title: Aspiration and swallowing in Parkinson disease and rehabilitation with EMST: a randomized trial.
abstract: OBJECTIVE
  Dysphagia is the main cause of aspiration pneumonia and death in Parkinson disease (PD) with no established restorative behavioral treatment to date. Reduced swallow safety may be related to decreased elevation and excursion of the hyolaryngeal complex. Increased submental muscle force generation has been associated with expiratory muscle strength training (EMST) and subsequent increases in hyolaryngeal complex movement provide a strong rationale for its use as a dysphagia treatment. The current study's objective was to test the treatment outcome of a 4-week device-driven EMST program on swallow safety and define the physiologic mechanisms through measures of swallow timing and hyoid displacement.
  
  
  METHODS
  This was a randomized, blinded, sham-controlled EMST trial performed at an academic center. Sixty participants with PD completed EMST, 4 weeks, 5 days per week, for 20 minutes per day, using a calibrated or sham, handheld device. Measures of swallow function including judgments of swallow safety (penetration-aspiration [PA] scale scores), swallow timing, and hyoid movement were made from videofluoroscopic images.
  
  
  RESULTS
  No pretreatment group differences existed. The active treatment (EMST) group demonstrated improved swallow safety compared to the sham group as evidenced by improved PA scores. The EMST group demonstrated improvement of hyolaryngeal function during swallowing, findings not evident for the sham group.
  
  
  CONCLUSIONS
  EMST may be a restorative treatment for dysphagia in those with PD. The mechanism may be explained by improved hyolaryngeal complex movement.
  
  
  METHODS
  This intervention study provides Class I evidence that swallow safety as defined by PA score improved post EMST.
authors.affiliation: PO Box 117420, University of Florida, Gainesville, FL 32611, USA. michi81@ufl.edu
authors.forename: M S
authors.initials: MS
authors.lastname: Troche
authors.forename: M S
authors.initials: MS
authors.lastname: Okun
authors.forename: J C
authors.initials: JC
authors.lastname: Rosenbek
authors.forename: N
authors.initials: N
authors.lastname: Musson
authors.forename: H H
authors.initials: HH
authors.lastname: Fernandez
authors.forename: R
authors.initials: R
authors.lastname: Rodriguez
authors.forename: J
authors.initials: J
authors.lastname: Romrell
authors.forename: T
authors.initials: T
authors.lastname: Pitts
authors.forename: K M
authors.initials: KM
authors.lastname: Wheeler-Hegland
authors.forename: C M
authors.initials: CM
authors.lastname: Sapienza
mesh_terms: D000368:Aged; D003679:Deglutition; D003680:Deglutition Disorders / Q000209:etiology* / Q000534:rehabilitation*; D004867:Equipment Design; D045853:Exhalation; D005260:Female; D006801:Humans; D006928:Hyoid Bone / Q000503:physiopathology; D001239:Inhalation; D007830:Larynx / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010300:Parkinson Disease / Q000150:complications / Q000503:physiopathology*; D011788:Quality of Life; D055070:Resistance Training / Q000295:instrumentation; D012132:Respiratory Muscles / Q000503:physiopathology*; D012449:Safety; D016037:Single-Blind Method