May 2009
Pitts T, Bolser D, Josenbek J, Troche M, Okun MS, Sapienza C
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.
