Study of the Link Between Freezing of Gait and Oropharyngeal Freezing in Parkinson's Patients

The Unified Parkinson's Disease Rating Scale (UPDRS) is a composite measurement tool that combines several evaluation scales and is organized into six sections. It is a multidimensional scale that allows for an objective assessment of the severity, fluctuations, and progression of clinical symptoms, as well as their impact on the patient's daily life.

The first section evaluates the patient's mental, behavioral, and mood state. The second section allows for a self-assessment of activities of daily living. The third section assesses motor functions, while the fourth section evaluates treatment complications over the week prior to the examination. The fifth section involves the administration of the Hoehn and Yahr scale, which classifies patients into five main stages based on the severity of their condition. The final section is the Schwab and England quality of life scale, which evaluates the patient's ability to perform activities of daily living in terms of speed and autonomy.

The New Freezing of Gait Questionnaire (NFOG-Q) is a 9-item questionnaire excluding patients with no freezing in item 1, duration and frequency of freezing in items 2 to 6, and the impact of freezing on daily activities in items 7 to 9). The concurrent validity is poor when compared to the freezing time in a TUG test and the number of freezing events that occurred. The reliability and internal consistency are good. Video assistance may improve scoring.

The Timed Up and Go (TUG) test is a simple test conducted during a consultation: the subject, seated on a chair, must stand, walk 3 meters, turn around, and return to sit. The score is given by the time in seconds. The test is normal if the time is less than 14 seconds (or 20 seconds according to some publications). The TUG test has good reproducibility over time and between observers. Its sensitivity is 87%, and its specificity is 87%.

The BAASTA Battery is a series of tests on a touchscreen tablet that assess rhythmic perceptual and sensorimotor abilities. It is used to detect deficits in rhythmic abilities through patented measurement methods and is designed for researchers and healthcare providers to assess the motor synchronization of their subjects/patients. They perform a series of exercises to evaluate their rhythmic abilities, such as tapping in time with sounds, music, and detecting isochrony errors.

The Modified Barium Swallow Impairment Profile (MBSImP) is a standardized protocol for pharyngography to interpret and communicate swallowing disorders in a specific, consistent, precise, and objective manner.

The Functional Oral Intake Scale (FOIS) is a scale used to document any changes in a patient's diet, reflecting the evolution of their functional swallowing abilities over time. Level 1 corresponds to "nothing by mouth," and level 7 corresponds to a "complete oral diet without restriction." This scale will be used during the clinical speech therapy assessment.

The Penetration Aspiration Scale (PAS) evaluates the severity of aspiration events. It is an 8-point scale, where score 1 indicates normal swallowing, and score 8 represents the most severe level, corresponding to silent aspiration. This scale will be used during nasofibroscopy and pharyngography exams.

The Test of Masticating and Swallowing Solids (TOMASS) allows for a quantitative assessment of the effectiveness of solid food ingestion. The patient is asked to eat a Tuc cracker as quickly and comfortably as possible and to state their name after the last swallow. The goal is to quantitatively evaluate the chewing and swallowing of a solid bolus. The examiner records the number of bites, chewing cycles, swallows, and total time. Norms are established based on age and gender, as these are considered influential factors on chewing. This test will be conducted during the clinical speech therapy assessment.

The Waster Swallowing Test (TWST) provides a quantitative evaluation of the effectiveness of liquid bolus ingestion. The patient is asked to drink a glass of water (150 mL for patients under 75 years old, and 100 mL for those over 75 years old) as quickly and comfortably as possible. The goal is to quantitatively evaluate liquid swallowing. The number of swallows and the total ingestion time are recorded. This test will be conducted during the clinical speech therapy assessment.

The Volume-Viscosity Swallow Test (V-VST) offers a quick, safe, and accurate diagnostic test to detect clinical signs of dysphagia, including silent aspirations. The test is detailed and easy to use, with good sensitivity (88.2%) and specificity (64.7%). The V-VST protocol includes three texture tests in this order: nectar, paste, and liquid. The liquid is colored with either mint or grenadine syrup, based on patient preference, to improve visual and taste appeal. Each texture is tested in three different volumes (5, 10, 20 mL) using both a spoon and a glass, while monitoring oxygen saturation with a fingertip pulse oximeter. Swallowing disorders are divided into two main categories: propulsion disorders and airway protection disorders.

The Swallowing Quality of Life (SWAL-QOL) is a 44-item questionnaire that addresses 10 concepts related to the quality of life of patients with oropharyngeal dysphagia. Each concept corresponds to a subscale: the burden of swallowing difficulties, meal duration, desire to eat, food choices, communication, fear, mental health, social impact, fatigue, and sleep. Each item is rated on a 5-point scale, and the total score is calculated, with a maximum score of 100. The lower the score, the worse the quality of life. This test will be conducted during the clinical speech therapy assessment.