Examining Timing and Safety of Swallow in Progressive Supranuclear Palsy PSP

1
Examining Timing and Safety of Swallow in
Progressive Supranuclear Palsy (PSP) Michelle S.
Troche1,2,3,4, Irene Huebner1,4, John C.
Rosenbek2,3,4, Hubert Fernandez3, Christine M.
Sapienza1,3,4 1University of Florida, Department
of Communication Sciences and Disorders,
2University of Florida, Department of
Communicative Disorders, 3University of Florida
Movement Disorders Center NPF Center of
Excellence, 4Brain Rehabilitation Research
Center (BRRC), Malcom Randall VAMC, Gainesville,
Florida

• Statistical Analyses
• Wilcoxon T Test to examine differences between
  consistencies
• Mann-Whitney U Test to examine differences
  between groups
• Non-parametric statistical tests were used
  given small sample size and non- normal
  distribution of data
• Within those with PSP
• Oral transit time was significantly longer for
  thick than thin consistency boluses (p .028)
• Pharyngeal transit times were not significantly
  different in duration between consistencies
• Total swallow duration was significantly longer
  for thick than thin consistency boluses (p
  .028)
• Within those with PD
• Oral transit time was significantly longer for
  thick than thin consistency boluses (p .028)
• Pharyngeal transit times were not significantly
  different in duration between consistencies
• Total swallow duration was not significantly
  longer for thick than thin consistency boluses
• When comparing swallow timing between groups

METHODS CONT

• INTRODUCTION
• Objective To investigate the effects of bolus
  consistency on swallow timing and
  penetration-aspiration (P-A) scale values (P-A
  Scale Rosenbek et al., 1996) in persons with
  progressive supranuclear palsy (PSP).
• Background Swallow dysfunction in
  neurodegenerative disease often leads to
  dysphagia, aspiration, aspiration pneumonia, and
  death. Progressive supranuclear palsy (PSP) is a
  neurodegenerative disease, often considered a
  parkinsonian plus syndrome, affecting cognitive
  and motor functioning. Previous studies suggest
  there are notable differences in swallow
  function among patients with PSP compared to
  healthy controls including fewer continuous
  swallows , increased swallow duration, (Livitan
  et al., 1997), oral phase and pharyngeal phase
  abnormalities, difficulty generating normal
  esophogeal pressures, (Johnston et al, 2000),food
  pooling on the tongue, difficulty in bolus
  formation, and preswallow spill of the bolus
  (Ichihara et al, 2000). Clinically, most
  intervention is compensatory in nature,
  specifically diet modification, yet differences
  in swallow function secondary to consistency have
  not been studied empirically. Additionally, the
  swallow function of persons with PSP has not been
  studied with a comparable cohort, like
  Parkinsons disease.
• Hypotheses
• Participants with PSP will demonstrate increased
  oral (OTT) and pharyngeal transit times (PTT) for
  thick vs. thin consistency boluses.
• Participants with PSP will demonstrate increased
  swallow transit times, decreased swallow safety,
  and decreased swallow-related quality of life as
  compared to participants with PD.

Outcome Measures
RESULTS SUMMARY
RESULTS

• METHODS
• Participants
• 18 Participants
• PSP 8 F, 1 M, Ages 62-78 (mean70)
• PD 8 F, 1 M, Ages 56-81 (mean 70.44)

Table 2. Oral Transit Times for thin and thick
consistency by disease
Table 3. Pharyngeal Transit Times for thin and
thick consistency by disease
CONCLUSIONS
Although considered a parkinsonian syndrome,
Progressive Supranuclear Palsy is quite distinct
from Parkinsons disease. The results of this
study support the notion that the mechanisms
underlying dysphagia with PSP are unique to that
in PD. Statistically and clinically significant
differences were found in swallow transit times,
with trends towards differences in swallow
safety. Those with PSP appear to have more
changes in swallow resulting from cognitive
slowing and spasticity of the swallow mechanism.
Despite the physiological differences between
populations, SWAL-QOL scores did not reveal
significant differences. This may be due to
cognitive or insight deficits this remains
unstudied. Continued investigation into the
swallow pathogenesis related to PSP is necessary
in order to identify appropriate therapeutic
targets in this population with significant
morbidity and mortality secondary to dysphagia
and aspiration pneumonia.
For questions or comments Michelle S. Troche
Ph.D. Candidatemichi81_at_ufl.edu
Table 4. SWAL-QOL scores by disease
Table 5. PA Scores by disease
Acknowledgements Supported in part by Cure PSP
Foundation and the VA Office of Research and
Development, Rehabilitation RD Service, Brain
Rehabilitation Research Center