Biofeedback to improve swallowing function in persons wiht dysphagia and Parkinson Disease: an intervention study
Citation:BATTEL, IRENE, Biofeedback to improve swallowing function in persons wiht dysphagia and Parkinson Disease: an intervention study, Trinity College Dublin.School of Linguistic Speech & Comm Sci, 2021
Thesis Post-viva 27.11.20 Irene Battel.pdf (PDF) 4.227Mb
This thesis is concerned with a therapeutic approach aimed at improving swallow function in people with Idiopathic Parkinson?s disease (IPD) and swallowing disorders.The neural impairments in IPD manifest as reduced ability to plan motor acts based on internal cues. Providing external cues using sEMG can bypass the impaired neural mechanisms and improve swallowing function. This has already shown some effects in limb rehabilitation, suggesting that people with IPD benefit from feedback more than other groups of patients because it is hypothesised that cues help integrate different movement components.Given the complexity of the swallowing intervention using biofeedback approach in people with IPD and dysphagia, this research study was informed by guidelines for developing complex intervention published by the UK Medical Research Council. This research comprises three key components: a systematic review of the literature, the development of a feasibility study and the cross cultural translation of a swallowing scale and finally the creation of an intervention protocol for a future study. Firstly, a systematic review was completed to verify the evidence of the use of biofeedback as an augmentative tool for the improvement of swallowing function in people with IPD. The review found that biofeedback had positive effects on increasing swallowing function in people with IPD and dysphagia, although the quality of the evidence was graded as low.Nevertheless, the narrative synthesis of the findings suggest that visual biofeedback as part of a swallow intervention programme for people with IPD and dysphagia was likely to benefits swallowing function in particular increasing quality of life of people with IPD and dysphagia. Moreover, surface electromyography (sEMG) was the most common method to deliver swallowing biofeedback in people with IPD and dysphagia. These findings combined with principles of neuroplasticity and motor learning led to a conceptual framework for a feasibility study on the implementation of sEMG biofeedback swallowing treatment in people with IPD and dysphagia. The feasibility study was conducted at the Neurological Department of the Venice hospital (Italy). Twelve participants were recruited; two withdrew from the study at the beginning of the research, the remaining 10 participants completed the study. The intervention involved biofeedback with sEMG. Participants received this intervention for 1 hour per day, 5 days per week, for 4 weeks (20 hours). The intervention programme incorporated a progression of swallowing tasks using the sEMG biofeedback and the treatment approach was based on motor learning and neuroplasticity principles.Overall, the swallowing intervention programme, found positive results in people with dysphagia and IPD. There were statistically significant positive changes at the FOIS-It (p < 0.05) and in saliva and solid food pharyngeal residue (p < 0.05) assessed during instrumental examination (FEES). The quality of life showed an improvement after treatment specifically the sub-part of food selection (p < 0.05). These changes in oral intake and pharyngeal clearance for saliva and solid food were maintained three months post intervention suggesting an important effect of retention in IPD people. The intervention was well tolerated by the participants who reported additional benefits not only in swallowing-related functions such as saliva control and decreased duration of meal times but also in non-swallowing functions such as voice and cognitive attention skills. These results of the quality analysis were selected to be included in the protocol of future study. The final chapter of the thesis presents a protocol for a further pilot study that is informed by the findings of this feasibility study. Directions for the next research phase are provided.
Author: BATTEL, IRENE
Publisher:Trinity College Dublin. School of Linguistic Speech & Comm Sci. Discipline of Clin Speech & Language Studies
Type of material:Thesis
Availability:Full text available