Pharyngeal dysphagia is a common and clinically relevant symptom in patients with Parkinson’s disease (PD). Dysphagia affects up to 80% of PD patients during the course of their disease.1 In later disease stages, severe dysphagia leads to complications in medication intake, dehydration, malnutrition, and aspiration pneumonia,2 but critical swallowing dysfunction is often already present in earlier disease stages.3 So far, only a few therapeutic options have been investigated, and more evidence of effectiveness and consistency of these methods is needed.4, 5 Besides optimization of dopaminergic medication,6, 7 behavioral treatment strategies like swallowing exercises, compensatory maneuvers or bolus modification guided by speech- and language therapists may be able to improve swallowing dysfunction.8-11 Within the past years, few studies indicated a potential benefit in swallowing function by performing expiratory muscle strength training (EMST) with the goal of increasing force generation capacity of pharyngeal muscles.12-14 Regarding swallowing dysfunction in PD, 1 randomized, controlled trial was able to show that a 4-week EMST could improve swallowing safety with positive, albeit mild effects on the penetration-aspiration scale,15 measured by videofluoroscopic swallow study. Furthermore, a potential detraining effect was described.16 Although these results suggest EMST training to be a good and cost-effective treatment candidate for PD patients,4 more evidence is needed regarding the effects of EMST on other features of swallowing dysfunction, in particular, swallowing efficiency and possibly connected cortical swallowing processing pathways.

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