Title: Can cueing improve swallowing and prevent drooling in Parkinson's disease?
Funder: Department of Health (England)

Abstract: Background Surveys suggest the majority of people with Parkinson’s disease (PD) experience problems with drooling, especially when attention is directed to other activities. Drooling is associated with changes in the triggering of the swallow reflex. Current treatment decreases saliva production with oral medication or botulinum injection of salivary glands with variable results, and significant side effects. Cueing has proved successful in management of other motor changes in PD. Our previous pilot work has shown that, at times when drooling is a problem, it is possible to utilise auditory cueing to trigger swallowing. Although, people with PD noted improvements, the device was awkward and only gave an auditory cue. A newly developed vibratory cueing device should overcome these problems . Aims Overall aim: We propose to trial a non-invasive, patient controlled device using vibratory cues to remind people to swallow, and so reduce the likelihood of drooling. Specific aims: 1. Perfect our user friendly vibration cueing device. 2. Trial the device in people with PD who have a problem with drooling to assess user acceptability and impact on drooling frequency, severity and drooling related quality of life. 3. Ascertain whether any benefit is sustained once the device is no longer being used. 4. Gather data in order to inform power calculations 5. Assess suitability of measurements used, and methods employed, in preparation for a full scale pragmatic randomised control trial. Plan of Investigation We will recruit 30 people with PD who are known to have a problem with drooling from the North Tyneside PD service. We will assess them at baseline using recognised drooling scales and a 3-day diary. Following training, they will use the device for 4 weeks at 2 separate 1 hour periods per day when drooling is a problem, keeping a diary of usage and any drooling problems We will repeat assessments at the end of intervention and after a further 2 and 6 weeks, to see if any effect is sustained. We will conduct semi-structured interviews about the strengths and weaknesses of the device and intervention to identify problems and potential improvements. The results from this study will inform the design of a large scale randomised controlled trial if the device is found to be successful. Potential Impact PD is the second most common neurodegenerative condition in the UK. A large proportion of people with PD have problems with drooling. Drooling has a major impact on quality of life for individuals with PD and their families, and can be a risk to health. Current treatments based on decreasing saliva production are variable in their success and have significant side effects. If we can successfully demonstrate that cueing a person to swallow using a vibratory cue reduces drooling at the time when the problem occurs, without the side effects seen with pharmacological treatments, this could have a major impact for patients throughout the NHS, and may be less expensive.


Research activity codes: 6.7 PHYSICAL
Health categories: NEUROLOGICAL