Parkinson’s disease (PD) is a neuromuscular disorder, which means that due to changes in the nervous system, the muscles don’t respond properly anymore. In the skeletal muscles this becomes obvious as the characteristic tremor. However, respiratory muscles may be affected as well. These are the muscles used for breathing, but also for speech and swallow. Loss of respiratory muscle strength can here lead to respiratory muscle weakness. If this affects the swallowing muscles, patients may experience dysphagia, which is often seen in people with Parkinson’s. With dysphagia, the swallowing function is impaired, which can lead to problems moving food in the mouth, or down the esophagus. Some of the food may also be aspirated, and end up in the lung, where it can increase the risk for aspiration-associated pneumonia. Pneumonia is one of the greatest mortality risks in people with dysphagia. Dysphagia can also lead to malnutrition, social isolation (as people worry about choking when eating in public), and reduced quality of life. Respiratory Muscle Training (RMT) improves strength and function of respiratory muscles, and can help reduce the symptoms and causes of dysphagia.
Besides breathing, respiratory muscles are also required for speech and voice production. These muscle groups are affected In people with Parkinson’s. PD patients often have difficulty speaking and not enough audible voice (dysphonia). They particularly struggle with speech intensity, capacity, rhythm and fluency as well as the facial expressions associated with their intent. This speech dysfunction can limit their ability and confidence to interact effectively with other people, leading to social isolation and loneliness. Voice disorders also cause distress and depression, thereby aggravating the disease.
Both inspiratory (IMT) and expiratory muscle training (EMT) support consistent muscular pressure and lung volume, which are essential for speech production. Speech is produced if sufficient air volume is pushed through the vocal cords with high enough airflow to produce audible sounds. Respiratory muscle strengthening using RMT activates and exercises the hyolaryngeal complex, the muscle group required for speech production. Speech breathing, measured by vowel phonation and speech quality, also improves with combined RMT. Research shows that RMT promotes optimal speech and intelligibility necessary for better communication and QoL in people with Parkinson’s.
Efficient Swallow Function
Difficulty in swallowing (dysphagia) is a prevalent dysfunction to PD patients due to weak hyolaryngeal muscles and dysfunctional breathe-swallow patterns. The swallowing reflex is a highly coordinated body response to food uptake and airway protection. The hyolaryngeal complex is responsible for controlling the movement of a food bolus down to the oesophagus. For optimal swallowing function to take place, this automatic body movement requires enough lung volume and capacity. Disturbance of the swallowing reflex may lead to aspiration of food debris into the lungs, which can cause pneumonia, malnutrition and even death to high-risk patient groups, such as the elderly.
Respiratory muscle weakness (RMW) is associated with ribcage inflexibility, decreased lung volume and weak laryngeal functions. RMT directly addresses RMW and retrains the respiratory muscles to optimize breathing and support safe swallowing. Evidence shows an increase of 27% maximal expiratory pressure (MEP) supporting deep breathing, airway defence and swallowing reflex. RMT strengthens the hyolaryngeal muscles for a conscious, efficient and coordinated breathe-swallow pattern. RMT also enhances recovery from swallow dysfunction and dysphagia and helps to enjoy food again and to stay healthy.
Effective Cough Production
Dysfunctional voluntary cough and cough reflex can often be observed in people with Parkinson’s. The coughing mechanism is essential to support the coordinated breathe-swallow pattern, to prevent penetration/AP and to facilitate airway protection. Strengthening of the expiratory muscles (EMT) promotes the breathe-swallow-cough mechanism by activating the hyolaryngeal complex in the upper airway. These accessory muscles play essential roles in phonation, airway defence, ventilation and expectoration. Strengthening of the inspiratory muscles (IMT), on the other hand, ensures that enough lung volume and airflow are available for the pattern timing and coordination.
Clinical evidence shows that RMT supports cough function that strengthens the cough reflex necessary for pulmonary hygiene and airway clearance. RMT also improves effective cough production in PD patients by increasing cough volume acceleration, therefore, leading to a decreased risk of aspiration.
It is a priority to address RMW in people with Parkinson’s, as it is the underlying cause for several symptoms. Evidence shows that RMT can effectively address RMW in PD patients, promoting safe swallowing, improved speech and voice production, and increased quality of life. RMT using the Breather can help people with Parkinson’s to improve respiratory, speech and swallow function, which can help to reduce social isolation and contribute to a more positive outlook on life.
The Breather is Better Breathing Ireland’s recommended respiratory muscle training device for Parkinson’s treatment. The Breather offers both inspiratory AND expiratory muscle training with just a few minutes of training per day. Performing RMT at a perceived 60-70% of your maximum capacity, measurable improvements should become noticeable in as early as two to three weeks.