Effects of Bolus Holding on Respiratory-Swallow Coordination in Parkinson's Disease.

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.