Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by rigidity, tremor, postural instability, bradykinesia, and autonomic dysfunction. It is a common movement disorder worldwide. Motor impairments in PD patients are not limited to the muscles of the extremities; the neck, upper respiratory tract, and respiratory muscles are also affected. The resulting pulmonary dysfunction is one of the main factors contributing to morbidity and mortality in PD patients.
Respiratory muscle exercise programs have been used to improve lung and swallowing function in patients with Parkinson's disease and other similar neurodegenerative disorders. Studies of inspiratory muscle exercise in Parkinson's patients have reported improvements in inspiratory muscle strength and endurance. Similarly, expiratory muscle exercise protocols have been shown to increase maximum expiratory pressure (MEP) and cough effectiveness. However, studies on expiratory muscle strengthening are lacking in the literature.
Positive expiratory pressure (PEP) devices are used to clear airway secretions and feature a resistance that provides resistance during exhalation. This creates a positive pressure that stabilizes the airways during exhalation and prevents airway collapse. Although there are many PEP devices available on the market, the bottle-PEP, a therapist-made device, is used because it can be produced easily and at low cost. The bottle-PEP device consists of a bottle filled with at least 10 cm of water and a tube placed inside the bottle. Although information on strengthening expiratory muscles is traditionally found in the literature, there is no data in the literature on the effect of bottle-PEP use on expiratory muscle strength, especially in Parkinson's patients. A review of the literature shows that the effect of expiratory strengthening on balance has not been studied before.
This study aimed to demonstrate the effects of the bottle-PEP device, used in addition to expiratory muscle strengthening, on expiratory muscle thickness, strength, and balance.
Patients with a confirmed Parkinson's diagnosis who are being monitored
Those aged 18-75
Patients who are ambulatory
Patients with acquired primary motor neuron disease (ischemic/hemorrhagic stroke, intracranial mass) and additional neurological diagnoses
Patients with hearing and cognitive impairments that prevent them from understanding or performing the exercise program
Presence of concomitant acute or chronic lung disease
History of thoracic or abdominal surgery
Patients aged 18-75 with a diagnosis of Parkinson's disease who are ambulatory
Case-control
Prospective
Not listed
Diaphragm and intercostal muscle thickness
In this study, ultrasonography will be used to measure muscle thickness at the end of inspiration and expiration. The thickness of the diaphragm and intercostal muscles will be measured in millimeters.
Pulmonary Function Tests
Forced Vital Capacity (FVC), FEV1 (Forced Expiratory Volume in 1 second). Values will be measured in liters.
Berg Balance Scale
The Berg Balance Test is an assessment comprising 14 tests that evaluate the ability to maintain balance in different positions, during changes in posture and whilst in motion. It is scored out of a total of 56 points, with a higher score indicating better balance.
Maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) measurements
MIP: Measures the strength of the muscles used to inhale (mainly the diaphragm and other inspiratory muscles). It is the maximum pressure a person can generate while trying to inhale forcefully against a blocked airway. MEP: Measures the strength of the muscles used to exhale (mostly abdominal and intercostal muscles). It is the maximum pressure generated during a forceful exhalation against a blocked airway.
Parkinson's Disease Quality of Life Questionnaire (PDQ-39)
Parkinson's Disease Quality of Life Questionnaire (PDQ-39), used to assess patients' quality of life, consists of 39 multiple-choice items covering eight factors (mobility, activities of daily living, emotional well-being, stigma, social support, cognitive functions, communication, and physical discomfort). Both the sub-scale scores and the total score are calculated out of 100 using a formula. Higher scores indicate a lower quality of life.
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