Objective: To evaluate the effect on speech after a strength training exercise targeting the swallowing biomechanics in Parkinson’s disease (PD) patients.

Background: Dysarthria and dysphagia are common in patients with PD and may reduce quality of life. Dysarthria in PD may include reduced volume, monopitch, short phrases, and variable rates. Prior studies have shown that device-assisted expiratory muscle strength training improves maximum expiratory pressure and speech breathing, but there was no significant improvement in speech and voice themselves ^[1,2]. Our group has demonstrated that the use of another exercise device involving swallowing against resistance has shown an improvement in the pharyngeal phase of swallowing, including in PD patients ^[3,4]. This study explores the potential impact of that device on speech in PD patients.

Method: We prospectively enrolled 6 PD patients to participate in our targeted exercise program with sRED (swallow against resistance exercise device). The device was worn around the neck 3 times daily, with participants swallowing 30 times at 15-second intervals. The device pressures (20-60 mmHg) provided resistance to swallow-induced laryngeal elevation. Speech evaluation was performed using icSpeech Standard Edition software (Rose Medical Solutions Ltd). The following parameters were obtained: average pitch (Hz), volume (dB), intelligibility score (%), audibility, speech rate (words per minute), and the number of recognized words. Statistical analysis was performed using a paired two-tailed t-test.

Results: The mean age was 64.3 ± 7.6 years old, with a mean MDS UPDRS III of 28.8 ± 12.7. Patients showed a mean improvement in average speech volume by 6% (P = 0.046), while no significant changes were noted in average pitch, audibility, speech rate, and the number of recognized words. There was a trend of 33 % improvement with the intelligibility score (P = 0.088) with sRED.

Conclusion: Patients with PD showed significant improvement in their speech volume after 6 weeks of a targeted exercise program with sRED, which in return showed improvement in intelligibility of speech. Increasing the study sample size may potentially result in improvement in other speech parameters.

References: 1. Antonsson M, Johansson K, Bonde Dalemo A, et al. Effect of expiratory muscle strength training on voice and speech: An exploratory study in persons with Parkinson’s disease or multiple sclerosis. Int J Speech Lang Pathol 2023:1-18.
2. Darling-White M, Huber JE. The Impact of Expiratory Muscle Strength Training on Speech Breathing in Individuals With Parkinson’s Disease: A Preliminary Study. Am J Speech Lang Pathol 2017;26(4):1159-1166.
3. Agrawal D, Kern M, Edeani F, et al. Swallow strength training exercise for elderly: A health maintenance need. Neurogastroenterol Motil 2018;30(10):e13382.
4. Hassan H, Kerschner A, Weng P, Yu E, Edeani F, Mei L, Sanvanson P, Kern M, Shaker R. Th effect of Rehabilitative Exercise on Swallowing Biomechanics in early-stage Parkinson’s disease. DDW 2024 Washington DC

This work was supported by the National Institute of Health (grant R01DK132082).

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effects-on-speech-after-the-use-of-swallow-against-resistance-exercise-device-in-parkinsons-disease-patients/