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McMahon L, Blake C, Lennon O. A systematic review and meta-analysis of respiratory dysfunction in Parkinson's disease. Eur J Neurol 2023; 30:1481-1504. [PMID: 36779856 DOI: 10.1111/ene.15743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/14/2023]
Abstract
INTRODUCTION Respiratory dysfunction in Parkinson's disease (PD) is common and associated with increased hospital admission and mortality rates. Central and peripheral mechanisms have been proposed in PD. To date no systematic review identifies the extent and type of respiratory impairments in PD compared with healthy controls. METHODS PubMed, EMBASE, CINAHL, Web of Science, Pedro, MEDLINE, Cochrane Library and OpenGrey were searched from inception to December 2021 to identify case-control studies reporting respiratory measures in PD and matched controls. RESULTS Thirty-nine studies met inclusion criteria, the majority with low risk of bias across Risk of Bias Assessment tool for Non-randomized Studies (RoBANS) domains. Data permitted pooled analysis for 26 distinct respiratory measures. High-to-moderate certainty evidence of impairment in PD was identified for vital capacity (standardised mean difference [SMD] 0.75; 95% CI 0.45-1.05; p < 0.00001; I2 = 10%), total chest wall volume (SMD 0.38; 95% CI 0.09-0.68; p = 0.01; I2 = 0%), maximum inspiratory pressure (SMD 0.91; 95% CI 0.64-1.19; p < 0.00001; I2 = 43%) and sniff nasal inspiratory pressure (SMD 0.58; 95% CI 0.30-0.87; p < 0.00001; I2 = 0%). Sensitivity analysis provided high-moderate certainty evidence of impairment for forced vital capacity and forced expiratory volume in 1 s during medication ON phases and increased respiratory rate during OFF phases. Lower certainty evidence identified impairments in PD for maximum expiratory pressure, tidal volume, maximum voluntary ventilation and peak cough flow. CONCLUSIONS Strong evidence supports a restrictive pattern with inspiratory muscle weakness in PD compared with healthy controls. Limited data for central impairment were identified with inconclusive findings.
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Affiliation(s)
- Laura McMahon
- UCD School of Public Health, Physiotherapy and Population Science, Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Catherine Blake
- UCD School of Public Health, Physiotherapy and Population Science, Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Olive Lennon
- UCD School of Public Health, Physiotherapy and Population Science, Health Sciences Centre, University College Dublin, Dublin, Ireland
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de Góes MCR, Sarmento A, Lima I, Lyra M, Lima C, Aliverti A, Resqueti V, Fregonezi GAF. After-effects of thixotropic conditionings on operational chest wall and compartmental volumes of patients with Parkinson's disease. PLoS One 2022; 17:e0275584. [PMID: 36240169 PMCID: PMC9565399 DOI: 10.1371/journal.pone.0275584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 09/20/2022] [Indexed: 11/24/2022] Open
Abstract
Individuals with Parkinson's disease (PD) present respiratory dysfunctions, mainly due to decreased chest wall expansion, which worsens with the course of the disease. These findings contribute to the restrictive respiratory pattern and the reduction in chest wall volume. According to literature, inspiratory muscle thixotropic conditioning maneuvers may improve lung volumes in these patients. The study aimed to determine the after-effects of respiratory muscle thixotropic maneuvers on breathing patterns and chest wall volumes of PD. A crossover study was performed with twelve patients with PD (8 males; mean age 63.9±8.8 years, FVC%pred 89.7±13.9, FEV1%pred 91.2±15, FEV1/FVC%pred 83.7±5.7). Chest wall volumes were assessed using OEP during thixotropic maneuvers. Increases in EIVCW (mean of 126mL, p = 0.01) and EEVCW (mean of 150mL, p = 0.005) were observed after DITLC (deep inspiration from total lung capacity) due to increases in pulmonary (RCp) and abdominal (RCa) ribcage compartments. Changes in ICoTLC (inspiratory contraction from TLC) led to significant EIVCW (mean of 224mL, p = 0.001) and EEVCW (mean of 229mL, p = 0.02) increases that were mainly observed in the RCp. No significant changes were found when performing DERV (deep expiration from residual volume) and ICoRV (Inspiratory contraction from RV). Positive correlations were also observed between the degree of inspiratory contraction during ICoTLC and EEVRCp (rho = 0.613, p = 0.03) and EIVRCp (rho = 0.697, p = 0.01) changes. Thixotropy conditioning of inspiratory muscles at an inflated chest wall volume increases EIVCW and EEVCW in the ten subsequent breaths in PD patients. These maneuvers are easy to perform, free of equipment, low-cost, and may help patients improve chest wall volumes during rehabilitation.
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Affiliation(s)
- Maria Clara Rodrigues de Góes
- PneumoCardioVascular Laboratory—Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH) & Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte (UFRN), Natal, Brazil
| | - Antonio Sarmento
- PneumoCardioVascular Laboratory—Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH) & Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte (UFRN), Natal, Brazil
| | - Illia Lima
- Faculdade de Ciências da Saúde do Trairí (FACISA), Universidade Federal do Rio Grande do Norte (UFRN), Santa Cruz, Brazil
| | - Marina Lyra
- PneumoCardioVascular Laboratory—Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH) & Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte (UFRN), Natal, Brazil
| | - Cristiane Lima
- PneumoCardioVascular Laboratory—Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH) & Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte (UFRN), Natal, Brazil
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Vanessa Resqueti
- PneumoCardioVascular Laboratory—Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH) & Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte (UFRN), Natal, Brazil
| | - Guilherme A. F. Fregonezi
- PneumoCardioVascular Laboratory—Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH) & Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte (UFRN), Natal, Brazil
- * E-mail:
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Kaczyńska K, Orłowska ME, Andrzejewski K. Respiratory Abnormalities in Parkinson's Disease: What Do We Know from Studies in Humans and Animal Models? Int J Mol Sci 2022; 23:ijms23073499. [PMID: 35408858 PMCID: PMC8998219 DOI: 10.3390/ijms23073499] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 12/12/2022] Open
Abstract
Parkinson’s disease (PD) is the second most common progressive neurodegenerative disease characterized by movement disorders due to the progressive loss of dopaminergic neurons in the ventrolateral region of the substantia nigra pars compacta (SNpc). Apart from the cardinal motor symptoms such as rigidity and bradykinesia, non-motor symptoms including those associated with respiratory dysfunction are of increasing interest. Not only can they impair the patients’ quality of life but they also can cause aspiration pneumonia, which is the leading cause of death among PD patients. This narrative review attempts to summarize the existing literature on respiratory impairments reported in human studies, as well as what is newly known from studies in animal models of the disease. Discussed are not only respiratory muscle dysfunction, apnea, and dyspnea, but also altered central respiratory control, responses to hypercapnia and hypoxia, and how they are affected by the pharmacological treatment of PD.
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Curtis JA, Huber JE, Dakin AE, Troche MS. Effects of Bolus Holding on Respiratory-Swallow Coordination in Parkinson's Disease. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:705-721. [PMID: 34752144 DOI: 10.1044/2021_ajslp-21-00044] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE The aim of this study was to examine the effects of bolus holding on respiratory-swallow coordination (RSC) in people with Parkinson's disease (PD). METHOD People with PD were prospectively recruited to undergo RSC assessment using simultaneous respiratory inductive plethysmography and flexible laryngoscopy. During RSC assessment, participants swallowed 5-ml thin liquid boluses during held and nonheld swallowing tasks. Measures of RSC were analyzed for each swallow, which included respiratory pause duration, lung volume at swallow initiation, respiratory phase patterning, and the presence of paradoxical respiratory movements. Multilevel statistical modeling was used to determine if differences in RSC were present between the held and nonheld tasks. RESULTS Thirty-three participants were enrolled. When compared to the nonheld swallows, the held swallows exhibited shorter respiratory pauses (p = .001, R 2 = .019), lower lung volumes at swallow initiation (p < .001, R 2 = .116), more frequent exhale-swallow-exhale patterns (p < .001, OR = 4.30), and less frequent paradoxical respiratory movements (p = .001, OR = 0.43). CONCLUSIONS Findings from this study revealed that bolus holding significantly influences RSC in people with PD. This demonstrates that bolus holding may be an efficacious strategy to immediately improve RSC in PD. However, clinicians and researchers should consider avoiding bolus holding during swallowing evaluations if attempting to assess RSC behaviors that are most typical for the examinee.
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Affiliation(s)
- James A Curtis
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | | | - Avery E Dakin
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
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Ghosh S. Breathing disorders in neurodegenerative diseases. HANDBOOK OF CLINICAL NEUROLOGY 2022; 189:223-239. [PMID: 36031306 DOI: 10.1016/b978-0-323-91532-8.00008-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Neurodegenerative disorders are a diverse group of conditions caused by progressive degeneration of neurons resulting in cognitive, motor, sensory, and autonomic dysfunction, leading to severe disability and death. Pulmonary dysfunction is relatively common in these conditions, may be present early in the disease, and is less well recognized and treated than other symptoms. There are variable disorders of upper and lower airways, central control of ventilation, strength of respiratory muscles, and breathing during sleep which further impact daily activities and quality of life and have the potential to injure vulnerable neurons. Laryngopharyngeal dysfunction affects speech, swallowing, and clearance of secretions, increases the risk of aspiration pneumonia, and can cause stridor and sudden death. In Parkinson's disease, L-Dopa benefits some pulmonary symptoms but there are limited pharmacological treatment options for pulmonary dysfunction. Targeted treatments include strengthening of respiratory muscles, positive airway pressure in sleep and techniques to improve cough efficacy. Well-designed clinical trials are needed to evaluate the long-term benefits of these interventions. Challenges for the future include earlier identification of pulmonary dysfunction in the clinic, institution of the most effective treatments (based on clinical trials that measure long-term meaningful outcomes) and the development of neuroprotective treatment.
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Affiliation(s)
- Soumya Ghosh
- Perron Institute for Neurological and Translational Science, University of Western Australia and Department of Neurology, Sir Charles Gairdner and Perth Children's Hospitals, Nedlands, WA, Australia.
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Dudchenko NG, Gadzhieva ZF, Koloman II, Kuzmina AV, Levin OS. [Respiratory dysfunction in Parkinson's disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:80-85. [PMID: 34870919 DOI: 10.17116/jnevro202112110280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
For a long time it was believed that respiratory disorders (RD) in Parkinson's disease (PD) are rare. However, the situation has changed dramatically over the past 10 years. Thus, special studies have revealed RD in almost half of patients with PD. The paper presents: a literature review, classification of RD in PD, various mechanisms of their development and general approaches to their treatment. Classification of RD in PD is presented.
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Affiliation(s)
- N G Dudchenko
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Z F Gadzhieva
- Russian Medical Academy of Continuing Professional Education, Moscow, Russia
| | - I I Koloman
- Russian Medical Academy of Continuing Professional Education, Moscow, Russia
| | - A V Kuzmina
- Russian Medical Academy of Continuing Professional Education, Moscow, Russia
| | - O S Levin
- Russian Medical Academy of Continuing Professional Education, Moscow, Russia
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Hoit JD, Lansing RW, Brown VP, Nitido H. Speaking dyspnea in Parkinson's disease: Preliminary findings. JOURNAL OF COMMUNICATION DISORDERS 2020; 88:106050. [PMID: 33190067 DOI: 10.1016/j.jcomdis.2020.106050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/16/2020] [Accepted: 08/29/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To determine if people with Parkinson's disease (PD) experience dyspnea (breathing discomfort) during speaking. METHOD The participants were 11 adults with PD and 22 healthy adults (11 young, 11 old). Participants were asked to recall experiences of breathing discomfort across different speaking contexts and provide ratings of those experiences (Retrospective ratings); then they rated the breathing discomfort experienced while performing speaking tasks that were designed to differ in respiratory demands (immediate Post-Speaking ratings). RESULTS Participants with PD reported experiencing breathing discomfort during speaking significantly more frequently (approximately 60 % of the time) than did healthy participants (less than 20 % of the time). Retrospective ratings did not differ significantly from Post-Speaking ratings. Breathing discomfort was experienced by the fewest number of participants with PD for Conversation (two) and Extemporaneous Speaking (three) and by the greatest number for Extended Reading (ten) and Long Counting (nine), although the magnitude of the ratings generally reflected only "Slight" discomfort. Breathing discomfort was most frequently described as air hunger and breathing work, less frequently as mental effort, and very rarely as lung tightness. A few participants with PD reported experiencing emotions associated with their breathing discomfort and most reported using strategies to avoid breathing discomfort in their daily lives. CONCLUSIONS Individuals with PD are more apt to experience speaking dyspnea than healthy individuals, especially when speaking for extended periods or when using long breath groups. Such dyspnea may contribute to a tendency to avoid speaking situations and thereby impair quality of life.
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Affiliation(s)
- Jeannette D Hoit
- University of Arizona, Department of Speech, Language, and Hearing Sciences, United States.
| | | | - Valerie Phan Brown
- University of Arizona, Department of Speech, Language, and Hearing Sciences, United States
| | - Hallie Nitido
- University of Arizona, Department of Speech, Language, and Hearing Sciences, United States
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Vijayan S, Singh B, Ghosh S, Stell R, Mastaglia FL. Dyspnea in Parkinson's disease: an approach to diagnosis and management. Expert Rev Neurother 2020; 20:619-626. [PMID: 32419523 DOI: 10.1080/14737175.2020.1763795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Dyspnea is a complex and debilitating non-motor symptom experienced by a significant proportion of PD patients which results in limitations to physical ability and a reduction in quality of life. AREAS COVERED The authors highlight the underlying pathophysiological mechanisms that can contribute to dyspnea in PD patients, and provide the clinician with a practical working algorithm for the management of such patients. The authors further highlight important clinical red flags that should be heeded in dyspneic PD patients and discuss therapeutic strategies for managing dyspnea. EXPERT OPINION Although awareness of dyspnea in PD is increasing, further studies of its prevalence and natural history at different stages of the disease are needed. In particular, it is important to determine whether dyspnea could be an early or prodromal disease manifestation. Although peripheral mechanisms are likely to play a major role in the pathophysiology of dyspnea, the possibility that central changes in brainstem ventilatory control may also play a part warrants further investigation.
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Affiliation(s)
- Srimathy Vijayan
- The Perron Institute for Neurological and Translational sciences, QEII Medical Centre , Nedlands, Perth, Australia.,Faculty of Health and Medical Sciences, University of Western Australia , Nedlands, Perth, Australia
| | - Bhajan Singh
- Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital , Nedlands, Perth, Australia.,School of Human Sciences, University of Western Australia , Crawley, Perth, Australia.,West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands , Perth, Australia
| | - Soumya Ghosh
- The Perron Institute for Neurological and Translational sciences, QEII Medical Centre , Nedlands, Perth, Australia
| | - Rick Stell
- The Perron Institute for Neurological and Translational sciences, QEII Medical Centre , Nedlands, Perth, Australia
| | - Frank L Mastaglia
- The Perron Institute for Neurological and Translational sciences, QEII Medical Centre , Nedlands, Perth, Australia
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Vijayan S, Singh B, Ghosh S, Stell R, Mastaglia FL. Brainstem Ventilatory Dysfunction: A Plausible Mechanism for Dyspnea in Parkinson's Disease? Mov Disord 2020; 35:379-388. [DOI: 10.1002/mds.27932] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
- Srimathy Vijayan
- Perron Institute for Neurological and Translational Sciences Nedlands Perth, Western Australia Australia
| | - Bhajan Singh
- West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital Nedlands Perth, Western Australia Australia
- School of Human Sciences, University of Western Australia Crawley Western Australia Australia
| | - Soumya Ghosh
- Perron Institute for Neurological and Translational Sciences Nedlands Perth, Western Australia Australia
| | - Rick Stell
- Perron Institute for Neurological and Translational Sciences Nedlands Perth, Western Australia Australia
| | - Frank L Mastaglia
- Perron Institute for Neurological and Translational Sciences Nedlands Perth, Western Australia Australia
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Broadfoot CK, Abur D, Hoffmeister JD, Stepp CE, Ciucci MR. Research-based Updates in Swallowing and Communication Dysfunction in Parkinson Disease: Implications for Evaluation and Management. PERSPECTIVES OF THE ASHA SPECIAL INTEREST GROUPS 2019; 4:825-841. [PMID: 32104723 PMCID: PMC7043100 DOI: 10.1044/2019_pers-sig3-2019-0001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Individuals with Parkinson disease (PD) present with complex and variable symptoms, with recent findings suggesting that the etiology of PD extends beyond the involvement of just the basal ganglia. These symptoms include significant impairments in the speech and swallowing domains, which can greatly affect quality of life and therefore require therapeutic attention. This research-based update reviews the neurophysiological basis for swallowing and speech changes in PD, the effectiveness of various types of treatments, and implications for symptom evaluation and management. CONCLUSION The mechanisms responsible for swallowing and speech symptoms in PD remain largely unknown. Dopaminergic medication and deep-brain-stimulation do not provide consistent benefits for these symptoms suggesting a non-dopaminergic network is involved. Importantly, evidence suggests that symptoms of dysphagia and hypokinetic dysarthria may be early indications of PD, so it is critical to investigate the cause of these changes.
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Affiliation(s)
- C K Broadfoot
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI
| | - D Abur
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA
| | - J D Hoffmeister
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI
| | - C E Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA
- Department of Biomedical Engineering, Boston University, Boston, MA
- Department of Otolaryngology, Boston University, Boston, MA
| | - M R Ciucci
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI
- Department of Surgery-Division of Otolaryngology Head & Neck Surgery, University of Wisconsin-Madison, Madison, WI
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Hyam JA, Wang S, Roy H, Moosavi SH, Martin SC, Brittain JS, Coyne T, Silburn P, Aziz TZ, Green AL. The pedunculopontine region and breathing in Parkinson's disease. Ann Clin Transl Neurol 2019; 6:837-847. [PMID: 31139681 PMCID: PMC6529926 DOI: 10.1002/acn3.752] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 01/11/2019] [Indexed: 01/02/2023] Open
Abstract
Objective Respiratory abnormalities such as upper airway obstruction are common in Parkinson's disease (PD) and are an important cause of mortality and morbidity. We tested the effect of pedunculopontine region (PPNr) stimulation on respiratory maneuvers in human participants with PD, and separately recorded PPNr neural activity reflected in the local field potential (LFP) during these maneuvers. Methods Nine patients with deep brain stimulation electrodes in PPNr, and seven in globus pallidus interna (GPi) were studied during trials of maximal inspiration followed by forced expiration with stimulation OFF and ON. Local field potentials (LFPs) were recorded in the unstimulated condition. Results PEFR increased from 6.41 ± 0.63 L/sec in the OFF stimulation state to 7.5 L ± 0.65 L/sec in the ON stimulation state (z = −2.666, df = 8, P = 0.024). Percentage improvement in PEFR was strongly correlated with proximity of the stimulated electrode contact to the mesencephalic locomotor region in the rostral PPN (r = 0.814, n = 9, P = 0.008). Mean PPNr LFP power increased within the alpha band (7–11 Hz) during forced respiratory maneuvers (1.63 ± 0.16 μV2/Hz) compared to resting breathing (0.77 ± 0.16 μV2/Hz; z = −2.197, df = 6, P = 0.028). No changes in alpha activity or spirometric indices were seen with GPi recording or stimulation. Percentage improvement in PEFR was strongly positively correlated with increase in alpha power (r = 0.653, n = 14 (7 PPNr patients recorded bilaterally), P = 0.0096). Interpretation PPNr stimulation in PD improves indices of upper airway function. Increased alpha‐band activity is seen within the PPNr during forced respiratory maneuvers. Our findings suggest a link between the PPNr and respiratory performance in PD.
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Affiliation(s)
- Jonathan A Hyam
- Department of Physiology, Anatomy & Genetics University of Oxford Oxford UK.,Department of Neurosurgery John Radcliffe Hospital Oxford UK.,Nuffield Department of Surgical Sciences University of Oxford Oxford UK
| | - Shouyan Wang
- Department of Physiology, Anatomy & Genetics University of Oxford Oxford UK
| | - Holly Roy
- Nuffield Department of Surgical Sciences University of Oxford Oxford UK
| | - Shakeeb H Moosavi
- Department of Biological and Medical Sciences Oxford Brookes University Headington, Oxford UK
| | - Sean C Martin
- Nuffield Department of Surgical Sciences University of Oxford Oxford UK
| | | | - Terry Coyne
- St Andrews and Wesley Hospitals Brisbane Australia
| | - Peter Silburn
- St Andrews and Wesley Hospitals Brisbane Australia.,Queensland Brain Institute University of Queensland Brisbane Australia
| | - Tipu Z Aziz
- Department of Physiology, Anatomy & Genetics University of Oxford Oxford UK.,Department of Neurosurgery John Radcliffe Hospital Oxford UK.,Nuffield Department of Surgical Sciences University of Oxford Oxford UK
| | - Alexander L Green
- Department of Physiology, Anatomy & Genetics University of Oxford Oxford UK.,Department of Neurosurgery John Radcliffe Hospital Oxford UK.,Nuffield Department of Surgical Sciences University of Oxford Oxford UK
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Chest wall volume and asynchrony in stroke and Parkinson's disease subjects: A case-control study. PLoS One 2019; 14:e0216641. [PMID: 31095580 PMCID: PMC6522099 DOI: 10.1371/journal.pone.0216641] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 04/26/2019] [Indexed: 11/22/2022] Open
Abstract
Background The expansion of the rib cage and abdomen occurs in a synchronic way during a coordinated contraction of the diaphragm and the abdominal and intercostal muscles under normal conditions and healthy. The presence of restrictive respiratory disease may lead to uncoordinated action of the respiratory muscles which affects breathing pattern and chest wall volumes. The aim of this study was to evaluate chest wall volumes, chest wall asynchrony and inspiratory paradoxical movement of breathing, as well as the influence of the time of disease diagnosis in subjects with Parkinson’s disease and post-Stroke in comparison to healthy individuals. Methods Total and compartmental chest wall volumes, chest wall asynchrony and paradoxical movement were measured at rest in a seated position by Optoelectronic Plethysmography in 76 individuals (29 healthy individuals, 20 post-Stroke and 27 Parkinson’s disease subjects). Post-stroke and Parkinson’s disease subjects were also grouped according to the length of diagnosis. Results In both groups with restrictive respiratory disease we observed that pulmonary rib cage compartment (VRCp) volume is reduced when compared to healthy subjects (p <0.05). This same pattern was observed when analyzing post-stroke subjects with more than three years of diagnosis and Parkinson’s subjects with less than three years of diagnosis (p<0.05). Furthermore, post-stroke subjects with inspiratory paradoxical movement showed decreased total and compartmental chest wall volumes (p<0.05), while individuals with Parkinson’s disease with inspiratory paradoxical movement only presented a decrease in pulmonary rib cage compartment volume (p<0.05). Conclusion Our study presents new findings for better understanding of chest wall volumes and chest wall asynchrony in post-stroke and Parkinson’s disease individuals. Half of the subjects with post-Stroke and Parkinson’s disease presented inspiratory paradox movement, but changes in breathing pattern was especially observed in post-stroke subjects with more than three years of diagnosis.
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de Campos PS, Kawamura LRSM, Hasegawa K, Kumei Y, Zeredo JL. Analysis of respiratory movements in a mouse model of late Parkinson's disease submitted to stress. Respir Physiol Neurobiol 2018; 251:50-56. [PMID: 29481879 DOI: 10.1016/j.resp.2018.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 02/08/2018] [Accepted: 02/18/2018] [Indexed: 12/16/2022]
Abstract
Parkinson's disease (PD) is known to cause tremor and rigidity, but other symptoms such as respiratory and autonomic dysfunctions are a major cause of disability and mortality in patients. In this study, we examined respiratory movements by using cineradiography on a murine model of late/advanced PD. Under surgical anesthesia, C57BL/6J mice received an injection of either 6-OHDA or vehicle solution to the right striatum. Two weeks after surgery, the animals had their respiratory movements recorded by video X-ray without any restraint. During recordings the animals were submitted to a mild acute-stress challenge. Behavioral tests were performed to assess the severity of the 6-OHDA lesion. As a result, behavioral tests confirmed severe motor impairments in 6-OHDA mice as compared to controls. 6-OHDA mice showed a predominantly thoracic respiratory pattern with reduced diaphragmatic excursion, and reduced respiratory frequency after stress. These results suggest that advanced nigrostrial degeneration may cause respiratory alterations with the features of obstructive-type respiratory disorders.
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Affiliation(s)
- P S de Campos
- Graduate Program in Health Science and Technology, University of Brasilia, Brasilia, Brazil
| | - L R S M Kawamura
- Graduate Program in Health Science and Technology, University of Brasilia, Brasilia, Brazil
| | - K Hasegawa
- JAXA/Institute of Space and Astronautical Science, Sagamihara, Japan
| | - Y Kumei
- Department of Hard Tissue Engineering, Tokyo Medical and Dental University, Tokyo, Japan
| | - J L Zeredo
- Graduate Program in Health Science and Technology, University of Brasilia, Brasilia, Brazil.
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Baille G, De Jesus AM, Perez T, Devos D, Dujardin K, Charley CM, Defebvre L, Moreau C. Ventilatory Dysfunction in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2017; 6:463-71. [PMID: 27314755 PMCID: PMC5008229 DOI: 10.3233/jpd-160804] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In contrast to some other neurodegenerative diseases, little is known about ventilatory dysfunction in Parkinson’s disease (PD). To assess the spectrum of ventilation disorders in PD, we searched for and reviewed studies of dyspnea, lung volumes, respiratory muscle function, sleep breathing disorders and the response to hypoxemia in PD. Among the studies, we identified some limitations: (i) small study populations (mainly composed of patients with advanced PD), (ii) the absence of long-term follow-up and (iii) the absence of functional evaluations under “off-drug” conditions. Although there are many reports of abnormal spirometry data in PD (mainly related to impairment of the inspiratory muscles), little is known about hypoventilation in PD. We conclude that ventilatory dysfunction in PD has been poorly studied and little is known about its frequency and clinical relevance. Hence, there is a need to characterize the different phenotypes of ventilation disorders in PD, study their relationships with disease progression and assess their prognostic value.
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Affiliation(s)
- Guillaume Baille
- Service de Neurologie et Pathologie du Mouvement, Pôle de neurosciences et appareil locomoteur, CHRU de Lille, Lille, France / INSERM UMR 1171, LILLE France, Troubles cognitifs dégénératifs et vasculaires, Lille, France
| | - Anna Maria De Jesus
- Service d'Explorations Fonctionnelles Respiratoires, Hôpital Albert Calmette, CHRU de Lille, Lille, France
| | - Thierry Perez
- Service d'Explorations Fonctionnelles Respiratoires, Hôpital Albert Calmette, CHRU de Lille, Lille, France
| | - David Devos
- Service de Pharmacologie Médicale, Université de Lille, CHRU de Lille, France / INSERM UMR 1171, Lille, France
| | - Kathy Dujardin
- Service de Neurologie et Pathologie du Mouvement, Pôle de neurosciences et appareil locomoteur, CHRU de Lille, Lille, France / INSERM UMR 1171, LILLE France, Troubles cognitifs dégénératifs et vasculaires, Lille, France
| | | | - Luc Defebvre
- Service de Neurologie et Pathologie du Mouvement, Pôle de neurosciences et appareil locomoteur, CHRU de Lille, Lille, France / INSERM UMR 1171, LILLE France, Troubles cognitifs dégénératifs et vasculaires, Lille, France
| | - Caroline Moreau
- Service de Neurologie et Pathologie du Mouvement, Pôle de neurosciences et appareil locomoteur, CHRU de Lille, Lille, France / INSERM UMR 1171, LILLE France, Troubles cognitifs dégénératifs et vasculaires, Lille, France
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15
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Azulay JP, Witjas T, Eusebio A. [No motor signs in Parkinson's disease]. Presse Med 2017; 46:195-201. [PMID: 28063757 DOI: 10.1016/j.lpm.2016.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 11/16/2016] [Accepted: 11/21/2016] [Indexed: 01/19/2023] Open
Abstract
In Parkinson's disease, motor signs have long been the main targets of the management of the disease. In recent years, non-motor disorders have elicited increasing interest. These disorders are under diagnosed and managed more difficultly than motor signs and are sometimes perceived as more disturbing by the patients. These signs are polymorphous, sometimes occurring before the motor symptoms but increase with the disease duration and complicating always the late stages. They may fluctuate as the motor signs, while being under the control of dopaminergic pathways, or be linked to the degeneration of other neuronal circuits. These clinical manifestations, whether or not fluctuating are classified into three major categories: psycho-cognitive including sleep disorders, autonomic and sensory.
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Affiliation(s)
- Jean-Philippe Azulay
- AP-HM, hôpital de la Timone, centre expert pour la maladie de Parkinson, service de neurologie et pathologie du mouvement, 13385 Marseille, France.
| | - Tatiana Witjas
- AP-HM, hôpital de la Timone, centre expert pour la maladie de Parkinson, service de neurologie et pathologie du mouvement, 13385 Marseille, France
| | - Alexandre Eusebio
- AP-HM, hôpital de la Timone, centre expert pour la maladie de Parkinson, service de neurologie et pathologie du mouvement, 13385 Marseille, France
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16
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Cineradiographic analysis of respiratory movements in a mouse model for early Parkinson's disease. Respir Physiol Neurobiol 2015; 218:40-5. [DOI: 10.1016/j.resp.2015.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 06/05/2015] [Accepted: 07/03/2015] [Indexed: 11/22/2022]
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17
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Atkinson-Clement C, Sadat J, Pinto S. Behavioral treatments for speech in Parkinson's disease: meta-analyses and review of the literature. Neurodegener Dis Manag 2015; 5:233-48. [DOI: 10.2217/nmt.15.16] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
SUMMARY Parkinson's disease (PD) results from neurodegenerative processes leading to alteration of motor functions. Most motor symptoms respond well to pharmacological and neurosurgical treatments, except some axial symptoms such as speech impairment, so-called dysarthria. However, speech therapy is rarely proposed to PD patients. This review aims at evaluating previous research on the effects of speech behavioral therapies in patients with PD. We also performed two meta-analyses focusing on speech loudness and voice pitch. We showed that intensive therapies in PD are the most effective for hypophonia and can lead to some improvement of voice pitch. Although speech therapy is effective in handling PD dysarthria, behavioral speech rehabilitation in PD still needs further validation.
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Affiliation(s)
- Cyril Atkinson-Clement
- Aix-Marseille Université, CNRS, Laboratoire Parole et Langage (LPL), UMR 7309, 13100, Aix-en-Provence, France
| | - Jasmin Sadat
- Aix-Marseille Université, CNRS, Laboratoire Parole et Langage (LPL), UMR 7309, 13100, Aix-en-Provence, France
| | - Serge Pinto
- Aix-Marseille Université, CNRS, Laboratoire Parole et Langage (LPL), UMR 7309, 13100, Aix-en-Provence, France
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18
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The physiological significance of postinspiration in respiratory control. PROGRESS IN BRAIN RESEARCH 2014; 212:113-30. [DOI: 10.1016/b978-0-444-63488-7.00007-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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19
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Monteiro L, Souza-Machado A, Valderramas S, Melo A. The Effect of Levodopa on Pulmonary Function in Parkinson's Disease: A Systematic Review and Meta-Analysis. Clin Ther 2012; 34:1049-55. [DOI: 10.1016/j.clinthera.2012.03.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 03/02/2012] [Accepted: 03/07/2012] [Indexed: 10/28/2022]
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20
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Lowit A, Dobinson C, Timmins C, Howell P, Kröger B. The effectiveness of traditional methods and altered auditory feedback in improving speech rate and intelligibility in speakers with Parkinson's disease. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2010; 12:426-436. [PMID: 20626310 DOI: 10.3109/17549507.2010.497559] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Communication problems are a frequent symptom for people with Parkinson's disease (PD) which can have a significant impact on their quality-of-life. Deciding on the right management approach can be problematic though, as, with the exception of LSVT, very few studies have been published demonstrating the effectiveness of treatment techniques. The aim of this study was to compare traditional rate reduction methods with altered auditory feedback (AAF) with respect to their effectiveness to reduce speech rate and improve intelligibility in speakers with PD. Ten participants underwent both types of treatments in once weekly sessions for 6 weeks. Outcomes measures were speech rate for passage reading as well as intelligibility on both a passage reading and a monologue task. The results showed that, as a group, there was no significant change in either speech rate or intelligibility resulting from either treatment type. However, individual speakers showed improvements in speech performance as a result of each therapy technique. In most cases, these benefits persisted for at least 6 months post-treatment. Possible reasons for the variable response to treatment, as well as issues to consider when planning to use AAF devices in treatment are discussed.
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Affiliation(s)
- Anja Lowit
- Department of Educational and Professional Studies, Strathclyde University, Glasgow, Scotland, UK.
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21
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De Letter M, Van Borsel J, Boon P, De Bodt M, Dhooge I, Santens P. Sequential changes in motor speech across a levodopa cycle in advanced Parkinson's disease. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2010; 12:405-413. [PMID: 20602581 DOI: 10.3109/17549507.2010.491556] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Previous research has indicated that in Parkinson's disease (PD) some motor speech characteristics are changed by levodopa administration, while others are not. In advanced PD, the time course of these changes and the correlations with motor performance have not been sufficiently investigated. The purpose was to investigate the sequential changes of respiratory, articulatory, and phonatory speech characteristics across a levodopa drug cycle, using spirometry, acoustic, and motor speech analysis. Seven patients with advanced PD were included. All patients were evaluated sequentually at 15 minute intervals before and following levodopa intake. Data were analysed using repeated measures ANOVA and non-parametric analysis. Significant changes were found in motor function, vital capacity, and standard deviation of the diadochokinetic period. A trend was present for shimmer and frequency of the first formant. Significant inter-individual differences in the sequential changes were demonstrated for nearly all evaluated parameters. The conclusion is that, in advanced PD, the evaluation of speech characteristics at one moment after levodopa administration is not representative of an entire drug cycle and that an individualized evaluation of an entire drug cycle is warranted before initiation of a speech-language pathology program.
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Troche MS, Huebner I, Rosenbek JC, Okun MS, Sapienza CM. Respiratory-swallowing coordination and swallowing safety in patients with Parkinson's disease. Dysphagia 2010; 26:218-24. [PMID: 20623304 DOI: 10.1007/s00455-010-9289-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Accepted: 06/22/2010] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to determine if individuals with Parkinson's disease (PD) demonstrate abnormal respiratory events when swallowing thin liquids. In addition, this study sought to define associations between respiratory events, swallowing apnea duration, and penetration-aspiration (P-A) scale scores. Thirty-nine individuals with PD were administered ten trials of a 5-ml thin liquid bolus. P-A scale score quantified the presence of penetration and aspiration during the swallowing of a 3-oz sequential bolus. Participants were divided into two groups based on swallowing safety judged during the 3-oz sequential swallowing: Group 1 = P-A ≤ 2; Group 2 = P-A ≥ 3. Swallows were examined using videofluoroscopy coupled with a nasal cannula to record respiratory signals during the event(s). Findings indicated that expiration was the predominant respiratory event before and after swallowing apnea. The data revealed no differences in our cohort versus the percentages of post-swallowing events reported in the literature for healthy adults. In addition, individuals with decreased swallowing safety, as measured by the P-A scale, were more likely to inspire after swallows and to have shorter swallowing apnea duration. Individuals who inspired before swallow also had longer swallowing apnea duration. The occurrence of inspiratory events after a swallow and the occurrence of shorter swallowing apnea durations may serve as important indicators during clinical swallowing assessments in patients at risk for penetration or aspiration with PD.
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Khan W, Naz S, Rana AQ. Shortness of breath, a 'wearing-off' symptom in Parkinson's disease. Clin Drug Investig 2009; 29:689-91. [PMID: 19715385 DOI: 10.2165/11315290-000000000-00000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Although levodopa is considered the gold standard for Parkinson's disease therapy, prolonged use of this drug can result in motor complications such as a 'wearing-off' phenomenon. This outcome is seen in a significant number of patients with Parkinson's disease taking levodopa and, in some cases, is observed only a few hours after intake of the last dose of levodopa. Patients experiencing the wearing-off period may present with sensory, autonomic, psychiatric and motor fluctuations. Although infrequent, shortness of breath is an important non-motor wearing-off symptom experienced by patients with Parkinson's disease. In addition to being a symptom induced by wearing off, other causes of shortness of breath include pulmonary diseases, coronary artery disease and anxiety. Thus, it is important to identify the cause of shortness of breath to ensure that the appropriate treatment is initiated. We report here on a patient with Parkinson's disease who was taking levodopa and developed both shortness of breath and hyperventilation during wearing-off periods. He underwent extensive pulmonary and cardiac investigations that were unremarkable. His shortness of breath was determined to be a wearing-off phenomenon and his condition improved with the addition of a catechol-O-methyltransferase inhibitor (entacapone).
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Affiliation(s)
- Waqas Khan
- Parkinson Clinic of Eastern Toronto and Movement Disorders Center, Toronto, Ontario, Canada
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Electromyographic activity of sternocleidomastoid muscle in patients with Parkinson’s disease. J Electromyogr Kinesiol 2009; 19:591-7. [DOI: 10.1016/j.jelekin.2008.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Revised: 01/08/2008] [Accepted: 01/11/2008] [Indexed: 11/19/2022] Open
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26
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Gross RD, Atwood CW, Ross SB, Eichhorn KA, Olszewski JW, Doyle PJ. The Coordination of Breathing and Swallowing in Parkinson’s Disease. Dysphagia 2007; 23:136-45. [PMID: 18027027 DOI: 10.1007/s00455-007-9113-4] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Accepted: 07/03/2007] [Indexed: 11/25/2022]
Affiliation(s)
- Roxann Diez Gross
- Division of Otolaryngology, University of Pittsburgh, Eye & Ear Institute, Suite 500, 200 Lothrop Street, Pittsburgh, Pennsylvania 15213, USA.
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27
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De Letter M, Santens P, De Bodt M, Van Maele G, Van Borsel J, Boon P. The effect of levodopa on respiration and word intelligibility in people with advanced Parkinson's disease. Clin Neurol Neurosurg 2007; 109:495-500. [DOI: 10.1016/j.clineuro.2007.04.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2007] [Revised: 03/07/2007] [Accepted: 04/09/2007] [Indexed: 11/26/2022]
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Pal PK, Sathyaprabha TN, Tuhina P, Thennarasu K. Pattern of subclinical pulmonary dysfunctions in Parkinson's disease and the effect of levodopa. Mov Disord 2007; 22:420-4. [PMID: 17230476 DOI: 10.1002/mds.21330] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We performed a detailed evaluation of pulmonary function in 53 patients with idiopathic Parkinson's disease (PD) who did not have symptoms of pulmonary or cardiac dysfunction. There was a significant pulmonary dysfunction of restrictive type which partially responded to levodopa. Compared to men, women were more severely affected. Pulmonary function assessment is recommended in PD, irrespective of severity of disease.
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Affiliation(s)
- Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
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Baker S, Davenport P, Sapienza C. Examination of strength training and detraining effects in expiratory muscles. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2005; 48:1325-33. [PMID: 16478374 DOI: 10.1044/1092-4388(2005/092)] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2004] [Revised: 12/18/2004] [Accepted: 04/28/2005] [Indexed: 05/06/2023]
Abstract
PURPOSE The purpose of this study was to determine strength gains following expiratory muscle strength training (EMST) and to determine detraining effects when the training stimulus is removed. METHOD Thirty-two healthy participants were enrolled in an EMST program. Sixteen participants trained for 4 weeks (Group 1) and 16 participants trained for 8 weeks (Group 2). All 32 participants were detrained for 8 weeks. Maximum expiratory pressure (MEP) was used to document change in expiratory muscle strength throughout the study. RESULTS Group 1 had a 41% increase and Group 2 had a 51% increase in MEP following the training. Mean MEP, for both groups, was significantly greater than baseline at the end of the training period (p = .0001), at the 4th week of detraining (p = .0001), and at the 8th week of detraining (p = .0001). The results also indicated that there was no significant difference in mean MEP between the groups at baseline, end of training, or throughout the detraining period (p = .960). DISCUSSION The results suggest that expiratory muscle strength gains following a 4- and 8-week EMST program do not differ significantly. Additionally, detraining rates do not appear to be dependent on length of training time.
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Pinto S, Ozsancak C, Tripoliti E, Thobois S, Limousin-Dowsey P, Auzou P. Treatments for dysarthria in Parkinson's disease. Lancet Neurol 2004; 3:547-56. [PMID: 15324723 DOI: 10.1016/s1474-4422(04)00854-3] [Citation(s) in RCA: 164] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Dysarthria in Parkinson's disease can be characterised by monotony of pitch and loudness, reduced stress, variable rate, imprecise consonants, and a breathy and harsh voice. Use of levodopa to replenish dopamine concentrations in the striatum seems to improve articulation, voice quality, and pitch variation, although some studies show no change in phonatory parameters. Traditional speech therapy can lead to improvement of dysarthria, and intensive programmes have had substantial beneficial effects on vocal loudness. Unilateral surgical lesions of subcortical structures are variably effective for the alleviation of dysarthria, whereas bilateral procedures typically lead to worsening of speech production. Among deep-brain stimulation procedures, only stimulation of the subthalamic nucleus improves some motor components of speech although intelligibility seems to decrease after surgery. Due to the variable treatment effects on parkinsonian speech, management of dysarthria is still challenging for the clinician and should be discussed with the patient.
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Affiliation(s)
- Serge Pinto
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology London, UK.
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