presented by Michelle Troche
Dysphagia is an inevitable consequence of Parkinson’s disease (PD). In fact, aspiration pneumonia is a leading cause of death in PD. The goal of this course is to provide information related to the assessment of airway protection, including swallowing and cough dysfunction in people with PD. The following topics will be addressed: 1) mechanisms underlying airway protective dysfunction in PD, and 2) methods for comprehensive assessment of swallowing and cough in PD. This information will help inform treatment planning and decision making for improved airway protection in PD (See Managing Swallowing and Cough Dysfunction in Parkinson’s Disease).
Dr. Michelle S. Troche is currently an Assistant Professor in the Communication Sciences and Disorders Program, Department of Biobehavioral Sciences at Teachers College, Columbia University. Additionally, she holds adjunct positions in the departments of Neurology and Otolaryngology. She completed her doctoral studies at the University of Florida, where she also served as a faculty member prior to joining Columbia University. She is director of the Laboratory for the Study of Upper Airway Dysfunction. Her research is aimed at improving health outcomes and quality of life associated with disorders of airway protection (i.e., swallowing and cough). To that end, she employs a two-pronged approach including both basic science and clinical research. Basic science research goals focus on developing a better understanding of the mechanisms underlying airway protection and its disorders. Clinical research goals are the development of novel and robust evaluation and treatment techniques for dystussia (deficits of cough function) and dysphagia (deficits of swallowing function). Current projects focus on multiple behaviors contributing to airway protection and the ability to modify those behaviors via non-pharmacological treatment paradigms. Research participants include healthy volunteers, people with Parkinson’s disease, other movement disorders, ischemic stroke, and motor neuron disease. Her research has been funded by the National Institutes of Health, Michael J Fox Foundation, and CurePSP Foundation. She directs a collaborative, multidisciplinary, and productive laboratory which creates a rich environment for trainees of all levels. Her clinical work has mainly been in the area of Movement Disorders where she has evaluated and treated the motor speech and airway protective function of hundreds of patients. She has expertise and has mentored students and taught in the areas of: cognitive-motor relationships, neural/myogenic adaptations to exercise and training, with emphasis on the swallowing, coughing and respiratory systems, and clinical disorders of motor speech, voice, and airway protection. Her research, teaching, and mentorship have been recognized by several awards and in her academic record.
In this chapter, we will discuss the shared substrates of swallowing and cough for airway protection. We will introduce a framework for understanding the shared substrates of airway protection.
In this chapter, we will discuss the underlying mechanisms of dysfunction resulting in PD. We will also discuss the variable dysfunction associated with PD which is relevant to the management of dysphagia in PD. We will briefly address the current medical management of PD (i.e. Levodopa, DBS, etc).
In this chapter, we will discuss how PD causes swallowing dysfunction. We will discuss what is known about swallowing biomechanics and airway protection in PD. We will discuss the role of PD severity on swallowing dysfunction.
In this chapter, we will discuss the role of some PD-specific factors on airway protection in PD. We will focus on the influence of deep brain stimulation, PD medications, and dyskinesia on swallowing outcomes.
In this chapter, we will discuss the role of a comprehensive and hypothesis-driven approach to the proper evaluation of airway protection in PD. We will focus on the use of instrumental swallowing assessment paired with adjunctive measures of swallowing physiology for the development of the management plan.
In this chapter, we will continue to discuss the role of a comprehensive and hypothesis-driven approach to the proper evaluation of airway protection in PD. We will focus on the use of quantitative approaches to the assessment of cough-related outcomes, in both the laboratory and the clinic.