•  
  •  
 

Rehabilitation Practice and Science

Abstract

Dysphagia is one of the most clinically important complications of Parkinson's disease (PD). It impairs nutrition and quality of life and is closely linked to aspiration pneumonia, a leading cause of death in this population. It is often underrecognized, partly because subjective complaints underestimate the impairment found on objective testing, and partly because silent aspiration progresses without a protective cough. This review examines dysphagia in PD from a rehabilitation perspective, covering its pathophysiology, clinical features, assessment, and the evidence for rehabilitative interventions. Parkinsonian dysphagia arises from dopaminergic, non-dopaminergic, and peripheral mechanisms, and because it responds inconsistently to levodopa, rehabilitation has a central role in management. Its clinical features can largely be understood as manifestations of bradykinesia, hypokinesia, and akinesia in the swallowing apparatus, forming a complex motor syndrome. Because the impairment is often unrecognized by patients and does not match the motor stage, active screening from the time of diagnosis, followed by instrumental assessments, such as videofluoroscopic swallow studies (VFSS) or fiberoptic/flexible endoscopic evaluation of swallowing (FEES), when clinically indicated. Among rehabilitative interventions, expiratory muscle strength training has the clearest rationale, but the overall evidence, including behavioral, neurostimulation, and pharmacological approaches, remains limited and of low certainty. We propose a practical framework that combines active screening, indication-based assessment, and stage-specific intervention. Until larger trials strengthen the evidence, balanced clinical judgment that recognizes current limitations while maintaining active management remains central to optimizing swallowing outcomes in patients with PD.

Download

Included in

Physiotherapy Commons

Share

COinS