Consensus on the Treatment of Dysphagia in Parkinson's Disease
Journal of the Neurological Sciences
Schindler, A., Pizzorni, N., et al. (2021).
Journal of the Neurological Sciences, 430, Article 120008.
This systematic review investigates the effects of dysphagia treatments on swallow function and nutrition status in individuals with Parkinson's disease and outlines a series of 26 consensus recommendations based upon findings. Please see the Notes on This Article section below for more information on the consensus recommendations.
Not stated
See Box 1 (p. 6) of the <a title="https://doi.org/10.1016/j.jns.2021.120008" href="https://doi.org/10.1016/j.jns.2021.120008" target="_blank" rel="noopener">full article</a> for consensus recommendations.
Not specified
Peer-reviewed articles, excluding case studies
64
<div>Three studies (one Class II study, two Class IV studies) investigated the efficacy of transcutaneous electrical stimulation (TES) as an adjunct to standard swallowing treatment for adults with Parkinson's disease. Of these, only one study reported greater improvement in the TES group on hyoid displacement. The remaining studies reported no significant differences between the intervention groups. An additional study investigated the effects of TES electrode positioning on swallow function (Class III study). No differences were found in temporal, spatial and visuoperceptual videofluoroscopic swallowing study parameters with different electrode positioning. Given the small number of studies and participants, further research is warranted on the use of TES as an adjunct to swallowing treatment to improve dysphagia outcomes for this population.</div>
<div>There is low level evidence that skill-based training with surface EMG biofeedback improves swallowing efficiency in adults with Parkinson's disease (one Class IV study). Given the low level of evidence, additional research is warranted.</div>
<div>There is low level evidence that Lee Silverman Voice Treatment improves swallowing functioning in individuals with Parkinson's disease (two Class IV studies). While improvements were noted in measures of oral residue, some swallowing-related temporal measures, pharyngeal constriction, upper esophageal sphincter opening, and pharyngeal residue, the small number of studies and small number of participants limit the utility of the findings.</div>
<div>There is low level evidence that conventional swallowing treatments can improve dysphagia and quality of life secondary to Parkinson’s disease (Class III-IV studies). However, limited information regarding the conventional swallowing treatments used and the lack of control groups lowers the quality of the evidence.</div>
<div>There is low level evidence that expiratory muscle strength training (EMST) improves swallowing function in adults with dysphagia secondary to Parkinson's disease. Small positive effects were noted with improvements in penetration aspiration scale scores, volitional cough, and performance on videofluoroscopic swallowing study (three Class IV studies, one Class I study). Gains following EMST were maintained at 3-month follow-up (Class IV study). Further research is warranted due to small sample sizes across studies, lack of methodological rigor, and incomplete data reporting.</div>
<div>There is insufficient evidence for postural maneuvers (i.e., chin-down strategy) to improve dysphagia in adults with Parkinson's disease (Class III-IV studies).</div>
<div>There is evidence that diet modification (i.e., thickened liquids) reduces the risk of aspiration in adults with Parkinson's disease (Class III-IV studies). However, there is no evidence that use of this treatment reduces mortality or pneumonia when compared to the chin-down posture with thin liquids (Class I study).</div>
