Treatment of swallowing disorders in PD has not been well studied. Conventional techniques have included oral motor exercises to improve muscle strength, range of motion and coordination, and behavioral modifications such as effortful breath-hold, chin positioning, double swallow, the Mendelsohn maneuver, swallow/cough, effortful swallow, and diet and liquid modifications (13,127). Effectiveness of these techniques varies and can be dependent on patient motivation and cooperation, family support, and the timeliness of the referral for a swallowing evaluation. Efficacy studies of the impact of behavioral treatment on dysphagia in PD are lacking (128). The effects of LSVT® on swallowing dysfunction in individuals with PD have been studied by Sharkawi et al. (8). These researchers found that the LSVT® reduced swallowing motility disorders by 51%. Some temporal measures of swallowing were also reduced, as was the amount of residue. This is the first study to find positive changes in both voice and swallowing function following intensive voice therapy alone without a therapy focusing on swallowing. A study by De Angelis et al. (129) has documented improved voice, speech, and swallowing functions in individuals with PD participating in an intensive treatment with a schedule similar to that of the LSVT® and with a clinical goal of improved glottic closure. These studies collectively point to the utility of intensive voice treatment for the reduction of swallowing dysfunction.
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