RecruitingPhase 2NCT05700825

Rehabilitation of Airway Protection in Parkinson's Disease

Rehabilitation of Airway Protection in Parkinson's Disease: Comparing In-person and Telehealth Service Delivery Models

Sponsor

Teachers College, Columbia University

Enrollment

120 participants

Start Date

Aug 11, 2022

Study Type

INTERVENTIONAL

Conditions

Parkinson Disease Dysphagia

Summary

Airway protective disorders are a prevalent and progressive consequence of Parkinson's Disease (PD), and often result in aspiration pneumonia which is the leading cause of death in PD. Despite this, a large number of patients with PD do not access specialized services to address these critical deficits. The investigators will examine the comparative effectiveness of a novel treatment paradigm delivered in-person versus via telehealth in persons with PD, as well as the role of patient burden and treatment adherence on outcomes; thus, the proposed research is relevant to public health and in line with NIH's mission to identify novel, efficacious, and accessible rehabilitation strategies for short- and long-term improvement of dysfunctional airway protection in PD.

Eligibility

Min Age: 50 YearsMax Age: 90 Years

Inclusion Criteria4

Diagnosed with PD (Hoehn and Yahr Stages II-IV)126,127 confirmed by a Movement Disorders fellowship trained neurologist having reviewed the video recorded Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) assessment for each participant and using strict UK brain bank criteria
airway protective deficits as defined as a minimum of penetration of thin liquids (penetration-aspiration score\>3) as determined by instrumental swallowing assessment and/or dystussia as determined by voluntary cough assessment (PEFR ≤4.1 L/s)
not actively receiving exercise-based swallowing therapy
between the ages of 50 and 90.

Exclusion Criteria8

Other neurological disorders (e.g., multiple sclerosis, stroke, brain tumor, 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 (i.e., severe depression with \>28 on the Beck Depression Index (BDI-II), dementia with \<19 on the Montreal Cognitive Assessment (MoCA))
allergy to capsaicin or barium
further than 1.5 hours (door to door) distance from either Teachers College, Columbia University or Purdue University.

Interventions

BEHAVIORALExpiratory Muscle Strength Training + Cough Skill Training

Expiratory Muscle Strength Training (EMST). EMST is a widely used and efficacious treatment approach that uses a calibrated device with a one-way, spring-loaded pressure relief valve to mechanically overload the expiratory and submental muscles. Cough Skill Training (CST) involves a digital peak flow meter device which measures PEFR (peak expiratory flow rate) in liters/second and allows patients to receive immediate biofeedback.