Efetividade do exercício Chin Tuck Against Resistance em comparação com a manobra Chin-Down na Doença de Parkinson

Abstract

Dysphagia is a condition frequently associated with Parkinson's disease (PD) and can cause not only a decline in quality of life, malnutrition, dehydration, and fear of eating but also increase the risk of aspiration pneumonia, the main cause of death in these patients. Although there is drug treatment for motor symptoms, increasing doses does not guarantee improvement in swallowing disorders. Interventions for oropharyngeal dysphagia include those based on the chin-down postural maneuver, which has shown positive effects on the efficiency and safety of swallowing in PD patients. However, other interventions are being developed, such as the Chin Tuck Against Resistance (CTAR) technique, which is a promising therapeutic proposal for rehabilitating swallowing function, although there is still no published data on its effectiveness in the Parkinson's population. Therefore, this research aims to investigate the effectiveness of an intervention program based on CTAR exercises, compared to the chin-down postural maneuver, in dysphagic patients with PD. Ethical principles were complied with and the project was approved by the Research Ethics Committee. The first study was a randomized clinical trial. It included 26 individuals with PD who were randomly allocated to two intervention groups for 4 weeks. Group A performed the CTAR exercises and functional swallowing training, while Group B performed the chin-down maneuver with functional swallowing training with different food consistencies. The outcomes evaluated included clinical assessment of swallowing, maximum isometric tongue pressure, quality of life, and peak cough flow, measured before and after the intervention period. The CTAR group showed a significant improvement in clinical assessment of swallowing, maximum isometric tongue pressure, and quality of life compared to the chin-down group. However, there was no significant difference in peak cough flow between the two groups. The second study, longitudinal in nature, compared the maximum isometric progression of the tongue over the 4 weeks of intervention. The analysis between the groups revealed a significant difference in the increase in tongue pressure in the CTAR group compared to the chin-down group in all the weeks of intervention. The highest peak measurement occurred in the third week and the effect size was considered large. The exploratory studies suggest the efficacy of CTAR exercises in the rehabilitation of dysphagia in PD patients, standing out as a promising and efficient approach.