presented by Michelle Troche
The management of dysphagia and dystussia in people with Parkinson’s disease is critical, particularly given the fact that aspiration pneumonia is a leading cause of death in PD. The goal of this course is to provide information related to treatment planning and management of airway protection in people with PD. The following topics will be addressed: 1) empirically tested treatment approaches for dysphagia and dystussia in PD and 2) the many other complex factors which influence the development airway protection management plans in complex patients with PD.
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 how we translate the results of our comprehensive evaluation into a robust and effective treatment plan for our patients.
In this chapter, we will discuss the treatment approaches which have been empirically tested for dysphagia in PD. We will also address related approaches for improved cough function in PD.
In this chapter, we will bring all previous concepts together to address the development of the holistic dysphagia management plan in PD. We will address issues of cognitive status, apathy and depression, specific impairments, adherence, compliance, maintenance, and follow-up.