Reproducibility and validity of patient-rated assessment of speech, swallowing, and saliva control in Parkinson's disease

Contains fulltext : 96283.pdf (publisher's version ) (Closed access)OBJECTIVE: To report on the development and psychometric evaluation of the Radboud Oral Motor Inventory for Parkinson's Disease (ROMP), a newly developed patient-rated assessment of speech, swallowing, and saliva control in patients with Parkinson's disease (PD). DESIGN: Reliability and validity study. SETTING: Tertiary-care Parkinson center for multidisciplinary assessment. PARTICIPANTS: Consecutive community-dwelling patients with PD (n=129) or atypical parkinsonism (AP; n=49; mean +/- SD age, 64+/-9.8y; mean +/- SD disease duration, 7y; median Hoehn and Yahr [HY] stage, 2.5). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: To evaluate reproducibility, 60 patients completed the ROMP twice within a mean of 24+/-12 days. To study validity, another cohort of 118 patients who had completed the ROMP was assessed by both a neurologist (HY stage, Unified Parkinson's Disease Rating Scale III) and speech-language pathologist (severity of dysarthria, dysphagia, drooling) who were blinded to ROMP scores. RESULTS: Confirmatory factor analysis identified the 3 a priori-designed ROMP domains of speech, swallowing, and saliva control. Internal consistency was .95 for the total ROMP and .87 to .94 for the 3 domains or subscales. Intraclass correlation coefficients for reproducibility were .94 and .83 to .92 for the subscales. Construct validity was substantial to good with correlations ranging from .36 to .82. The ROMP differentiated significantly (P<.001) between patients indicated for speech therapy (based on independent assessment) and those who were not and between mild, moderate, and severe PD according to HY stage. CONCLUSIONS: The ROMP provides a reliable and valid instrument to evaluate patient-perceived problems with speech, swallowing, and saliva control in patients with PD or AP

Pathophysiology of diurnal drooling in Parkinson's disease

Contains fulltext : 98191.pdf (publisher's version ) (Closed access)Drooling is an incapacitating feature of Parkinson's disease. Better pathophysiological insights are needed to improve treatment. In this study, we tested the hypothesis that the cause of drooling is multifactorial. We examined 15 patients with Parkinson's disease with distinct diurnal saliva loss ("droolers") and 15 patients with Parkinson's disease without drooling complaints ("nondroolers"). We evaluated all factors that could potentially contribute to drooling: swallowing capacity (maximum volume), functional swallowing (assessed with the dysphagia subscale of the Therapy Outcome Measures for rehabilitation specialists), unintentional mouth opening due to hypomimia (Unified Parkinson's Disease Rating Scale item), posture (quantified from sagittal photographs), and nose-breathing ability. We also quantified the frequency of spontaneous swallowing during 45 minutes of quiet sitting, using polygraphy. Droolers had more advanced Parkinson's disease than nondroolers (Unified Parkinson's Disease Rating Scale motor score 31 vs 22; P=.014). Droolers also scored significantly worse on all recorded variables except for nose breathing. Swallowing frequency tended to be higher, possibly to compensate for less efficient swallowing. Logistic regression with adjustment for age and disease severity showed that hypomimia correlated best with drooling. Linear regression with hypomimia as the dependent variable identified disease severity, dysphagia, and male sex as significant explanatory factors. Drooling in Parkinson's disease results from multiple risk factors, with hypomimia being the most prominent. When monitored, patients appear to compensate by increasing their swallowing frequency, much like the increased cadence that is used to compensate for stepping akinesia. These findings can provide a rationale for behavioral approaches to treat drooling

Mikromekaaninen oskillaattori

Tässä diplomityössä tutustuttiin kapasitiivisesti kytketyllä mikromekaanisella resonaattorilla stabiloidun sähkömekaanisen oskillaattorin teoriaan: resonaattorin mekaniikkaan ja vahvistimen elektroniikkaan. Esitetyn teorian pohjalta suunniteltiin ja rakennettiin sähkömekaaninen 500 kHz:n Pierce-oskillaattori. Prototyypin toiminta demonstroitiin mittauksin. Prototyypin mittauksissa todennettiin mikromekaanisen oskillaattorin värähtelytaajuuden ja -amplitudin riippuvuus resonaattorin biasjännitteestä; mittaustulokset olivat ennusteiden mukaiset. Oskillaattorin värähtelytarkkuutta kuvaava vaihekohina mitattiin tarkoitukseen suunnitellulla laitteistolla. Mitattu vaihekohina oli -123dBc@SkHz. Prototyypissä käytettiin palkkiresonaattoria, jonka epälineaarisuuden seurauksena oskillaattorin ulostulo oli säröytynyt. Työssä pohdittiin myös fysikaalisia rajoja palkkiresonaattoriin perustuvan mikromekaanisen oskillaattorin suorituskyvylle