A systematic review of behavioural therapies for improving swallow and cough function in Parkinson’s disease

Stemming the Tide: The Proactive Role of Allied Health Therapy in Parkinson’s Disease

“…Recent meta-analyses highlighted the effectiveness of high intensity, target-specific, exercise-based programs for improving voice loudness [15,19], respiratory support [20], and speech intelligibility [19]. However, evidence for long-term maintenance of improvements, other than in sustained vowel volume, are less robust [21]. Recent evidence suggests that device-mediated interventions may have positive effects on vocal mechanism efficiency and improve communication compared to high intensity exercise programs [77].…”

“…Swallowing-related interventions, which can include transdisciplinary care models (ST, OT, and dieticians) (Fig. 1) in early PD may include pharmacotherapy and nutritional optimization, compensatory strategies for sensorimotor changes including sialorrhea management, and system-targeted oral, respiratory and pharyngeal exercises [16,21,75]. Although the need for diet modification may be less likely in early PD, there is international consensus that management should be initiated at the first onset of clinical or instrumental evidence of swallowing changes, regardless of disease stage [75].…”

“…Multiple therapies have been identified as important in the care of people with PD (PwP) [8]. This review focuses on the roles of physical therapy (PT), occupational therapy (OT), speech and language therapy (ST), and psychological therapies in prodromal and early PD, as they have a robust body of evidence, including strong randomized controlled trials (RCT) [9][10][11][12], meta-analyses [7,[13][14][15][16], and systematic reviews [6,[17][18][19][20][21][22][23][24][25] that guide clinical practice recommendations [26][27][28].…”

Medicare Restriction of Telehealth Speech Services Negatively Impacts Patient Care

“…VSU therapy are well-established medically necessary service modalities to treat patients suffering from these symptoms. 1,4,5,[8][9][10][11]16,[18][19][20][21][27][28][29][30][31][32] Delivery of these services through a virtual format, via teletherapy, have shown equivalent or better outcomes compared to in-person therapy. 16,[18][19][20][21][27][28][29][30][31][32] In this study, changes in reimbursement for teletherapy speech-language pathology services (ie, the elimination of teletherapy services for Medicare patients) had a clearly negative impact on patients' access to this effective and impactful care.…”

“…These conditions can restrict patients' ability to function, impact their personal, professional, and social interactions, and/or pose a risk to life. [1][2][3][4][5][6][7] The role of the Otolaryngologist and Speech-Language Pathologist (SLP) is vital to identify and treat these conditions. Voice, swallowing, and upper airway (VSU) therapy are amply described in the literature as effective, vital components of otolaryngologic and speechlanguage pathology care.…”