Respiratory-swallow training in Parkinson's disease: Effects of a single session on swallowing safety and efficiency with exploratory comparisons of biofeedback.

Abstract

Dysphagia and pulmonary aspiration are common in people with Parkinson's disease (PwPD) and has detrimental effects on health, quality of life, and survivorship. One mechanism underlying dysphagia in PwPD is impaired respiratory-swallow coordination, with Respiratory-Swallow Training (RST) emerging as a promising new therapy. The aims of this randomized clinical trial were to assess whether a single session of RST targeting pre- and post-swallow exhalations would improve swallowing safety (primary aim 1) and efficiency (primary aim 2) in PwPD, and to explore whether RST with versus without biofeedback differed in effects on EX-EX usage (exploratory aim). Twenty-three PwPD (12 females) were recruited, with 52.2%, 34.8%, and 13% of participants classified as having early, mid- and late-stage PD, respectively. All participants completed a pre-RST assessment, one in-person RST session, and a post-RST assessment. Participants were randomized to receive RST with or without biofeedback. Swallowing was assessed using flexible endoscopic evaluation of swallowing (FEES). Outcomes included changes in DIGEST Safety and Efficiency Grades and exhalation usage before and after swallowing. DIGEST Safety (p = .012) and Efficiency (p = .010) Grades significantly improved following RST. Pre-swallow exhalations increased significantly from 62.4% to 85.8% (p < .001) and post-swallow exhalations from 76.6% to 89.6% (p < .001). No significant training differences were observed on pre- and post-swallow exhalation usage between the biofeedback and no biofeedback RST groups. A single session of RST was associated with significant improvements in swallowing safety (less aspiration), swallowing efficiency (less residue), and respiratory swallow coordination (more frequent exhalations before/after swallowing), though biofeedback usage did not appear to confer additional benefit. These findings support continued investigation of RST and may inform the design of future clinical trials.