title: Dysphagia progression and swallowing management in Parkinson's disease: an observational study.
abstract: BACKGROUND
  Dysphagia is relatively common in individuals with neurological disorders.
  
  
  OBJECTIVE
  To describe the swallowing management and investigate associated factors with swallowing in a case series of patients with Parkinson's disease.
  
  
  METHODS
  It is a long-term study with 24 patients. The patients were observed in a five-year period (2006-2011). They underwent Fiberoptic Endoscopic Evaluation of Swallowing, Functional Oral Intake Scale and therapeutic intervention every three months. In the therapeutic intervention they received orientation about exercises to improve swallowing. The Chi-square, Kruskal-Wallis and Fisher's tests were used. The period of time for improvement or worsening of swallowing was described by Kaplan-Meier analysis.
  
  
  RESULTS
  During the follow-up, ten patients improved, five stayed the same and nine worsened their swallowing functionality. The median time for improvement was ten months. Prior to the worsening there was a median time of 33 months of follow-up. There was no associated factor with improvement or worsening of swallowing. The maneuvers frequently indicated in therapeutic intervention were: chin-tuck, bolus consistency, bolus effect, strengthening-tongue, multiple swallows and vocal exercises.
  
  
  CONCLUSIONS
  The swallowing management was characterized by swallowing assessment every three months with indication of compensatory and rehabilitation maneuvers, aiming to maintain the oral feeding without risks. There was no associated factor with swallowing functionality in this case series.
authors.affiliation: Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil. Electronic address: karenluchesi@yahoo.com.br.
authors.forename: Karen Fontes
authors.initials: KF
authors.lastname: Luchesi
authors.affiliation: Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kitamura
authors.affiliation: Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil.
authors.forename: Lucia Figueiredo
authors.initials: LF
authors.lastname: Mourão
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000209:etiology / Q000534:rehabilitation*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications*; D012720:Severity of Illness Index
keywords: Deglutition; Deglutition disorders; Deglutição; Disease progression; Doença de Parkinson; Fonoterapia; Parkinson disease; Progressão da doença ;Transtornos de deglutição; Speech therapy