{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T15:39:49Z","timestamp":1784302789352,"version":"3.55.0"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2022,2,16]],"date-time":"2022-02-16T00:00:00Z","timestamp":1644969600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,2,16]],"date-time":"2022-02-16T00:00:00Z","timestamp":1644969600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100009684","name":"parkinson\u2019s western australia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009684","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Curtin University"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Dysphagia"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>One of the most debilitating symptoms of advanced Parkinson\u2019s disease is drooling. Currently, the main treatment that is offered for drooling is botulinum toxin injections to the saliva glands which have a number of side effects and do not treat the causes of drooling, such as impaired swallowing and lip closure. This study explored the effect of an alternative therapy approach for drooling that aimed at improving the swallow, expiratory muscle strength training (EMST). Sixteen participants received EMST over a 6- to 8-week period. Measurements were taken pre- and post-training for drooling (Sialorrhea Clinical Scale for Parkinson\u2019s Disease; SCS-PD), swallowing, lip strength and peak cough flow. Measures of drooling, swallowing and peak cough flow were stable over pre-training assessments and improved following training (<jats:italic>p\u2009<\/jats:italic>&lt;\u20090.01). The most conservative estimate of the within-group change for SCS-PD was \u2212\u00a02.50 (95% confidence interval \u2212\u00a0\u20093.22 to \u2212\u00a0\u20091.22). No adverse effects were reported and participants gave high satisfaction ratings for the training. A programme of EMST offers promise as a therapy to reduce drooling for people with Parkinson\u2019s disease. Adequately powered randomised controlled trials of EMST are now needed.<\/jats:p>","DOI":"10.1007\/s00455-022-10408-6","type":"journal-article","created":{"date-parts":[[2022,2,16]],"date-time":"2022-02-16T06:03:54Z","timestamp":1644991434000},"page":"1525-1531","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Expiratory Muscle Strength Training for Drooling in Adults with Parkinson\u2019s Disease"],"prefix":"10.1007","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1744-6979","authenticated-orcid":false,"given":"Naomi","family":"Cocks","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Rafols","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Embley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kylie","family":"Hill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,2,16]]},"reference":[{"key":"10408_CR1","doi-asserted-by":"publisher","first-page":"1391","DOI":"10.1007\/s00415-009-5098-2","volume":"256","author":"JG Kalf","year":"2009","unstructured":"Kalf JG, de Swart BJ, Borm GF, Bloem BR, Munneke M. Prevalence and definition of drooling in Parkinson\u2019s disease: a systematic review. J Neurol. 2009;256:1391\u20136.","journal-title":"J Neurol"},{"key":"10408_CR2","first-page":"213","volume":"22","author":"H Bagheri","year":"1999","unstructured":"Bagheri H, Damase-Michel C, Lapeyre-Mestre M, Cismondo S, O\u2019Connell D, Senard JM, Rascol O, Montastruc JL. A study of salivary secretion in Parkinson\u2019s disease. Clin Neuropharmacol. 1999;22:213\u20135.","journal-title":"Clin Neuropharmacol"},{"key":"10408_CR3","doi-asserted-by":"publisher","first-page":"1670","DOI":"10.1002\/mds.23720","volume":"26","author":"JG Kalf","year":"2011","unstructured":"Kalf JG, Munneke M, van den Engel-Hoek L, de Swart BJ, Borm GF, Bloem BR, Zwarts MJ. Pathophysiology of diurnal drooling in Parkinson\u2019s disease. Mov Disord. 2011;26:1670\u20136.","journal-title":"Mov Disord"},{"key":"10408_CR4","doi-asserted-by":"publisher","first-page":"1646","DOI":"10.1002\/mds.23135","volume":"25","author":"M Politis","year":"2010","unstructured":"Politis M, Wu K, Molloy S, Bain PG, Chaudhuri RK, Piccini P. Parkinson\u2019s disease symptoms: the patient\u2019s perspective. Mov Disord. 2010;25:1646\u201351.","journal-title":"Mov Disord"},{"key":"10408_CR5","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1007\/s00455-007-9144-x","volume":"23","author":"T Pitts","year":"2008","unstructured":"Pitts T, Bolser D, Rosenbek J, Troche M, Sapienza C. Voluntary cough production and swallow dysfunction in Parkinson\u2019s disease. Dysphagia. 2008;23:297\u2013301.","journal-title":"Dysphagia"},{"key":"10408_CR6","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1136\/jnnp.67.3.300","volume":"67","author":"MA Hely","year":"1999","unstructured":"Hely MA, Morris JGL, Traficante R, Reid WGJ, O\u2019Sullivan DJ, Williamson PM. The ydney multicentre study of Parkinson\u2019s disease: progression and mortality at 10 years. J Neurol Neurosurg Psychiatry. 1999;67:300\u20137.","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"10408_CR7","doi-asserted-by":"publisher","first-page":"1109","DOI":"10.1016\/j.parkreldis.2014.08.013","volume":"20","author":"P Srivanitchapoom","year":"2014","unstructured":"Srivanitchapoom P, Pandey S, Hallett M. Drooling in Parkinson\u2019s disease: a review. Parkinsonism Relat Disord. 2014;20:1109\u201318.","journal-title":"Parkinsonism Relat Disord"},{"key":"10408_CR8","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1136\/jnnp.67.5.697","volume":"67","author":"KP Bhatia","year":"1999","unstructured":"Bhatia KP, M\u00fcnchau A, Brown P. Botulinum toxin is a useful treatment in excessive drooling of saliva. J Neurol Neurosurg Psychiatry. 1999;67:697\u2013697.","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"10408_CR9","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1016\/j.parkreldis.2006.05.005","volume":"13","author":"MF Contarino","year":"2007","unstructured":"Contarino MF, Pompili M, Tittoto P, Vanacore N, Sabatelli M, Cedrone A, Rapaccini GL, Gasbarrini G, Tonali PA, Bentivoglio AR. Botulinum toxin B ultrasound-guided injections for sialorrhea in amyotrophic lateral sclerosis and Parkinson\u2019s disease. Parkinsonism Relat Disord. 2007;13:299\u2013303.","journal-title":"Parkinsonism Relat Disord"},{"key":"10408_CR10","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1212\/01.WNL.0000101713.81253.4C","volume":"62","author":"WG Ondo","year":"2004","unstructured":"Ondo WG, Hunter C, Moore W. A double-blind placebo-controlled trial of botulinum toxin B for sialorrhea in Parkinson\u2019s disease. Neurology. 2004;62:37\u201340.","journal-title":"Neurology"},{"key":"10408_CR11","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/S0022-510X(01)00565-2","volume":"190","author":"EK Tan","year":"2001","unstructured":"Tan EK, Lo YL, Seah A, Auchus AP. Recurrent jaw dislocation after botulinum toxin treatment for sialorrhoea in amyotrophic lateral sclerosis. J Neurol Sci. 2001;190:95\u20137.","journal-title":"J Neurol Sci"},{"key":"10408_CR12","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1016\/0007-1226(83)90081-4","volume":"36","author":"PJ Nicolau","year":"1983","unstructured":"Nicolau PJ. The orbicularis oris muscle: a functional approach to its repair in the cleft lip. Br J Plast Surg. 1983;36:141\u201353.","journal-title":"Br J Plast Surg"},{"key":"10408_CR13","doi-asserted-by":"publisher","first-page":"1974","DOI":"10.1589\/jpts.29.1974","volume":"29","author":"D-H Oh","year":"2017","unstructured":"Oh D-H, Park J-S, Kim W-J. Effect of neuromuscular electrical stimulation on lip strength and closure function in patients with dysphagia after stroke. J Phys Ther Sci. 2017;29:1974\u20135.","journal-title":"J Phys Ther Sci"},{"key":"10408_CR14","doi-asserted-by":"publisher","first-page":"1355","DOI":"10.1589\/jpts.30.1355","volume":"30","author":"H-S Park","year":"2018","unstructured":"Park H-S, Park J-Y, Kwon Y-H, Choi HS, Kim HJ. Effect of orbicularis oris muscle training on muscle strength and lip closure function in patients with stroke and swallowing disorder. J Phys Ther Sci. 2018;30:1355\u20136.","journal-title":"J Phys Ther Sci"},{"key":"10408_CR15","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1589\/jpts.26.259","volume":"26","author":"Y Yanagisawa","year":"2014","unstructured":"Yanagisawa Y, Matsuo Y, Shuntoh H, Horiuchi N. Effect of expiratory resistive loading in expiratory muscle strength training on orbicularis oris muscle activity. J Phys Ther Sci. 2014;26:259\u201361.","journal-title":"J Phys Ther Sci"},{"key":"10408_CR16","doi-asserted-by":"publisher","first-page":"1301","DOI":"10.1378\/chest.08-1389","volume":"135","author":"T Pitts","year":"2009","unstructured":"Pitts T, Bolser D, Rosenbek J, Troche M, Okun MS, Sapienza C. Impact of expiratory muscle strength training on voluntary cough and swallow function in Parkinson disease. Chest. 2009;135:1301\u20138.","journal-title":"Chest"},{"key":"10408_CR17","doi-asserted-by":"publisher","first-page":"1912","DOI":"10.1212\/WNL.0b013e3181fef115","volume":"75","author":"MS Troche","year":"2010","unstructured":"Troche MS, Okun MS, Rosenbek JC, Musson N, Fernandez HH, Rodriguez R, Romrell J, Pitts T, Wheeler-Hegland KM, Sapienza CM. Aspiration and swallowing in Parkinson disease and rehabilitation with EMST: a randomized trial(LOE Classification). Neurology. 2010;75:1912\u20139.","journal-title":"Neurology"},{"key":"10408_CR18","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1136\/jnnp.51.6.745","volume":"51","author":"WR Gibb","year":"1988","unstructured":"Gibb WR, Lees AJ. The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson\u2019s disease. J Neurol Neurosurg Psychiatry. 1988;51:745\u201352.","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"10408_CR19","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/0022-3956(75)90026-6","volume":"12","author":"MF Folstein","year":"1975","unstructured":"Folstein MF, Folstein SE, McHugh PR. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189\u201398.","journal-title":"J Psychiatr Res"},{"key":"10408_CR20","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1136\/jnnp.2003.020982","volume":"75","author":"G Wooten","year":"2004","unstructured":"Wooten G, Currie L, Bovbjerg V, Lee JY, Patrie J. Are men at greater risk for Parkinson\u2019s disease than women? J Neurol Neurosurg Psychiatry. 2004;75:637\u20139.","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"10408_CR21","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1002\/mds.21152","volume":"22","author":"S Perez Lloret","year":"2007","unstructured":"Perez Lloret S, Piran Arce G, Rossi M, CaivanoNemet ML, Salsamendi P, Merello M. Validation of a new scale for the evaluation of sialorrhea in patients with Parkinson\u2019s disease. Mov Disord. 2007;22:107\u201311.","journal-title":"Mov Disord"},{"key":"10408_CR22","volume-title":"MASA: the Mann assessment of swallowing ability","author":"G Mann","year":"2002","unstructured":"Mann G. MASA: the Mann assessment of swallowing ability. Singular: Thomson Learning, Inc; 2002."},{"key":"10408_CR23","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1007\/s00455-001-0109-1","volume":"17","author":"CA McHorney","year":"2002","unstructured":"McHorney CA, Robbins J, Lomax K, Rosenbek JC, Chignell KA, Kramer AE, Earl Bricker D. The SWAL\u2013QOL and SWAL\u2013CARE outcomes tool for oropharyngeal dysphagia in adults: III. Documentation of reliability and validity. Dysphagia. 2002;17:97\u2013114.","journal-title":"Dysphagia"},{"key":"10408_CR24","doi-asserted-by":"publisher","first-page":"1516","DOI":"10.1016\/j.apmr.2004.11.049","volume":"86","author":"MA Crary","year":"2005","unstructured":"Crary MA, Mann GDC, Groher ME. Initial psychometric assessment of a Functional Oral Intake Scale for dysphagia in stroke Patients. Arch Phys Med Rehabil. 2005;86:1516\u201320.","journal-title":"Arch Phys Med Rehabil"},{"key":"10408_CR25","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1159\/000016094","volume":"10","author":"G Mann","year":"2000","unstructured":"Mann G, Hankey GJ, Cameron D. Swallowing disorders following acute stroke: prevalence and diagnostic accuracy. Cerebrovasc Dis. 2000;10:380\u20136.","journal-title":"Cerebrovasc Dis"},{"key":"10408_CR26","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1007\/s004550010013","volume":"15","author":"CA McHorney","year":"2000","unstructured":"McHorney CA, Bricker DE, Robbins J, Kramer AE, Rosenbek JC, Chignell KA. The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: II. Item reduction and preliminary scaling. Dysphagia. 2000;15:122\u201333.","journal-title":"Dysphagia"},{"key":"10408_CR27","doi-asserted-by":"publisher","first-page":"1334","DOI":"10.1249\/MSS.0b013e318213fefb","volume":"43","author":"CE Garber","year":"2011","unstructured":"Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, Nieman DC, Swain DP. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43:1334\u201359.","journal-title":"Med Sci Sports Exerc"},{"key":"10408_CR28","doi-asserted-by":"publisher","first-page":"1119","DOI":"10.1183\/09031936.06.00105205","volume":"27","author":"K Hill","year":"2006","unstructured":"Hill K, Jenkins SC, Philippe DL, Cecins N, Shepherd KL, Green DJ, Hillman DR, Eastwood PR. High-intensity inspiratory muscle training in COPD. Eur Respir J. 2006;27:1119\u201328.","journal-title":"Eur Respir J"},{"key":"10408_CR29","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1249\/00005768-198205000-00012","volume":"14","author":"GA Borg","year":"1982","unstructured":"Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14:377\u201381.","journal-title":"Med Sci Sports Exerc"},{"key":"10408_CR30","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1044\/1092-4388(2011\/11-0219)","volume":"55","author":"J Marshall","year":"2012","unstructured":"Marshall J, Best W, Cocks N, Cruice M, Pring T, Bulcock G, Creek G, Eales N, Mummery AL, Matthews N, Caute A. Gesture and naming therapy for people with severe aphasia: a group study. J Speech Lang Hear Res. 2012;55:726\u201338.","journal-title":"J Speech Lang Hear Res"},{"key":"10408_CR31","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.parkreldis.2017.03.009","volume":"39","author":"S Palermo","year":"2017","unstructured":"Palermo S, Lopiano L, Zibetti M, Rosato R, Leotta D, Amanzio M. A novel framework for understanding reduced awareness of dyskinesias in Parkinson\u2019s disease. Parkinsonism Relat Disord. 2017;39:58\u201363.","journal-title":"Parkinsonism Relat Disord"},{"key":"10408_CR32","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1002\/mds.22260","volume":"24","author":"ML Evatt","year":"2009","unstructured":"Evatt ML, Chaudhuri KR, Chou KL, Cubo E, Hinson V, Kompoliti K, Yang C, Poewe W, Rascol O, Sampaio C, Stebbins GT, Goetz CG. Dysautonomia rating scales in Parkinson\u2019s disease: Sialorrhea, dysphagia, and constipation\u2014critique and recommendations by movement disorders task force on rating scales for Parkinson\u2019s disease. Mov Disord. 2009;24:635\u201346.","journal-title":"Mov Disord"}],"container-title":["Dysphagia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00455-022-10408-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00455-022-10408-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00455-022-10408-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,8]],"date-time":"2022-11-08T20:20:51Z","timestamp":1667938851000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00455-022-10408-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,16]]},"references-count":32,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["10408"],"URL":"https:\/\/doi.org\/10.1007\/s00455-022-10408-6","relation":{},"ISSN":["0179-051X","1432-0460"],"issn-type":[{"value":"0179-051X","type":"print"},{"value":"1432-0460","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,16]]},"assertion":[{"value":"15 July 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 January 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 February 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have no conflict of interest to report.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}