Objective: To examine the effectiveness of an Outpatient Voice and Swallowing Clinic in a tertiary referral centre for the management of swallowing of patients with atypical Parkinson

Background: Patients with Atypical Parkinson often present with swallowing problems earlier in the disease process.

Method: We delivered a combined management approach based on the patient’s pathophysiology of swallowing disorder, encompassing the following: clinical bedside observation and questionnaire; Endoscopic Examination of Swallowing (FEES); swallowing education for patient and caregiver; and provision of specific therapeutic program based on the patient’s needs (e.g. EMST150; LSVT LOUD; re-training of cough function and saliva management; change of food consistency; thickening of fluids; head positioning and specific manoeuvres). Penetration-Aspiration Score (PAS) change from baseline to 6 months was the primary outcome.

Results: Twenty-six consecutive patients with PSP (N=15) and MSA (N=11) were included. FEES in people with PSP showed that penetration/aspiration was more common with liquids than with semi-solids, with a pronounced premature spillage, a delayed swallowing reflex and residue in the valleculae and piriform sinuses. Due to a disinhibited cough reflex, even small boluses that penetrate the laryngeal vestibule can trigger a violent sustained cough. The most effective strategies for improving swallowing were: the chin-tuck manoeuvre in the event of premature spillage, effortful swallow to treat residue, dietary modifications to address penetration/aspiration and control of the rate of drinking fluids.

Patients with MSA showed more difficulties with the oral stage (delayed oral bolus transport; insufficient movement of the tongue base and slowed laryngeal elevation). Meals tend to last longer with subsequent fatigue. Dysphagia therapy targeted the coordination of breathing and swallowing, the overall education on the mechanism of swallowing and the appropriate food consistencies.

Patients’ ability to swallow was re-evaluated in 6 months.

Conclusion: Swallowing management of patients with Atypical Parkinsonism should encompass a FEES examination, patient and caregiver swallowing education, cough and saliva management re-training and specific swallowing rehabilitation advice to address the individual swallowing problem

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MDS Abstracts - https://www.mdsabstracts.org/abstract/atypical-parkinson-what-can-an-outpatient-voice-and-swallowing-clinic-offer-to-patients/