Jundishapur Scientific Medical Journal

Jundishapur Scientific Medical Journal

Rehabilitation Management and Treatment of Swallowing Disorder in Patients with Parkinson's Disease: a Narrative Review

Document Type : Review

Authors
Karaneh Mahdavi 1
Hassan Khoramshahi 2
1 Department of speech therapy, School of Rehabilitation, Babol University of Medical Sciences,, Babol, Iran.
2 Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences , Babol, Iran.
10.32592/jsmj.24.2.153
Abstract
Background and Objectives More than 80% of patients with Parkinson's suffer from swallowing disorder (dysphagia) during the course of their disease. Dysphagia reduces quality of life, complicates medication administration, and leads to malnutrition and aspiration pneumonia, a leading cause of death in Parkinson's patients.
The purpose of this study is to review the pathophysiology and approaches to rehabilitation management and treatment of Parkinson's-related dysphagia, which can be useful for neurologists, speech and language pathologists, and other practitioners dealing with patients with Parkinson's disease.
Subjects and Methods In order to obtain the required data, articles related to the topic were collected using a targeted search of keywords in reliable electronic databases such as Web of Science, PubMed, Google Scholar, Science Direct, SID, and Magiran, and in order to obtain further studies, the references of this articles were also reviewed.
Results Based on the findings, the approaches used in the rehabilitation management and treatment of swallowing disorders in patients with Parkinson's disease can be divided into behavioral, nutritional, pharmaceutical, surgical and rehabilitation sub-branches, and according to the patient's condition, one or more approaches can be used in combination.
Conclusion Finally, it seems that the use of a multidisciplinary team approach is important to identify and properly manage dysphagia in Parkinson's patients, and regular clinical screenings along with objective instrumental evaluations are necessary for the early diagnosis of dysphagia. In order to determine the effectiveness of different treatments on dysphagia in patients with Parkinson's, more research is needed, especially prospective studies and randomized controlled trials.
Keywords
Parkinson's disease
Swallowing disorder
Dysphagia
Rehabilitation management
Subjects

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    • Pringsheim T, Jette N, Frolkis A, Steeves TD. The prevalence of Parkinson's disease: a systematic review and meta‐analysis. Movement disorders. 2014 Nov;29(13):1583-90. [1002/mds.25945 ] [PMID]
    • Dorsey EA, Constantinescu R, Thompson JP, Biglan KM, Holloway RG, Kieburtz K, Marshall FJ, Ravina BM, Schifitto G, Siderowf A, Tanner CM. Projected number of people with Parkinson disease in the most populous nations, 2005 through 2030. Neurology. 2007 Jan 30;68(5):384-6. [1212/01.wnl.0000247740.47667.03 ] [PMID]
    • Rudisch DM, Krasko MN, Burdick R, Broadfoot CK, Rogus-Pulia N, Ciucci MR. Dysphagia in Parkinson Disease: Part I–Pathophysiology and Diagnostic Practices. Current physical medicine and rehabilitation reports. 2023 Jun;11(2):176-87. [1007/s40141-023-00392-9 ] [PMID]
    • Docu Axelerad A, Stroe AZ, Arghir OC, Docu Axelerad D, Gogu AE. Respiratory dysfunctions in Parkinson’s disease patients. Brain sciences. 2021 May 4;11(5):595. [3390/brainsci11050595 ] [PMID]
    • Warnecke T, Schäfer KH, Claus I, Del Tredici K, Jost WH. Gastrointestinal involvement in Parkinson’s disease: pathophysiology, diagnosis, and management. npj Parkinson's Disease. 2022 Mar 24;8(1):31. [1038/s41531-022-00295-x ] [PMID]
    • Miller N, Allcock L, Hildreth AJ, Jones D, Noble E, Burn DJ. Swallowing problems in Parkinson disease: frequency and clinical correlates. Journal of Neurology, Neurosurgery & Psychiatry. 2009 Sep 1;80(9):1047-9. [1136/jnnp.2008.157701 ] [PMID]
    • Cosentino G, Avenali M, Schindler A, Pizzorni N, Montomoli C, Abbruzzese G, Antonini A, Barbiera F, Benazzo M, Benarroch EE, Bertino G. A multinational consensus on dysphagia in Parkinson's disease: screening, diagnosis and prognostic value. Journal of Neurology. 2022 Mar;269(3):1335-52. [1007/s00415-021-10739-8 ] [PMID]
    • Kalf JG, De Swart BJ, Bloem BR, Munneke M. Prevalence of oropharyngeal dysphagia in Parkinson’s disease: a meta-analysis. Parkinsonism & related disorders. 2012 May 1;18(4):311-5. [1016/j.parkreldis.2011.11.006 ] [PMID]
    • Barone P, Antonini A, Colosimo C, Marconi R, Morgante L, Avarello TP, Bottacchi E, Cannas A, Ceravolo G, Ceravolo R, Cicarelli G. The PRIAMO study: a multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson's disease. Movement disorders: official journal of the Movement Disorder Society. 2009 Aug 15;24(11):1641-9. [1002/mds.22643 ] [PMID]
    • Cereda E, Cilia R, Klersy C, Canesi M, Zecchinelli AL, Mariani CB, Tesei S, Sacilotto G, Meucci N, Zini M, Isaias IU. Swallowing disturbances in Parkinson's disease: a multivariate analysis of contributing factors. Parkinsonism & Related Disorders. 2014 Dec 1;20(12):1382-7. [1016/j.parkreldis.2014.09.031 ] [PMID]
    • Miller N, Noble E, Jones D, Burn D. Hard to swallow: dysphagia in Parkinson’s disease. Age and ageing. 2006 Nov 1;35(6):614-8. [1093/ageing/afl105 ] [PMID]
    • Morgante L, Salemi G, Meneghini F, Di Rosa AE, Epifanio A, Grigoletto F, Ragonese P, Patti F, Reggio A, Di Perri R, Savettieri G. Parkinson disease survival: a population-based study. Archives of neurology. 2000 Apr 1;57(4):507-12. [1001/archneur.57.4.507 ] [PMID]

     

    • Warnecke T, Schäfer KH, Claus I, Del Tredici K, Jost WH. Gastrointestinal involvement in Parkinson’s disease: pathophysiology, diagnosis, and management. npj Parkinson's Disease. 2022 Mar 24;8(1):31. [1038/s41531-022-00295-x ] [PMID]
    • Dilmaghani S, Atieh J, Khanna L, Hosfield EA, Camilleri M, Katzka DA. Severity of dysphagia is associated with hospitalizations and mortality in patients with Parkinson’s disease. Neurogastroenterology & Motility. 2022 Jun;34(6):e14280. [1111/nmo.14280 ] [PMID]
    • Manor Y, Balas M, Giladi N, Mootanah R, Cohen JT. Anxiety, depression and swallowing disorders in patients with Parkinson's disease. Parkinsonism & related disorders. 2009 Jul 1;15(6):453-6. [1016/j.parkreldis.2008.11.005 ] [PMID]
    • Gandhi P, Steele CM. Effectiveness of interventions for dysphagia in Parkinson disease: a systematic review. American Journal of Speech-Language Pathology. 2022 Jan 18;31(1):463-85. [1044/2021_AJSLP-21-00145 ] [PMID]
    • Menezes C, Melo A. Does levodopa improve swallowing dysfunction in Parkinson’s disease patients?. Journal of clinical pharmacy and therapeutics. 2009 Dec;34(6):673-6. [1111/j.1365-2710.2009.01031.x ] [PMID]
    • Dai Y, Cai J, Wang H, Zhang Y, Niu C, Wang Y. Effect of respiratory training on swallowing function in swallowing disorders: a systematic review and meta-analysis. European Archives of Oto-Rhino-Laryngology. 2024 Mar;281(3):1069-81. [1007/s00405-023-08280-7 ] [PMID]
    • Bloem BR, Okun MS, Klein C. Parkinson's disease. The Lancet. 2021 Jun 12;397(10291):2284-303. [1016/S0140-6736(21)00218-X ] [PMID]
    • 20- Zhou ZD, Yi LX, Wang DQ, Lim TM, Tan EK. Role of dopamine in the pathophysiology of Parkinson’s disease. Translational neurodegeneration. 2023 Sep 18;12(1):44. [1186/s40035-023-00378-6 ] [PMID]
    • Politis M, Wu K, Molloy S, G. Bain P, Chaudhuri KR, Piccini P. Parkinson's disease symptoms: the patient's perspective. Movement Disorders. 2010 Aug 15;25(11):1646-51. [1002/mds.23135 ] [PMID]
    • Jamwal S, Kumar P. Insight into the emerging role of striatal neurotransmitters in the pathophysiology of Parkinson’s disease and Huntington’s disease: a review. Current neuropharmacology. 2019 Feb 1;17(2):165-75. [2174/1570159X16666180302115032 ] [PMID]
    • Moore DJ, West AB, Dawson VL, Dawson TM. Molecular pathophysiology of Parkinson's disease. Annu. Rev. Neurosci.. 2005 Jul 21;28(1):57-87. [1146/annurev.neuro.28 .061604. 135718 ] [PMID]
    • Carboni E, Lingor P. Insights on the interaction of alpha-synuclein and metals in the pathophysiology of Parkinson's disease. Metallomics. 2015 Mar;7(3):395-404. [1039/c4 mt00339j ] [PMID]
    • Umay E, Ozturk E, Gurcay E, Delibas O, Celikel F. Swallowing in Parkinson’s disease: How is it affected?. Clinical neurology and neurosurgery. 2019 Feb 1;177:37-41. [1016/j.clineuro. 2018.12.015 ] [PMID]
    • Leopold NA, Daniels SK. Supranuclear control of swallowing. Dysphagia. 2010 Sep;25:250-7. [1007/s00455-009-9249-5 ] [PMID]
    • Suzuki M, Asada Y, Ito J, Hayashi K, Inoue H, Kitano H. Activation of cerebellum and basal ganglia on volitional swallowing detected by functional magnetic resonance imaging. Dysphagia. 2003 May;18:71-7. [1007/s00455-002-0088-x ] [PMID]

     

    • Braak H, Del Tredici K, Rüb U, De Vos RA, Steur EN, Braak E. Staging of brain pathology related to sporadic Parkinson’s disease. Neurobiology of aging. 2003 Mar 1;24(2):197-211. [1016/s0197-4580(02)00065-9 ] [PMID]
    • Mu L, Sobotka S, Chen J, Su H, Sanders I, Adler CH, Shill HA, Caviness JN, Samanta JE, Beach TG, Arizona Parkinson's Disease Consortium. Alpha-synuclein pathology and axonal degeneration of the peripheral motor nerves innervating pharyngeal muscles in Parkinson disease. Journal of Neuropathology & Experimental Neurology. 2013 Feb 1;72(2):119-29. [1097/NEN.0b013e3182801cde ] [PMID]
    • Mu L, Sobotka S, Chen J, Su H, Sanders I, Nyirenda T, Adler CH, Shill HA, Caviness JN, Samanta JE, Sue LI. Parkinson disease affects peripheral sensory nerves in the pharynx. Journal of Neuropathology & Experimental Neurology. 2013 Jul 1;72(7):614-23. [1097/NEN.0b013e3182965886 ] [PMID]
    • Mu L, Sobotka S, Chen J, Su H, Sanders I, Adler CH, Shill HA, Caviness JN, Samanta JE, Beach TG, Arizona Parkinson's Disease Consortium. Altered pharyngeal muscles in Parkinson disease. Journal of Neuropathology & Experimental Neurology. 2012 Jun 1;71(6):520-30. [1097/NEN.0b013e 318258381b ] [PMID]
    • Fabbri M, Coelho M, Abreu D, Guedes LC, Rosa MM, Godinho C, Cardoso R, Guimaraes I, Antonini A, Zibetti M, Lopiano L. Dysphagia predicts poor outcome in late-stage Parkinson's disease. Parkinsonism & Related Disorders. 2019 Jul 1;64:73-81. [1016/j.parkreldis.2019.02.043 ] [PMID]
    • Tjaden K. Speech and swallowing in Parkinson's disease. Topics in geriatric rehabilitation. 2008 Apr 1;24(2):115-26. [1097/01.TGR.0000318899.87690.44 ] [PMID]
    • Ra JY, Hyun JK, Ko KR, Lee SJ. Chin tuck for prevention of aspiration: effectiveness and appropriate posture. Dysphagia. 2014 Oct;29:603-9. [1007/s00455-014-9551-8 ] [PMID]
    • Evatt ML. Nutritional therapies in Parkinson’s disease. Current Treatment Options in Neurology. 2007 May;9(3):198-204. [1007/BF02938409 ] [PMID]
    • Ryu JS, Park D, Oh Y, Lee ST, Kang JY. The effects of bolus volume and texture on pharyngeal pressure events using high-resolution manometry and its comparison with videofluoroscopic swallowing study. Journal of neurogastroenterology and motility. 2016 Apr 30;22(2):231. [5056/jnm15095 ] [PMID]
    • Andersen TM, Bolton L, Toussaint M. Practical recommendations for swallowing and speaking during NIV in people with neuromuscular disorders. Acta Myologica. 2024 Jun 30;43(2):62. [36185/2532-1900-417 ] [PMID]
    • Troche MS, Okun MS, Rosenbek JC, Altmann LJ, Sapienza CM. Attentional resource allocation and swallowing safety in Parkinson's disease: A dual task study. Parkinsonism & related disorders. 2014 Apr 1;20(4):439-43. [1016/j.parkreldis. 2013.12.011 ] [PMID]
    • Rusch C, Flanagan R, Suh H, Subramanian I. To restrict or not to restrict? Practical considerations for optimizing dietary protein interactions on levodopa absorption in Parkinson’s disease. npj Parkinson's Disease. 2023 Jun 24;9(1):98. [1038/s41531-023-00541-w ] [PMID]
    • Breasail MÓ, Smith MD, Tenison E, Henderson EJ, Lithander FE. Parkinson's disease: the nutrition perspective. Proceedings of the Nutrition Society. 2022 Mar;81(1):12-26. [1017/S0029665121003645 ] [PMID]
    • Butler SG, Stuart A, Markley L, Feng X, Kritchevsky SB. Aspiration as a function of age, sex, liquid type, bolus volume, and bolus delivery across the healthy adult life span. Annals of Otology, Rhinology & Laryngology. 2018 Jan;127(1):21-32. [1177/0003489417742161 ] [PMID]
    • Clavé P, De Kraa M, Arreola V, Girvent M, Farre R, Palomera E, Serra‐Prat M. The effect of bolus viscosity on swallowing function in neurogenic dysphagia. Alimentary pharmacology & therapeutics. 2006 Nov;24(9):1385-94. [1111/j.1365-2036.2006.03118.x ] [PMID]
    • Mulheren R, Westemeyer RM, Dietsch AM. The effect of taste on swallowing: A scoping and systematic review. Critical Reviews in Food Science and Nutrition. 2024 Feb 17;64(5):1256-82. [1080/10408398.2022.2115003 ] [PMID]
    • Logemann JA, Gensler G, Robbins J, Lindblad AS, Brandt D, Hind JA, Kosek S, Dikeman K, Kazandjian M, Gramigna GD, Lundy D. A randomized study of three interventions for aspiration of thin liquids in patients with dementia or Parkinson’s disease. Journal of speech, language, and hearing research. 2008;51(1):173-83. [1044/1092-4388(2008/013) ] [PMID]
    • Gillman A, Winkler R, Taylor NF. Implementing the free water protocol does not result in aspiration pneumonia in carefully selected patients with dysphagia: a systematic review. Dysphagia. 2017 Jun;32:345-61. [1007/s00455-016-9761-3 ] [PMID]
    • Panther K. The Frazier free water protocol. Perspectives on Swallowing and Swallowing Disorders (Dysphagia). 2005 Mar;14(1):4-9.
    • Bloom L, Seckel MA. Placement of nasogastric feeding tube and postinsertion care review. AACN Advanced Critical Care. 2022 Mar 15;33(1):68-84. [4037/aacnacc2022306 ] [PMID]
    • Marik PE, Kaplan D. Aspiration pneumonia and dysphagia in the elderly. Chest. 2003 Jul 1;124(1):328-36. [1378/chest.124.1.328 ] [PMID]
    • Chen S, Kent B, Cui Y. Interventions to prevent aspiration in older adults with dysphagia living in nursing homes: a scoping review. BMC geriatrics. 2021 Dec;21:1-4. [1186/s12877-021-02366-9 ] [PMID]
    • Evatt ML. Nutritional therapies in Parkinson’s disease. Current Treatment Options in Neurology. 2007 May;9(3):198-204. [1007/BF02938409 ] [PMID]
    • Sutton JP. Dysphagia in Parkinson's disease is responsive to levodopa. Parkinsonism & related disorders. 2013 Mar 1;19(3):282-4. [1016/j.parkreldis.2012.11.007 ] [PMID]
    • Chaudhuri KR, Healy DG, Schapira AH. Non-motor symptoms of Parkinson's disease: diagnosis and management. The Lancet Neurology. 2006 Mar 1;5(3):235-45. [1016/S1474-4422(06)70373-8 ] [PMID]
    • Jankovic J. Parkinson’s disease: clinical features and diagnosis. Journal of neurology, neurosurgery & psychiatry. 2008 Apr 1;79(4):368-76. [1136/jnnp.2007.131045 ] [PMID]
    • Suttrup I, Oelenberg S, Hamacher C, Dziewas R, Warnecke T. Endoscopic L-dopa-test for parkinsonian dysphagia (a pilot study). Dysphagia. 2011;26:482. [1136/jnnp.2007.131045 ] [PMID]
    • Lim A, Leow L, Huckabee ML, Frampton C, Anderson T. A pilot study of respiration and swallowing integration in Parkinson’s disease:“on” and “off” levodopa. Dysphagia. 2008 Mar;23:76-81. [1007/s00455-007-9100-9 ] [PMID]
    • Klingelhoefer L, Reichmann H. Parkinson’s disease and gastrointestinal non motor symptoms: diagnostic and therapeutic options–a practise guide. Journal of Parkinson’s disease. 2015 Sep 14;5(3):647-58. [3233/JPD-150574 ] [PMID]
    • Ramprasad C, Douglas JY, Moshiree B. Parkinson’s disease and current treatments for its gastrointestinal neurogastromotility effects. Current Treatment Options in Gastroenterology. 2018 Dec;16:489-510. [1007/s11938-018-0201-3 ] [PMID]
    • Cassilly D, Kantor S, Knight LC, Maurer AH, Fisher RS, Semler J, Parkman HP. Gastric emptying of a non‐digestible solid: assessment with simultaneous SmartPill pH and pressure capsule, antroduodenal manometry, gastric emptying scintigraphy. Neurogastroenterology & Motility. 2008 Apr;20(4):311-9. [1111/j.1365-2982.2007.01061.x ] [PMID]
    • Mills R, Bahroo L, Pagan F. An update on the use of botulinum toxin therapy in Parkinson’s disease. Current Neurology and Neuroscience Reports. 2015 Jan;15:1-1. [1007/s11910-014-0511-3 ] [PMID].
    • Dou Z, Zu Y, Wen H, Wan G, Jiang L, Hu Y. The effect of different catheter balloon dilatation modes on cricopharyngeal dysfunction in patients with dysphagia. Dysphagia. 2012 Dec;27:514-20. [1007/s00455-012-9402-4 ] [PMID]
    • Kim YK, Choi SS, Choi JH, Yoon JG. Effectiveness of rehabilitative balloon swallowing treatment on upper esophageal sphincter relaxation and pharyngeal motility for neurogenic dysphagia. Annals of Rehabilitation Medicine. 2015 Aug 25;39(4):524-34. [5535/arm.2015.39.4.524 ] [PMID]
    • Håkanson BS, Lundell L, Bylund A, Thorell A. Comparison of laparoscopic 270 posterior partial fundoplication vs total fundoplication for the treatment of gastroesophageal reflux disease: a randomized clinical trial. JAMA surgery. 2019 Jun 1;154(6):479-86. [1001/jamasurg.2019.0047 ] [PMID]
    • Kim DS, Jones RN, Shireman TI, Kluger BM, Friedman JH, Akbar U. Trends and outcomes associated with gastrostomy tube placement in common neurodegenerative disorders. Clinical Parkinsonism & Related Disorders. 2021 Jan 1;4:100088. [1016/j.prdoa.2020.100088 ] [PMID]
    • Marois C, Amador MD, Payan C, Lacomblez L, Bonnet AM, Degos B, Corvol JC, Vidailhet M, Le Forestier N, Mesnage V, Grabli D. Outcome of gastrostomy in parkinsonism: a retrospective study. Parkinsonism & Related Disorders. 2017 Oct 1;43:110-3. [1016/j.parkreldis.2017.06.012 ] [PMID]
    • 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 May 1;135(5):1301-8. [1378/chest.08-1389 ] [PMID]
    • Saleem AF, Sapienza CM, Okun MS. Respiratory muscle strength training: treatment and response duration in a patient with early idiopathic Parkinson's disease. NeuroRehabilitation. 2005 Dec 26;20(4):323-33.

     

     

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    • 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. Neurology. 2010 Nov 23;75(21):1912-9. [1212/WNL.0b013e3181fef115 ] [PMID]
    • Hegland KW, Davenport PW, Brandimore AE, Singletary FF, Troche MS. Rehabilitation of swallowing and cough functions following stroke: an expiratory muscle strength training trial. Archives of physical medicine and rehabilitation. 2016 Aug 1;97(8):1345-51. [1016/j.apmr.2016.03.027 ] [PMID]
    • Miles A, Jardine M, Johnston F, de Lisle M, Friary P, Allen J. Effect of Lee Silverman Voice Treatment (LSVT LOUD®) on swallowing and cough in Parkinson's disease: a pilot study. Journal of the Neurological Sciences. 2017 Dec 15;383:180-7. [1016/j.jns.2017.11.015 ] [PMID]
    • Wheeler-Hegland KM, Rosenbek JC, Sapienza CM. Submental sEMG and hyoid movement during Mendelsohn maneuver, effortful swallow, and expiratory muscle strength training. [1044/1092-4388(2008/07-0016) ] [PMID]
    • 71- Ramig LO, Fox C, Sapir S. Speech treatment for Parkinson’s disease. Expert review of neurotherapeutics. 2008 Feb 1;8(2):297-309. [1586/14737175.8.2.297 ] [PMID]
    • Nozaki S, Fujiu-Kurachi M, Tanimura T, Ishizuka K, Miyata E, Sugishita S, Imai T, Nishiguchi M, Furuta M, Yorifuji S. Effects of Lee Silverman Voice Treatment (LSVT LOUD) on swallowing in patients with progressive supranuclear palsy: a pilot study. Progress in Rehabilitation Medicine. 2021;6:20210012. [2490/prm.20210012 ] [PMID]
    • Leder SB, Novella S, Patwa H. Use of fiberoptic endoscopic evaluation of swallowing (FEES) in patients with amyotrophic lateral sclerosis. Dysphagia. 2004 Aug;19:177-81. [1007/s00455-004-0009-2 ] [PMID]
    • Kim Y, Han SH, Shin YB, Yoon JA, Kim SH. Diagnosis and successful visual biofeedback therapy using fiberoptic endoscopic evaluation of swallowing in a young adult patient with psychogenic dysphagia: a case report. Journal of Yeungnam medical science. 2023 Jan;40(1):91-5. [12701/yujm.2021.01543 ] [PMID]
    • Baijens LW, Speyer R, Passos VL, Pilz W, Roodenburg N, Clavé P. The effect of surface electrical stimulation on swallowing in dysphagic Parkinson patients. Dysphagia. 2012 Dec;27:528-37. [1007/s00455-011-9387-4 ] [PMID]
    • Chen YW, Chang KH, Chen HC, Liang WM, Wang YH, Lin YN. The effects of surface neuromuscular electrical stimulation on post-stroke dysphagia: a systemic review and meta-analysis. Clinical rehabilitation. 2016 Jan;30(1):24-35. [1177/ 0269215515571681 ] [PMID]
    • Park J-S, Oh D-H, Hwang N-K, Lee J-H. Effects of neuromuscular electrical stimulation in patients with Parkinson’s disease and dysphagia: a randomized, single-blind, placebo-controlled trial. NeuroRehabilitation. 2018;42(4):457-63. [3233/NRE-172306 ] [PMID]

  • Receive Date 18 December 2024
  • Revise Date 02 April 2025
  • Accept Date 07 April 2025