Chest
Volume 135, Issue 5, May 2009, Pages 1301-1308
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Original Research
Cough and Aspiration
Impact of Expiratory Muscle Strength Training on Voluntary Cough and Swallow Function in Parkinson Disease

https://doi.org/10.1378/chest.08-1389Get rights and content

Background

Cough provides high expiratory airflows to aerosolize and remove material that cannot be adequately removed by ciliary action. Cough is particularly important for clearing foreign particles from the airway in those with dysphagia who may be at risk for penetration/aspiration (P/A). Expiratory muscle strength training (EMST) was tested to improve cough and swallow function.

Methods

Ten male participants, diagnosed with Parkinson disease (PD), with videofluorographic evidence of penetration or with evidence for aspiration of material during swallow of a thin 30-mL bolus, completed 4 weeks of an EMST program to test the hypothesis that EMST would improve cough and/or swallow function. Measured parameters from an airflow waveform produced during voluntary cough, pre-EMST and post-EMST, included inspiration phase duration, compression phase duration (CPD), expiratory phase peak flow (EPPF), expiratory phase rise time (EPRT), and cough volume acceleration (VA) [ie, the EPPF/EPRT ratio]. The swallow outcome measure was the degree of P/A during the swallow task.

Results

There was a significant decrease in the duration of the CPD and EPRT; the decrease in EPRT resulted in a significant increase in cough VA. Significant decreases in the P/A scores were found posttraining.

Conclusions

The results demonstrate that EMST is a viable treatment modality for a population of participants with PD at risk of aspiration.

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.

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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.

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