Chest
Original ResearchCough and AspirationImpact of Expiratory Muscle Strength Training on Voluntary Cough and Swallow Function in Parkinson Disease
Section snippets
Materials and Methods
Ten male participants (60 to 82 years of age) with PD were included in the study. A neurologist who specializes in movement disorders, affiliated with the University of Florida Movement Disorders Center, provided the diagnosis of PD by UK Brain Bank Criteria, and he further provided the evaluation disease stage (Hoehn and Yahr scale, 1967). Only participants with midstage PD were used with Hoehn and Yahr scores between 2 and 3 (Table 1), and these participants had demonstrated
Results
Intrameasurer reliability for the P/A scores and the measurements made from the cough flow signals was assessed using intraclass correlation coefficients. The ratings were significant for reliability for the P/A scores (α = 0.56; p = 0.001) and the measurements from the cough flow signals (α = 0.70; p < 0.001).
Discussion
This study examined the effects of 4 weeks of EMST on voluntary cough function and the occurrence of P/A in a group of persons with PD. The overall effectiveness of the participants' voluntary cough increased, as indicated by the increase in cough VA, which relates to the ability of the cough to create shearing forces and remove unwanted material from the airway.45 Specifically, CPD and EPRT, as measured from the voluntary cough airflow waveform, from before training to after training,
Conclusion
This study demonstrates clear improvement in cough and swallow, as measured by P/A scores, following EMST training, and it shows it is a viable treatment option for participants with PD who are at risk for aspiration. Future studies should examine larger cohorts and also a more diverse group of participants, including those in different disease stages and of a different gender.
In future studies we aim to establish the relationship between P/A scores and timing events. These events may include
Acknowledgment
The authors would like to thank the National Parkinson Foundation Center of Excellence.
References (61)
Global physiology and pathophysiology of cough: ACCP evidence-based clinical practice guidelines
Chest
(2006)- et al.
Nonpharmacologic airway clearance therapies: ACCP evidence-based clinical practice guidelines
Chest
(2006) - et al.
Impaired efficacy of cough in participants with Parkinson disease
Chest
(2003) - et al.
Cough motor mechanisms
Respir Physiol Neurobiol
(2006) - et al.
Relationship between expired lung volume, peak flow rate and peak velocity time during a voluntary cough manoeuvre
Br J Anaesth
(1994) - et al.
What is cough and what should be measured?
Pulm Pharmacol Ther
(2007) - et al.
The effect of breathing exercises with body positioning on regional lung ventilation
Aust J Physiother
(1996) - et al.
Incentive spirometry versus routine chest physiotherapy for prevention of pulmonary complications after abdominal surgery
Lancet
(1991) - et al.
Comparison of manual and mechanical chest percussion in hospitalized participants with cystic fibrosis
J Pediatr
(1994) Evaluation of chest percussion in the treatment of participants with copious sputum production
Respir Med
(1991)
Chest percussion and postural drainage in participants with bronchiectasis
Chest
Expiratory muscle strength training in persons with multiple sclerosis having mild to moderate disability: effect on maximal expiratory pressure, pulmonary function, and maximal voluntary cough
Arch Phys Med Rehabil
Expiratory muscle training increases pressure support in high school band students
J Voice
Treatment outcomes for professional voice users
J Voice
“Mini-mental state”: a practical method for grading the cognitive state of participants for the clinician
J Psychiatr Res
Laryngeal movement, oropharyngeal pressure, and submental muscle contraction during swallowing
Arch Phys Med Rehabil
Aspiration in participants with head and neck cancer and tracheostomy
Am J Otolaryngol
Defective motor control of coughing in Parkinson's disease
Am J Respir Crit Care Med
Relationship between lung mechanics and ventilation distribution
Physiologist
Physiotherapy for airway clearance in adults
Eur Respir J
Improving the cough in participants with spinal cord injury
Am J Phys Med
Evaluation of the forced expiration technique as an adjunct to postural drainage in treatment of cystic fibrosis
BMJ
Incidence of Parkinson's disease: variation by age, gender, and race/ethnicity
Am J Epidemiol
Prognosis of Parkinson's disease in Japan: Tottori University Parkinson's Disease Epidemiology (TUPDE) Study Group
Eur Neurol
Predictors of mortality among nursing home residents with a diagnosis of Parkinson's disease
Med Sci Monit
Parkinson's disease and its comorbid disorders: an analysis of Michigan mortality data, 1970 to 1990
Neurology
Breathing and locomotion in participants with Parkinson's disease
Pflügers Arch
Respiratory function in Parkinson's disease
Clin Neurosci
Voluntary cough production and swallow dysfunction in Parkinson's disease
Dysphagia
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Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).
- 1
Ms. Pitts, Dr. Bolser, Dr. Rosenbek, Ms. Troche, and Dr. Okun have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
- 2
Dr. Sapienza, is a cofounder of and has financial interest in Aspire, the company that makes the device used in this study. She is also a member of the Scientific Advisory Board of the company.