99(5):489-95
10805091
Neurobiol Aging. 2003 Mar-Apr;24(2):197-211
12498954
Arch Neurol. 2001 Dec;58(12):1995-2002
11735773
Eur Neurol. 1991;31 Suppl 1:48-59
1830274
Mov Disord. 1991;6(2):151-6
2057006
Can J Neurol Sci. 1994 Feb;21(1):53-6
8180906
Age Ageing. 2006 Nov;35(6):614-8
17047007
Dysphagia. 1996 Fall;11(4):225-33
8870348
AJR Am J Roentgenol. 2002 Feb;178(2):393-8
11804901
Mol Chem Neuropathol. 1991 Jun;14(3):153-97
1958262
Arch Phys Med Rehabil. 1993 Feb;74(2):178-81
8431103
J Neurol Neurosurg Psychiatry. 1991 May;54(5):388-96
1865199
Semin Roentgenol. 1974 Oct;9(4):273-82
4421910
Mov Disord. 2005 Sep;20(9):1104-8
15884038
Neurol Sci. 2002 Sep;23 Suppl 2:S121-2
12548373
Ann Neurol. 1986 Mar;19(3):283-7
3963773
Neurogastroenterol Motil. 2003 Feb;15(1):69-77
12588471
J Physiol. 1998 Feb 1;506 ( Pt 3):857-66
9503343
Arch Phys Med Rehabil. 1993 Jul;74(7):736-9
8328896
Acta Neurochir (Wien). 2006 Dec;148(12):1247-55; discussion 1255
17072792
Dysphagia. 1995 Summer;10(3):165-6
7614856
N Engl J Med. 2003 Nov 13;349(20):1925-34
14614167
Dysphagia. 1999 Summer;14(3):139-45
10341109
Dysphagia. 1996 Spring;11(2):144-50
8721074