Novel Management of Airway Protection in Parkinson's Disease: A Clinical Trial

Study Overview
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Brief Summary
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Currently, there are no efficacious behavioral treatment approaches to address uncompensated aspiration, or aspiration without appropriate cough response, in Parkinson's disease (PD). This is of particular public health concern given that aspiration pneumonia is the leading cause of death in persons with PD. The overarching aim of the proposed study is to determine the efficacy of two distinct intensive rehabilitation paradigms, expiratory muscle strength training (EMST) and sensorimotor treatment for airway protection (smTAP), on airway protective clinical outcomes in persons with PD and dysphagia. The investigators anticipate the results will lead to reductions in the risks associated with airway protective deficits.

Detailed Description
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Study Rationale: Aspiration pneumonia is a leading cause of death in persons with Parkinson's disease (PD). One of the main reasons people with PD develop aspiration pneumonia is that they often have both swallowing dysfunction (dysphagia) and cough dysfunction (dystussia). Because of this, if food or liquid enters the airway, a cough is not elicited and the material remains in the airway (silent aspiration). It is then possible for the material to enter the lungs resulting in an infection called aspiration pneumonia. Currently, there are no tested treatment approaches that specifically target silent aspiration. Hypothesis: The goal of this study is to determine how well two different rehabilitation treatments, expiratory muscle strength training (EMST) and sensorimotor treatment for airway protection (smTAP), work to improve cough and swallowing function in persons with PD and dysphagia. Study Design: This study will include two participant groups; one group will receive EMST and the other will receive smTAP. There will be initial baseline testing of swallowing, coughing, respiratory, and laryngeal function. The investigators will also measure the participants' perception of their cough and swallowing problem. Then, participants will be randomly assigned (much like the flip of a coin) to either the EMST or smTAP training groups. The participants will be further randomized to receive immediate training or delayed training where there is a 5-week wait to start with a second baseline performed at the end of the 5-week delay. Once training is complete the participants will once again complete measures of swallowing, coughing, respiratory and laryngeal function. Impact on Diagnosis/Treatment of Parkinson's Disease: The investigators anticipate that this study will assist in better understanding what treatments work best to improve swallowing and cough in people with PD; resulting in an immediate shift in the clinical management of swallowing and cough dysfunction in PD. The investigators also believe that participants will have improvements in swallowing and cough function; therefore, reducing the risk of aspiration pneumonia.

Official Title
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Novel Management of Airway Protection in Parkinson's Disease: A Clinical Trial

Conditions
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Parkinson's Disease, Dysphagia, Dystussia

Intervention / Treatment
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* Device: EMST
* Behavioral: smTAP


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosed with PD (Hoehn and Yahr Stages II-IV) Difficulty swallowing Not actively receiving swallowing therapy. Exclusion Criteria: Other neurological disorders (e.g., multiple sclerosis, stroke, etc.) History of head and neck cancer History of breathing disorders or diseases (e.g., COPD) History of smoking in the last five years Uncontrolled hypertension Difficulty complying due to neuropsychological dysfunction

Ages Eligible for Study
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Minimum Age: 45 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Immediate Treatment<br>Participants will begin treatment immediately following baseline testing. | Device: EMST<br> <br> Behavioral: smTAP<br> <br> |
| Other: Delayed Treatment<br>Following baseline testing, participants will receive no treatment for five weeks, then begin treatment immediately following a second baseline testing session. | Device: EMST<br> <br> Behavioral: smTAP<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Voluntary Cough Peak Flow | Peak expiratory flow rate (PEFR) was measured before (baseline) and after 5 weeks of treatment with EMST and smTAP. | Pre to Post treatment (Pre: Baseline and Post Treatment: 5 weeks) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Rehabilitation, Parkinson's disease, Swallowing, Cough, Dysphagia, Dystussia