User-centred design, validation and clinical testing of an anti-choking mug for people with Parkinson's disease

Abstract

Oropharyngeal dysphagia, or difficulty initiating swallowing, is a frequent problem in people with Parkinson's disease (PD) and can lead to aspiration pneumonia. The efficacy of pharmacological options is limited. Postural strategies, such as a chin-down manoeuvre when drinking, have had some degree of success but may be difficult for people who have other limitations such as dementia or neck rigidity, to reproduce consistently. Using a user-centred design approach and a multidisciplinary team, we developed and tested an anti-choking mug for people with PD that helps angle the head in the optimum position for drinking. The design reflected anthropometric and ergonomic aspects of user needs with features including regulation of water flow rate and sip volume, an inner slope, a thickened handle and a wide base, which promoted a chin-down posture when used. Prototype testing using digital technology to compare neck flexion angles (the primary outcome), plus clinical outcomes assessed using standard tools (Swallowing Clinical Assessment Score in Parkinson's Disease (SCAS-PD) and Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Parts II and III), found significant improvements in a range of parameters related to efficient swallowing and safe drinking when using the anti-choking mug versus a sham mug.

Keywords: Anti-choking mug; Aspiration; Chin-down manoeuvre; Oropharyngeal dysphagia; Parkinson’s disease; User-centred design.

Figure 1

The cyclical user-centred, iterative design process implemented for the development of the anti-choking mug.

Figure 2

An example of the different ‘personas’ developed to represent potential target end-users that illustrate the practical problems that can result in the aspiration of thin fluids and the associated goal for device development.

Figure 3

The design and specifications of the anti-choking mug.

Figure 4

Comparison of neck flexion angles when drinking from a normal cup versus the anti-choking mug. The primary outcome measure of the study was the neck flexion angle, which comprises the axis-occipital angle and cervical flexion. The axis-occipital angle was calculated as the difference between the chin angle when using the anti-choking mug and the neutral position. The cervical flexion was determined as the difference between the modified lordosis angle when using the anti-choking mug and the neutral position. The α angle denotes the inclination of the inside slope of the mug.

Figure 5

Final prototype of the anti-choking mug used for objective and clinical efficacy testing.