Breathing and swallowing share a common pathway, making the timing and co-ordination extremely important. Breathing is inhibited before and during the swallow, and this cessation of breathing is accomplished by closure of the vocal folds, that also serve as the last line of defense against anything threatening the airway.
Swallowing problems are common for many patients with a neurological diagnosis like Parkinson’s disease (PD), and in fact, estimates suggests that 80% of people with PD have some degree of swallowing difficulty, with aspiration ( saliva, food or liquid getting into the airway) among the more serious of problems, as repeated or recurrent aspiration can lead to an aspiration pneumonia.
Respiratory Muscle Training and Old Method with New Applications
Respiratory muscle training (RMT) devices have been around for over 30 years, and were first introduced to replace manual methods of percussion for patients who had difficulty mobilizing secretions or with cough. They became a convenient method of improving pulmonary hygiene for individuals with pulmonary or neuromuscular diseases. As they have made their way into the hands of dysphagia (swallowing) researchers, more specific benefits that improve swallowing function have emerged.
These handheld devices have varying types of designs, but all provide some level of resistance to the muscles of inspiration, exhalation, or both. And, in the same way you might use free weights, resistance machines, or resistance bands to strengthen your arms and legs (skeletal muscles), RMT devices are designed to improve strength and use of the breathing muscles.
Expiratory muscle strength training (EMST) using a pressure threshold device focuses on improving strength of the expiratory muscles which are important for cough. Cough, both voluntary and reflexive, is a necessary clearance mechanism when something has gotten into the upper or lower airways, and since weakness and/or stiffness of the respiratory muscles has been documented in Parkinson’s disease, EMST training has been established to be a worthwhile goal for improving or maintaining essential cough function.[i]
Patient using EMST-150™ device
Respiratory muscle training might also be used to improve timing and co-ordination of breathing and swallowing, and for this purpose, a resistive respiratory muscle trainer which provides variable levels of resistance to both inspiratory and expiratory muscles can be beneficial. This type of resistance training can serve as a good primer or warm-up exercise, completed before a meal, thereby preparing patients for the endurance component of swallowing that requires continuous co-ordination of breathing-swallowing. If a patient has a history of aspiration (i.e mis-timed swallows) RMT training can be used to try to re-establish a more optimal breathing-swallowing pattern, and in this way provides more skill-based training. [ii]
Patient using The Breather® with manometer attachment for targeted training and feedback
RMT Benefits for PD in the palm of your hand
Stiffness of rib cage muscles, postural changes, and dyskinesia affecting trunk and respiratory muscles, can all be problematic symptoms impacting speech and swallowing in individuals with Parkinson’s disease. Dysregulation of respiration due to dyskinesia or “wearing off” of PD medications can also promote anxiety for some individuals. So, adding respiratory muscle training to your exercise and self-care plan might offer numerous benefits, all in the palm of your hand.
Parkinson’s disease and Swallowing Webinar June 25, 2019 7-8:30pm EDT
June is Dysphagia Awareness month, and next week, it will be my honor to provide a webinar sponsored by the National Foundation of Swallowing Disorders (NFOSD). NFOSD has a stated commitment: “to provide patient hope and improve quality of life for those suffering from all types of swallowing disorders. By enhancing direct patient support, education, research and raising public, professional and governmental awareness, our mission is to advance the prevention and treatment of swallowing disorders in our lifetime.”
A small, $10 registration fee will help to support the NFOSD mission. No one however will be turned away based on their ability to pay, and if needed, please use the promo code: MSPASS at the time of registration and the fee will be waived.
To register visit: https://voiceaerobicsdvd.com/featured-event/nfosd-webinar-parkinsons-disease-swallowing/
[i] Troche et al,Aspiration and swallowing in Parkinson disease and rehabilitation with EMST: a randomized trial.Neurology. 2010 Nov 23;75(21):1912-9. [ii] Huckabee, ML. & Lamvik-Gozdzikowska, K.Reconsidering Rehabilitation for Neurogenic Dysphagia: Strengthening Skill in Swallowing Curr Phys Med Rehabil Rep (2018) 6: 186. https://doi.org/10.1007/s40141-018-0193-x
My Mission: To enlist individuals in their treatment, and help them express their personality & spirit through voice. To educate and empower.
Mary Spremulli, MA, CCC-SLP