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Dakin AE, Troche MS. Ratings of perceived effort during expiratory pressure tasks in healthy adults. Respir Physiol Neurobiol 2024:104356. [PMID: 39326810 DOI: 10.1016/j.resp.2024.104356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 09/20/2024] [Accepted: 09/22/2024] [Indexed: 09/28/2024]
Abstract
PURPOSE Expiratory muscle strength training (EMST) is a resistance exercise used to improve maximal expiratory pressure and airway protective functions (cough and swallow) in clinical populations. Although ratings of perceived exertion/effort (RPE) are commonly used in exercise prescription and monitoring, they have been underutilized in EMST and require investigation. Our study aims were to: (1) examine how healthy adults rate their effort using the EMST-150 device and MicroRPM respiratory manometer; (2) assess variability in RPE; and (3) compare RPE and relative expiratory pressures obtained from the two devices. METHOD Twenty healthy adults completed thirty randomized expiratory maneuvers into a respiratory manometer and an EMST-150 device. RPE was measured using the Borg Category Ratio Scale. Linear mixed multilevel models were used for Aim 1 and 3, and coefficient of variation was used for Aim 2. RESULTS Twenty healthy adults (Median age: 24.5 years) participated. Results demonstrated a strong positive relationship between resistive load and perceived effort when using both devices. Intra-individual variability in perceived effort decreased as resistive load increased. Participants produced an average of 18.2% lower expiratory pressure when blowing into the manometer (relative to their maximum) than when blowing into the EMST device. DISCUSSION Our results support the utilization of RPE in EMST research and clinical practice. The addition of RPE as a measure of intensity during respiratory exercise prescription may be used in future research to help refine EMST protocols and improve rehabilitation outcomes.
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Affiliation(s)
- Avery E Dakin
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University.
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University
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Antonsson M, Johansson K, Bonde Dalemo A, Ivehorn Axelsson C, Burge Å, Lesueur U, Hartelius L. Effect of expiratory muscle strength training on voice and speech: An exploratory study in persons with Parkinson's disease or multiple sclerosis. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 26:475-492. [PMID: 37787640 DOI: 10.1080/17549507.2023.2243402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE This study explored how respiration, voice, and speech were affected following expiratory muscle strength training (EMST) and maintenance training in persons with Parkinson's disease (PD) or multiple sclerosis (MS). METHOD Nine participants with PD and six with MS participated in a randomised study, where the effects of EMST, sham, and maintenance treatment were investigated. Outcome measures included maximum expiratory pressure (MEP); maximum phonation time (MPT); intelligibility; verbal diadochokinesis (DDK); speech rate; a self-report form on voice, speech, and communication; and open questions about how the participants experienced the intervention. Group comparisons were performed within and between groups. RESULT The PD and the MS groups both improved significantly in MEP, and this improvement remained after 3 months of maintenance EMST. An improvement was also seen in DDK. Post-EMST, 33% of the PD group and 80% of the MS group reported a positive effect on communication. CONCLUSION The results of this study support previous evidence that EMST has positive effects on expiratory pressure in persons with PD or MS, but its effect on voice and speech remains unclear. Since subjective reports of the intervention and effects on communication were predominantly positive, further research is needed on larger groups to explore appropriate outcome measures.
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Affiliation(s)
- Malin Antonsson
- Speech and Language Pathology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Kerstin Johansson
- Division of Speech Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Anna Bonde Dalemo
- Speech and Language Pathology Unit, Skaraborg Hospital, Gothenburg, Region Västra Götaland, Sweden
| | | | - Åsa Burge
- Department of Neurology, Angered Hospital, Region Västra Götaland, Sweden
| | - Ulrike Lesueur
- Department of Neurology, Angered Hospital, Region Västra Götaland, Sweden
| | - Lena Hartelius
- Speech and Language Pathology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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Saleem S, Miles A, Allen J. A systematic review of behavioural therapies for improving swallow and cough function in Parkinson's disease. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 26:457-474. [PMID: 37534927 DOI: 10.1080/17549507.2023.2215488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
PURPOSE This systematic review evaluated the efficacy of therapeutic interventions on improving swallow, respiratory, and cough functions in Parkinson's disease (PD). METHOD A PRISMA systematic search was implemented across six databases. We selected studies reporting pre- and post-assessment data on the efficacy of behavioural therapies with a swallow or respiratory/cough outcome, and excluded studies on medical/surgical treatments or single-session design. Cross-system outcomes across swallow, respiratory, and cough functions were explored. Cochrane's risk of bias tools were utilised to evaluate study quality. RESULT Thirty-six articles were identified and further clustered into four treatment types: swallow related (n = 5), electromagnetic stimulation (n = 4), respiratory loading (n = 20), and voice loading (n = 7) therapies. The effects of some behavioural therapies were supported with high-quality evidence in improving specific swallow efficiency, respiratory pressure/volume, and cough measures. Only eleven studies were rated with a low risk of bias and the remaining studies failed to adequately describe blinding of assessors, missing data, treatment adherence, and imbalance assignment to groups. CONCLUSION Behavioural therapies were diverse in nature and many treatments demonstrated broad cross-system outcome benefits across swallow, respiratory, and cough functions. Given the progressive nature of the condition, the focus of future trials should be evaluating follow-up therapy effects and larger patient populations, including those with more severe disease.
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Affiliation(s)
- Shakeela Saleem
- School of Psychology, The University of Auckland, Auckland, New Zealand
- Department of Disability Studies, University of Kelaniya, Colombo, Sri Lanka
| | - Anna Miles
- School of Psychology, The University of Auckland, Auckland, New Zealand
| | - Jacqueline Allen
- Department of Surgery, The University of Auckland, Auckland, New Zealand
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Quibin K, Crawley BK, Saab R, Krishna P, Murry T. Expiratory Muscle Strength Treatment for Refractory Chronic Cough: A Short-term Single Exercise Program. J Voice 2024; 38:864-869. [PMID: 35260288 DOI: 10.1016/j.jvoice.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Patients with chronic cough are some of the most challenging to treat. This preliminary study is the first to examine the effects of a single exercise muscle strength training program to reduce cough severity in patients who failed other treatments. METHODS A total of 19 females were included in this study, ranging from age 24 to 80. The maximum phonation time (MPT), laryngeal airway resistance (LAR), maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), Voice Handicap Index-10, (VHI-10) and the Cough Severity Index (CSI) values were obtained pre- and post-treatment. ANOVA two-factor without replication was used to compare values pre- and post-treatment. RESULTS MIP (Mean of 62.00 to a mean of 78.53) and MEP (Mean of 90.00 to a mean of 112.16) showed significant increase post-treatment. In addition, LAR (Mean of 73.30 to a mean of 60.67) and CSI (Mean of 19.37 to a mean of 15.00) significantly decreased post-treatment. General changes in pre- and post-treatment values were identified with MPT (Mean of 14.89 to a mean of 16.17) and VHI-10 (Mean of 8.00 to a mean of 6.76). A follow-up questionnaire indicated that the majority of patients felt their cough was better after 4 weeks. CONCLUSIONS Muscle strength training provides a tool to aid in the control of cough for patients who are refractory to medical and other behavioral treatments. Improvement in cough may be associated with a reduction in subglottic pressure and increased air flow resulting in lower laryngeal airway resistance.
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Affiliation(s)
| | | | - Rim Saab
- Drexel University, College of Medicine, Philadelphia, Pennsylvania
| | - Priya Krishna
- Loma Linda Health University Health, Loma Linda, California
| | - Thomas Murry
- Drexel University, College of Medicine, Philadelphia, Pennsylvania; Loma Linda Health University Health, Loma Linda, California
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Dallal-York J, Troche MS. Hypotussic cough in persons with dysphagia: biobehavioral interventions and pathways to clinical implementation. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1394110. [PMID: 38933659 PMCID: PMC11199739 DOI: 10.3389/fresc.2024.1394110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/13/2024] [Indexed: 06/28/2024]
Abstract
Cough is a powerful, protective expulsive behavior that assists in maintaining respiratory health by clearing foreign material, pathogens, and mucus from the airways. Therefore, cough is critical to survival in both health and disease. Importantly, cough protects the airways and lungs from both antegrade (e.g., food, liquid, saliva) and retrograde (e.g., bile, gastric acid) aspirate contents. Aspiration is often the result of impaired swallowing (dysphagia), which allows oral and/or gastric contents to enter the lung, especially in individuals who also have cough dysfunction (dystussia). Cough hyposensitivity, downregulation, or desensitization- collectively referred to as hypotussia- is common in individuals with dysphagia, and increases the likelihood that aspirated material will reach the lung. The consequence of hypotussia with reduced airway clearance can include respiratory tract infection, chronic inflammation, and long-term damage to the lung parenchyma. Despite the clear implications for health, the problem of managing hypotussia in individuals with dysphagia is frequently overlooked. Here, we provide an overview of the current interventions and treatment approaches for hypotussic cough. We synthesize the available literature to summarize research findings that advance our understanding of these interventions, as well as current gaps in knowledge. Further, we highlight pragmatic resources to increase awareness of hypotussic cough interventions and provide support for the clinical implementation of evidence-based treatments. In culmination, we discuss potential innovations and future directions for hypotussic cough research.
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Affiliation(s)
- Justine Dallal-York
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, United States
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Bartlett RS, Walters AS, Stewart RS, Wayment HA. Perceptions of Dysphagia Evaluation and Treatment Among Individuals with Parkinson's Disease. Dysphagia 2024:10.1007/s00455-024-10723-0. [PMID: 38839626 DOI: 10.1007/s00455-024-10723-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/22/2024] [Indexed: 06/07/2024]
Abstract
Dysphagia is a leading cause of morbidity and mortality among individuals with Parkinson's disease (PD). The primary objectives of the present study were to explore patients' narrative reports focused on what information and evaluation and treatment experiences they identified as they manage dysphagia, and to identify practice patterns relevant to dysphagia management. A secondary objective was to produce an educational resource for this population that addressed their questions about dysphagia. A sample of individuals with oropharyngeal dysphagia secondary to PD (n = 25) across all regions of the United States were interviewed using open- and closed questions and a written questionnaire. Verbatim interview transcripts were interrogated using qualitative content analysis (QCA) with an inductive approach to identify themes from the participants' reported knowledge of dysphagia and experiences with swallowing evaluation and treatment. Authors developed a pamphlet addressing common questions that participants posed in the interviews and conducted a member check to revise it with their feedback. Most participants reported having been asked about their swallowing function by a healthcare professional. 60% of the sample reported having had a swallowing evaluation. Only 20% (5/25) of participants reported having completed swallowing therapy. Some participants did not know that swallowing therapy exists. Nearly all participants reported having a strong desire to know more about dysphagia and preferred a pamphlet as a resource format. Few of the study participants had received swallowing therapy, and nearly all participants were eager to learn about the nature of dysphagia, its progression, and treatment options. Given the physical, emotional, and social ramifications of living with dysphagia, access to swallowing education and treatment needs to be a stronger focus of PD management.
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Affiliation(s)
- Rebecca S Bartlett
- Communication Sciences and Disorders, Northern Arizona University, Rm 313 208 E. Pine Knoll Drive, Flagstaff, AZ, 86011, USA.
| | - Andrew S Walters
- Department of Psychological Sciences, Northern Arizona University, Rm 323, Flagstaff, United States
| | - Rosa S Stewart
- Communication Sciences and Disorders, Northern Arizona University, Rm 313 208 E. Pine Knoll Drive, Flagstaff, AZ, 86011, USA
| | - Heidi A Wayment
- Department of Psychological Sciences, Northern Arizona University, Rm 323, Flagstaff, United States
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Guillen-Sola A, Ramírez C, Nieto S, Duarte E, Tejero M, Grillo C, Bel H, Boza R. Therapeutic approach to dysphagia in post-COVID patients in a rehabilitation unit: a descriptive longitudinal study. Eur J Phys Rehabil Med 2024; 60:373-381. [PMID: 38502558 PMCID: PMC11112509 DOI: 10.23736/s1973-9087.24.08234-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/06/2024] [Accepted: 02/19/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND A high rate of hospitalized patients for COVID-19 had dysphagia, frequently underdiagnosed, and not treated, inducing a prolonged dysphagia with protracted recovery. Specific treatments and protocols have not been well described yet. AIM Given the potential benefits of respiratory muscle training (IEMT) and neuromuscular stimulation (NMES) in dysphagia treatment, this study aimed to assess the feasibility of the protocol used for treating dysphagia in patients who experienced prolonged hospitalization for COVID-19. DESIGN Observational, descriptive, prospective study. SETTING Department of Physical Medicine and Rehabilitation of a tertiary University hospital. POPULATION Fifty-eight COVID-19 patients were admitted for intensive rehabilitation (March 2020 to October 2021) were prospectively studied. METHODS Dysphagia was diagnosed using videofluoroscopy and treated with a 3-week protocol adapted from neuromuscular stimulation (NMES) in a motor threshold and inspiratory/expiratory muscle strength training (IEMST), five sets of five repetitions three times daily for 3 weeks. Feasibility was assessed with adherence, outcomes achieved, and occurrence of adverse/unexpected events. Respiratory function (peak cough flow, maximal inspiratory/expiratory pressures) and swallow function (Penetration-Aspiration Scale and Bolus Residue Scale measured by videofluoroscopy) were recorded descriptive statistics, Student's t test for numerical data, and Wilcoxon Test for ordinal variables were applied. SPPSS vs28 and STATA version 15.1 (StataCorp, College Station, TX, USA) were used for statistical analysis. P values 0.05 were considered significant. RESULTS Dysphagia was highly prevalent in severe COVID-19 patients (86.6%); all respiratory and swallow parameters improved after a 3-week intervention and 12 of 18 patients dependent on tube feeding resumed a normal diet (66.7%; McNemar P=0.03), and 84.09% attended a no restriction diet at discharge. Adherence to treatment was 85%. No significant adverse events were detected. CONCLUSIONS We conclude that a structured swallowing-exercise training intervention based on IEMT and NMES is feasible and safe in prolonged hospitalization post-COVID patients. CLINICAL REHABILITATION IMPACT To describe rehabilitation protocols used to treat dysphagia in post-COVID patients will help us to optimize the available techniques in each center and to induce a faster recovery avoiding potential complications.
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Affiliation(s)
- Anna Guillen-Sola
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar, Barcelona, Spain -
- Rehabilitation Research Group, Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain -
| | - Cindry Ramírez
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar, Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Sonia Nieto
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar, Barcelona, Spain
| | - Esther Duarte
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar, Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Marta Tejero
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar, Barcelona, Spain
| | - Christian Grillo
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar, Barcelona, Spain
| | - Helena Bel
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar, Barcelona, Spain
| | - Roser Boza
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar, Barcelona, Spain
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Dai Y, Cai J, Wang H, Zhang Y, Niu C, Wang Y. Effect of respiratory training on swallowing function in swallowing disorders: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2024; 281:1069-1081. [PMID: 37843618 PMCID: PMC10858149 DOI: 10.1007/s00405-023-08280-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/04/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE To determine the clinical efficacy of different respiratory training interventions on swallowing function in patients with swallowing disorders through the systematic review. METHODS We reviewed the literature regarding the application of respiratory training therapy in patients with swallowing disorders, followed by a PRISMA search of published literature in five databases (PubMed, Web of Science, The Cochrane Library, CINAHL and EMBASE) in December 2022. Two reviewers performed study selection, quality evaluation, and risk of bias, followed by data extraction and detailed analysis. RESULTS A total of six randomized controlled studies with a total sample size of 193 cases were included. Respiratory training improved swallowing safety (PAS (n = 151, SMD = 0.69, 95% CI - 1.11 to - 0.26, I2 = 36, p < 0.001)) and swallowing efficiency [residual (n = 63, SMD = 1.67, 95% CI - 2.26 to - 1.09, I2 = 23%, p < 0.001)] compared to control groups. The results of the qualitative analysis conducted in this study revealed that respiratory training enhanced hyoid bone movement but had no effect on swallowing quality of life. CONCLUSIONS Respiratory training interventions may improve swallowing safety and efficiency in patients with dysphagia. However, the level of evidence is low, and there is a limited amount of research on the effectiveness and physiology of this intervention to improve swallowing function. In the future, there is a need to expand clinical studies, standardize measurement tools, and improve study protocols.
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Affiliation(s)
- Yinuo Dai
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Jianzheng Cai
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Haifang Wang
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
| | - Yingying Zhang
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
| | - Chunyan Niu
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Yalan Wang
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
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Doruk C, Curtis JA, Dakin AE, Troche MS. Cough and Swallowing Therapy and Their Effects on Vocal Fold Bowing and Laryngeal Lesions. Laryngoscope 2024; 134:1127-1132. [PMID: 37497803 DOI: 10.1002/lary.30922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE Expiratory muscle strength training (EMST) and sensorimotor training of airway protection (smTAP) are two exercises intended to improve cough and swallowing in people with Parkinson's Disease (PwPD). The aims of this study were to (1) examine whether EMST or smTAP elicit changes to vocal fold bowing; and (2) describe the safety of EMST and smTAP as it relates to the development of vocal fold lesions. METHOD(S) This was a secondary analysis of data from PwPD who completed EMST or smTAP as part of a prospective randomized controlled trial. Vocal fold bowing (BI) and the presence of laryngeal lesions were blindly analyzed from flexible endoscopic evaluation of swallowing (FEES) using ImageJ software and operational definitions. Linear regression was used to examine the influence time (pre- vs. post-therapy) and therapy (EMST vs. smTAP) on vocal fold bowing. Descriptive statistics were used to describe the presence of laryngeal lesions. RESULT(S) Overall, 56 participants were included, 28 per group. The median BI scores pre- and post-therapy were 8.2% and 8.3% for the EMST group and 11.3% and 8.4% for the smTAP group, respectively. Statistical analyses revealed insufficient evidence to suggest an effect of time and treatment type on BI (p > 0.05) or on the presence of vocal fold lesions (p > 0.05). CONCLUSION Based on these and previous findings, it appears that changes in vocal fold bowing do not drive treatment effects following EMST and smTAP. Also, this study further supports the safety of smTAP and EMST despite the required forceful exhalation and repetitive coughing. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1127-1132, 2024.
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Affiliation(s)
- Can Doruk
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
- Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - James A Curtis
- Aerodigestive Innovations Research lab (AIR), Department of Otolaryngology-Head & Neck Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Avery E Dakin
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
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Cheng SW, Leung KHV, Mok KCJ, Yeung KW, Wong SYI, Lam YL, Ip KM, Lok YW, Wong ACL. Improvement in Swallowing Function in Patients with Previous Irradiation for Nasopharyngeal Carcinoma by Expiratory Muscle Strength Training. Dysphagia 2024; 39:129-139. [PMID: 37392211 DOI: 10.1007/s00455-023-10600-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 06/07/2023] [Indexed: 07/03/2023]
Abstract
Dysphagia and chronic aspiration are common post-irradiation complications in nasopharyngeal carcinoma (NPC) survivors. Expiratory Muscle Strength Training (EMST) is a simple device-driven exercise therapy for swallowing training. This study investigates the effectiveness of EMST in a group of post-irradiated NPC patients. This prospective cohort, including twelve patients with previous irradiation for NPC and with swallowing disturbance, was performed between 2019 and 2021 in a single institution. Patients were trained with EMST for 8 weeks. Non-parametric analyses examined effects of EMST on primary outcome, maximum expiratory pressure. Secondary outcomes were measured with Penetration-aspiration scale, Yale pharyngeal residue severity rating scale (YPRSRS) by flexible endoscopic evaluation of swallowing, and Eating Assessment Tool (EAT-10) and M.D. Anderson Dysphagia Inventory questionnaire. Twelve patients, with a mean (SD) age of 64.3 (8.2) were recruited. There was no patient dropout with 88.9% overall compliance of training. Maximum expiratory pressure improved by 41% (median 94.5 to 133.5 cmH2O, p = 0.003). There was reduction in Penetration-aspiration scale with thin liquid (median 4 to 3, p = 0.026), and in YPRSRS at pyriform fossa with mildly thick liquid (p = 0.021) and at vallecula with thin liquid (p = 0.034), mildly thick liquid (p = 0.014) and pureed meat congee (p = 0.016). Questionnaire scores did not significantly change statistically. EMST is an easy-to-use and effective exercise therapy to improve airway safety and swallowing function in post-irradiated NPC survivors.
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Affiliation(s)
- Siu Woon Cheng
- Department of Otorhinolaryngology, Head and Neck Surgery, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, New Territories, Hong Kong.
| | - Kwok Hung Vincent Leung
- Department of Otorhinolaryngology, Head and Neck Surgery, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, New Territories, Hong Kong
| | - Kar Cheong Jason Mok
- Department of Otorhinolaryngology, Head and Neck Surgery, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, New Territories, Hong Kong
| | - Kong Wah Yeung
- Department of Otorhinolaryngology, Head and Neck Surgery, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, New Territories, Hong Kong
| | - Sin Yee Ivy Wong
- Department of Speech Therapy, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Yin Ling Lam
- Department of Speech Therapy, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Ka Man Ip
- Department of Speech Therapy, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Yin Wing Lok
- Department of Speech Therapy, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Andrew Chun Lok Wong
- Department of Otorhinolaryngology, Head and Neck Surgery, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, New Territories, Hong Kong
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Hu J, Guo R, Li H, Wen H, Wang Y. Perioperative Diaphragm Dysfunction. J Clin Med 2024; 13:519. [PMID: 38256653 PMCID: PMC10816119 DOI: 10.3390/jcm13020519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/07/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
Diaphragm Dysfunction (DD) is a respiratory disorder with multiple causes. Although both unilateral and bilateral DD could ultimately lead to respiratory failure, the former is more common. Increasing research has recently delved into perioperative diaphragm protection. It has been established that DD promotes atelectasis development by affecting lung and chest wall mechanics. Diaphragm function must be specifically assessed for clinicians to optimally select an anesthetic approach, prepare for adequate monitoring, and implement the perioperative plan. Recent technological advancements, including dynamic MRI, ultrasound, and esophageal manometry, have critically aided disease diagnosis and management. In this context, it is noteworthy that therapeutic approaches for DD vary depending on its etiology and include various interventions, either noninvasive or invasive, aimed at promoting diaphragm recruitment. This review aims to unravel alternative anesthetic and operative strategies that minimize postoperative dysfunction by elucidating the identification of patients at a higher risk of DD and procedures that could cause postoperative DD, facilitating the recognition and avoidance of anesthetic and surgical interventions likely to impair diaphragmatic function.
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Affiliation(s)
- Jinge Hu
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China; (J.H.); (R.G.); (H.L.)
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China;
| | - Ruijuan Guo
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China; (J.H.); (R.G.); (H.L.)
| | - Huili Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China; (J.H.); (R.G.); (H.L.)
| | - Hong Wen
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China;
| | - Yun Wang
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China; (J.H.); (R.G.); (H.L.)
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Hirschwald J, Finnegan L, Hofacker J, Walshe M. Underserved groups in dysphagia intervention trials in Parkinson's disease: A scoping review. Ageing Res Rev 2024; 93:102150. [PMID: 38043779 DOI: 10.1016/j.arr.2023.102150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Underserved groups in Parkinson's disease (PD) intervention studies are well recognised. However, it remains unclear whether these exclusions apply to oropharyngeal dysphagia (OD) intervention studies in PD. The aim of this scoping review was to identify characteristics of included participants and underserved groups in intervention studies in OD in PD. METHODS Six electronic databases and one trial registry were searched without language restrictions. Screening of studies and data extraction were independently conducted by four reviewers. RESULTS Of the 26 studies included, none fully reported the participants' ethnicity. Where data was available, 70% of participants were male with a mean age of 68 years, mean PD duration of 7.26 years, median Hoehn and Yahr stage of 2.5, mild OD and mostly recruited from movement disorders clinics. Underserved groups were younger people (< 50 years), older people (≥ 80 years), women, non-white people, people with severe OD and PD, longer PD duration, other neurological conditions, cognitive impairment/dementia, and depression. CONCLUSIONS Careful consideration of all characteristics of individuals with OD in PD is essential for improving the external validity of studies. This will enhance the generalisability of research findings to the broader PD population, ultimately strengthening the evidence base for OD interventions in PD.
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Affiliation(s)
- Julia Hirschwald
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Ireland.
| | - Lauren Finnegan
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Ireland
| | - Jule Hofacker
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Ireland
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Ueha R, Cotaoco C, Kondo K, Yamasoba T. Management and Treatment for Dysphagia in Neurodegenerative Disorders. J Clin Med 2023; 13:156. [PMID: 38202163 PMCID: PMC10779554 DOI: 10.3390/jcm13010156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/21/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
Patients with neurodegenerative disorders (NDDs) often experience functional dysphagia, which may involve dysfunction in a specific phase of swallowing or in the entire process. This review outlines the approach to dysphagia in the setting of NDDs. Distinguishing the etiology of dysphagia can be difficult, and it is important to always look out for signs pointing to NDD as the cause. Thorough diagnostic work-up is essential, and it includes a comprehensive history and physical examination, alongside swallowing function tests, such as fiberoptic endoscopic evaluation of swallowing, videofluoroscopic swallowing study, and high-resolution manometry. Management requires a multidisciplinary approach with a treatment plan tailored to each patient. This involves dietary guidance, swallowing rehabilitation, and surgery in cases in which improvement with rehabilitation is inadequate. Surgery may involve altering certain pharyngolaryngeal structures to facilitate swallowing and reduce the risk of aspiration (swallowing improvement surgery) or separating the airway and digestive tract while sacrificing laryngeal function, with the main goal of preventing aspiration (aspiration prevention surgery). Proper management stems from recognizing the impact of these disorders on swallowing and consistently finding ways to improve the quality of life of patients.
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Affiliation(s)
- Rumi Ueha
- Swallowing Center, The University of Tokyo Hospital, Tokyo 113-8655, Japan
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (C.C.); (K.K.); (T.Y.)
| | - Carmel Cotaoco
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (C.C.); (K.K.); (T.Y.)
- Ear Nose Throat Head and Neck Surgery Institute, The Medical City, Metro Manila 1600, Philippines
| | - Kenji Kondo
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (C.C.); (K.K.); (T.Y.)
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (C.C.); (K.K.); (T.Y.)
- Tokyo Teishin Hospital, Tokyo 102-0071, Japan
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14
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Hahn Arkenberg RE, Mitchell SS, Craig BΑ, Brown B, Burdo-Hartman W, Lundine JP, Goffman L, Smith A, Malandraki GA. Neuromuscular adaptations of swallowing and speech in unilateral cerebral palsy: shared and distinctive traits. J Neurophysiol 2023; 130:1375-1391. [PMID: 37877193 PMCID: PMC11068406 DOI: 10.1152/jn.00502.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 10/02/2023] [Accepted: 10/19/2023] [Indexed: 10/26/2023] Open
Abstract
Our aims were to 1) examine the neuromuscular control of swallowing and speech in children with unilateral cerebral palsy (UCP) compared with typically developing children (TDC), 2) determine shared and separate neuromuscular underpinnings of the two functions, and 3) explore the relationship between this control and behavioral outcomes in UCP. Surface electromyography (sEMG) was used to record muscle activity from the submental and superior and inferior orbicularis oris muscles during standardized swallowing and speech tasks. The variables examined were normalized mean amplitude, time to peak amplitude, and bilateral synchrony. Swallowing and speech were evaluated using standard clinical measures. Sixteen children with UCP and 16 TDC participated (7-12 yr). Children with UCP demonstrated higher normalized mean amplitude and longer time to peak amplitude across tasks than TDC (P < 0.01; and P < 0.02) and decreased bilateral synchrony than TDC for swallows (P < 0.01). Both shared and distinctive neuromuscular patterns were observed between swallowing and speech. In UCP, higher upper lip amplitude during swallows was associated with shorter normalized mealtime durations, whereas higher submental bilateral synchrony was related to longer mealtime durations. Children with UCP demonstrate neuromuscular adaptations for swallowing and speech, which should be further evaluated for potential treatment targets. Furthermore, both shared and distinctive neuromuscular underpinnings between the two functions are documented.NEW & NOTEWORTHY Systematically studying the swallowing and speech of children with UCP is new and noteworthy. We found that they demonstrate neuromuscular adaptations for swallowing and speech compared with typically developing peers. We examined swallowing and speech using carefully designed tasks, similar in motor complexity, which allowed us to directly compare patterns. We found shared and distinctive neuromuscular patterns between swallowing and speech.
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Affiliation(s)
- Rachel E Hahn Arkenberg
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, United States
| | - Samantha S Mitchell
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, United States
| | - Bruce Α Craig
- Department of Statistics, Purdue University, West Lafayette, Indiana, United States
| | - Barbara Brown
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, United States
| | - Wendy Burdo-Hartman
- Nationwide Children's Hospital, Columbus, Ohio, United States
- Department of Pediatrics, College of Medicine, Ohio State University, Columbus, Ohio, United States
| | - Jennifer P Lundine
- Nationwide Children's Hospital, Columbus, Ohio, United States
- Department of Speech & Hearing Sciences, Ohio State University, Columbus, Ohio, United States
| | - Lisa Goffman
- Callier Center for Communication Disorders, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas Texas, United States
| | - Anne Smith
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, United States
| | - Georgia A Malandraki
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, United States
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, United States
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15
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Donohue C, Wiele L, Terry A, Jeng E, Beaver T, Martin T, Vasilopoulos T, Plowman EK. Preoperative respiratory strength training is feasible and safe and improves pulmonary physiologic capacity in individuals undergoing cardiovascular surgery. JTCVS OPEN 2023; 15:324-331. [PMID: 37808054 PMCID: PMC10556933 DOI: 10.1016/j.xjon.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/06/2023] [Accepted: 07/13/2023] [Indexed: 10/10/2023]
Abstract
Objective To determine the safety, feasibility, and physiologic impact of a preoperative respiratory strength training (RST) program in individuals undergoing elective cardiac surgery (CS). Methods Twenty-five adults undergoing an elective CS at an academic hospital setting enrolled and completed RST 5 days/week (50 repetitions, 50% training load, ≥3 weeks) at home via telehealth in this open-label prospective cohort study. RST adherence, telehealth attendance, and adverse events were tracked. Pre- and post-RST outcomes of maximum expiratory pressure (MEP), maximum inspiratory pressure (MIP), voluntary cough spirometry, and patient-reported dyspnea were collected. Descriptive analyses and Wilcoxon signed rank-tests were performed. Results Two participants (9%) did not complete the prescribed RST program. No significant RST-related adverse events occurred. Treatment adherence for all enrolled participants was 90%, and telehealth attendance was 99%. Of the CS patients who completed the prescribed program (n = 23; 91%), treatment adherence and telehealth attendance were excellent (98% and 100%, respectively). Significant increases in primary outcomes were observed: MEP mean change, +15.4 (95% confidence interval [CI], +3.4 to +27.3, P < .007); MIP mean change, +14.9 (95% CI, +9.4 to +20.4, P < .0001). No statistically significant differences in voluntary cough or perceived dyspnea outcomes were observed (P > .05). Conclusions These preliminary data demonstrate that a preoperative RST program is safe and feasible and can improve short-term respiratory physiologic capacity (MEP and MIP) in CS patients. Future research is warranted to validate the current findings in a larger cohort of CS patients and to determine whether RST improves postoperative extubation outcomes, airway clearance capacity, and aspiration following cardiac surgery.
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Affiliation(s)
- Cara Donohue
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville, Fla
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Fla
- Breathing Research and Therapeutics Center, University of Florida, Gainesville, Fla
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, Tenn
| | - Lauren Wiele
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville, Fla
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Fla
| | - Alyssa Terry
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville, Fla
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Fla
| | - Eric Jeng
- Department of Surgery, University of Florida, Gainesville, Fla
| | - Thomas Beaver
- Department of Surgery, University of Florida, Gainesville, Fla
| | - Tomas Martin
- Department of Surgery, University of Florida, Gainesville, Fla
| | | | - Emily K. Plowman
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville, Fla
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Fla
- Breathing Research and Therapeutics Center, University of Florida, Gainesville, Fla
- Department of Surgery, University of Florida, Gainesville, Fla
- Department of Neurology, University of Florida, Gainesville, Fla
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16
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Krasko MN, Rudisch DM, Burdick RJ, Schaen-Heacock NE, Broadfoot CK, Nisbet AF, Rogus-Pulia N, Ciucci MR. Dysphagia in Parkinson Disease: Part II-Current Treatment Options and Insights from Animal Research. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2023; 11:188-198. [PMID: 39301152 PMCID: PMC11411792 DOI: 10.1007/s40141-023-00393-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 09/22/2024]
Abstract
Purpose of Review Dysphagia is highly prevalent in Parkinson disease (PD) but is not typically identified nor treated until later in the disease process. This review summarizes current pharmacological, surgical, and behavioral treatments for PD-associated dysphagia and contributions from translational animal research. Recent Findings Swallowing is a complex physiologic process controlled by multiple brain regions and neurotransmitter systems. As such, interventions that target nigrostriatal dopamine dysfunction have limited or detrimental effects on swallowing outcomes. Behavioral interventions can help target PD-associated dysphagia in mid-to-late stages. Animal research is necessary to refine treatments and useful in studying prodromal dysphagia. Summary Dysphagia is an early, common, and debilitating sign of PD. Current pharmacological and surgical interventions are not effective in ameliorating swallowing dysfunction; behavioral intervention remains the most effective approach for dysphagia treatment. Animal research has advanced our understanding of mechanisms underlying PD and PD-associated dysphagia, and continues to show translational promise for the study of dysphagia treatment options.
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Affiliation(s)
- Maryann N Krasko
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, 1300 University Ave, Madison, WI 53706, USA
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1975 Willow Drive, Madison, WI 53706, USA
| | - Denis Michael Rudisch
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, 1300 University Ave, Madison, WI 53706, USA
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1975 Willow Drive, Madison, WI 53706, USA
| | - Ryan J Burdick
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin-Madison, 1685 Highland Avenue, Madison, WI 53705, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Nicole E Schaen-Heacock
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin-Madison, 1685 Highland Avenue, Madison, WI 53705, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Courtney K Broadfoot
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin-Madison, 1685 Highland Avenue, Madison, WI 53705, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Alex F Nisbet
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Nicole Rogus-Pulia
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin-Madison, 1685 Highland Avenue, Madison, WI 53705, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Michelle R Ciucci
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, 1300 University Ave, Madison, WI 53706, USA
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1975 Willow Drive, Madison, WI 53706, USA
- Neuroscience Training Program, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI 53705, USA
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17
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Lee KW, Kim SB, Lee JH, Kim SW. Cut-Off Value of Voluntary Peak Cough Flow in Patients with Parkinson's Disease and Its Association with Severe Dysphagia: A Retrospective Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050921. [PMID: 37241153 DOI: 10.3390/medicina59050921] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/29/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives. Swallowing and coughing reflexes are both closely associated with airway protection. Peak cough flow (PCF) is associated with dysphagia in several neurogenic diseases. In this study, we aimed to analyze the relationship between PCF and aspiration in Parkinson's disease (PD) and determine the cut-off value of PCF. Materials and Methods. We retrospectively analyzed the records of patients with PD who underwent a videofluoroscopic swallowing study and checked for PCF. A total of 219 patients were divided into an aspiration group (n = 125) and a non-aspiration group (n = 94). Results. Significantly lower PCF values were observed in the aspiration group compared to the non-aspiration group (132.63 ± 83.62 vs. 181.38 ± 103.92 L/min, p < 0.001). Receiver operating characteristic curve analysis revealed that a PCF cut-off value of 153 L/min (area under the receiver operating characteristic curve, 0.648; sensitivity, 73.06%; specificity, 51.06%) was associated with aspiration in PD. Additionally, a univariate analysis showed that the male sex, lower body mass indexes, higher Hoehn and Yahr scales, and PCF values of ≤153 L/min indicated an increased risk of aspiration. Conclusions. Through a multivariate analysis, we demonstrated that a PCF value ≤153 L/min was associated with an increased risk of aspiration (odds ratio 3.648; 1.797-7.407), highlighting that a low PCF is a risk factor for aspiration in patients with PD.
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Affiliation(s)
- Kyeong-Woo Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Dong-A University, Busan 49201, Republic of Korea
| | - Sang-Beom Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Dong-A University, Busan 49201, Republic of Korea
| | - Jong-Hwa Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Dong-A University, Busan 49201, Republic of Korea
| | - Seong-Woo Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Dong-A University, Busan 49201, Republic of Korea
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18
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Monleón Guinot S, San Martín Valenzuela C, Aranda Asensi V, de Salazar Antón C, Villanueva Navarro M, Tomás JM. Functional balance training in people with Parkinson's disease: a protocol of balanceHOME randomized control trial with crossover. Front Aging Neurosci 2023; 15:1137360. [PMID: 37266404 PMCID: PMC10231658 DOI: 10.3389/fnagi.2023.1137360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/29/2023] [Indexed: 06/03/2023] Open
Abstract
Introduction Balance disturbances in Parkinson's Disease (PD) are usually assessed in a single-task as well as standard balance physiotherapy is carried out in isolated environments. Conversely, daily activities are developed in highly challenging environments. Although functional balance training (FBT) is included in the latest protocols, several methodological issues have not yet been considered. In the proposed single-blinded randomized control trial with crossover (NCT04963894), the aims are (1) to quantify the effects achieved by domiciliary FBT (balanceHOME program) in participants with and without cognitive impairment, and (2) to compare them with the effects of a passive-control period and a conventional face-to-face physiotherapy program for PD. Methods The initial recruitment was estimated at 112 people with idiopathic PD. Two-thirds of the participants will be randomized to one of the two groups to make the crossover. In contrast, the other third will do a face-to-face group program only. The balanceHOME protocol consists of challenging balance exercises incorporated into functional daily tasks, developed in-home and conducted two times per week for 60-min over an 8-weeks period. The primary strategy will consist of splitting functional tasks of daily life into static and dynamic balance components, besides standardized facilitate and disturbing strategies to execution of each exercise. Biomechanics and clinical performance of balance and gait, perception of quality of life, cognitive and mental functioning, and severity of PD will be measured at baseline (T0), post-8 weeks training (T1), and follow-up (T2). Results The primary outcome of the study will be the center of pressure sway area. The secondary outcomes consist of biomechanics and clinical variables related to static and dynamic balance. Outcomes from biomechanical of gait, quality of life, cognitive and mental state, and severity of PD, represent the tertiary outcomes. Discussion The balanceHOME program standardizes the FBT in demanding and daily environments for people with PD who prefer individualized treatment from home. This is the first time that the effects of group versus individual balance rehabilitation have been compared in people with and without cognitive impairment and evaluated in complex environments. This still-to-be-finished study will open the possibility of new strategies according to changes in post-pandemic therapeutic approaches.
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Affiliation(s)
- Sara Monleón Guinot
- Department of Methodology for the Behavioral Sciences, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Constanza San Martín Valenzuela
- Unit of Personal Autonomy, Dependency, and Mental Disorders Assessment, INCLIVA Biomedical Research Institute, Valencia, Spain
- Departament of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | - Jose M. Tomás
- Department of Methodology for the Behavioral Sciences, Faculty of Psychology, University of Valencia, Valencia, Spain
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19
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Kashima K, Watanabe K, Sato T, Katori Y. Analysis of Dysphagia and Cough Strength in Patients with Unilateral Vocal Fold Paralysis. Dysphagia 2023; 38:510-516. [PMID: 33728514 DOI: 10.1007/s00455-021-10274-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 02/16/2021] [Indexed: 11/26/2022]
Abstract
The association between swallowing function and cough strength in patients with unilateral vocal fold paralysis (UVFP) is unknown. We evaluated the relationship between voluntary cough strength and dysphagia among patients with UVFP (UVFP group) by comparing their data with that of corresponding healthy participants (healthy control [HC] group) in a prospective observational study. From February 1st, 2018 to March 30th, 2019, we recruited patients with a voice disorder due to UVFP, who were referred to our university hospital. Patients with a history of laryngeal surgery, vagal nerve paralysis, or cardiac and respiratory failure were excluded. Descriptive and clinical data regarding swallowing, voice, and cough peak flow (CPF) were collected as a measure of cough strength. The UVFP group comprised six women and seven men (median age, 68.0 years), and the HC group comprised six women and eight men (median age 65.5 years). The groups differed significantly in the Eating Assessment Tool (EAT)-10 scores and CPF rates (P < 0.001). Among patients with UVFP, 84.6% had an abnormal EAT-10 score of ≥ 3. Additionally, 16.7% of the patients exhibited liquid aspiration with contrast medium on a videofluorographic swallowing study (VFSS). There was no correlation between the CPF values, EAT-10 scores, or the VFSS results. Therefore, patients with severe UVFP, whose condition had been fixed, had difficulties when swallowing (85% of cases), and some even presented with aspiration on VFSS (20% of cases), while receiving a regular diet.
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Affiliation(s)
- Kazutaka Kashima
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
| | - Kenichi Watanabe
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Takeshi Sato
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Yukio Katori
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
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20
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Kim JY, Kim H. Effects of behavioural swallowing therapy in patients with Parkinson's disease: A systematic review. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:269-280. [PMID: 35282718 DOI: 10.1080/17549507.2022.2045356] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE A previous 2014 systematic review outlining the treatment effects of swallowing therapies in Parkinson's disease (PD) demonstrated a lack of well-designed randomised controlled studies. This current review presents and evaluates the latest evidence for behaviour swallowing therapies for PD-related dysphagia to enhance speech-language pathologists' evidence-based decision-making around treatment choices. METHOD A systematic review of articles published in English and Korean was conducted from January 2014 through June 2020 using the electronic databases PubMed, Embase, and Cochrane Library. Two authors independently searched the literature and differences after the search were settled following discussion and consensus. Identified studies were evaluated for quality with the ABC rating scale and critical appraisal criteria. RESULT Eight studies after initial search and three additional studies which met our original criteria but were not freely available, or published after the initial search period were also included. Eleven studies included the following treatments: biofeedback therapy (N = 1), respiratory-swallow coordination training (N = 2), neuromuscular electrical stimulation (NMES) (N = 1), expiratory muscle strength training (EMST) (N = 2), intensive exercise-based swallowing program (ISP) (N = 1), chin-down strategy (N = 2), Lee Silverman Voice Treatment (N = 1), and therapeutic singing (N = 1). CONCLUSION Most of the behavioural therapies improved swallowing function in PD. Treatments that enhanced airway function globally demonstrated positive effects on swallow function as did intensive, targeted swallowing treatment. However, the chin-down strategy did not show a significant effect on swallowing measured by flexible endoscopic evaluations of swallowing. EMST detraining effects implied a need to design maintenance training in PD. In the future, well-designed randomised controlled trials are needed to consolidate the effects of these therapies.
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Affiliation(s)
- Ja Young Kim
- Graduate Program in Speech-Language Pathology, Yonsei University, Seoul, Korea
| | - HyangHee Kim
- Graduate Program in Speech-Language Pathology, Yonsei University, Seoul, Korea
- Graduate Program of Speech-Language Pathology; Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
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21
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A Primer on Hypotussic Cough: Mechanisms and Assessment. CURRENT OTORHINOLARYNGOLOGY REPORTS 2023. [DOI: 10.1007/s40136-023-00446-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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22
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Patterson JM, Lawton M. Dysphagia Advances in Head and Neck Cancer. CURRENT OTORHINOLARYNGOLOGY REPORTS 2023; 11:1-8. [PMID: 36816911 PMCID: PMC9930077 DOI: 10.1007/s40136-023-00445-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 02/19/2023]
Abstract
Purpose of Review This review summarises the current literature regarding head and neck cancer-associated dysphagia. Up-to-date evidence for dysphagia outcome measurement for this population is provided, in addition to recent innovations that aim to prevent, reduce or remediate the common and debilitating side effects of treatment. Recent Findings Both patient-reported outcomes and clinical measures are necessary to capture the multi-dimensional nature of swallowing. A minimally important difference in scores has been calculated for some of these measures, to aid interpretation and powering of clinical trials. The number of dysphagia-related trials has increased, predominantly investigating optimal treatment for oropharyngeal HPV-positive disease, and speech and language pathology interventions using an impairment-based approach. Summary Although substantial progress has been made, further work is necessary to establish a consensus over outcome measures. Modifying treatments may improve outcomes. Several trials are underway to establish the effectiveness of speech and language pathology dysphagia interventions.
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Affiliation(s)
- J. M. Patterson
- School of Health Sciences, Institute of Population Health/Liverpool Head and Neck Centre, University of Liverpool, 1.17 Thompson Yates Building, The Quadrangle, Brownlow Hill, Liverpool, L69 3GB USA
| | - M. Lawton
- School of Health Sciences, Institute of Population Health/Liverpool Head and Neck Centre, University of Liverpool, 1.17 Thompson Yates Building, The Quadrangle, Brownlow Hill, Liverpool, L69 3GB USA
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23
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Mohammed Yusuf SF, Bhise A, Nuhmani S, Alghadir AH, Khan M. Effects of an incentive spirometer versus a threshold inspiratory muscle trainer on lung functions in Parkinson's disease patients: a randomized trial. Sci Rep 2023; 13:2516. [PMID: 36781936 PMCID: PMC9925741 DOI: 10.1038/s41598-023-29534-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/06/2023] [Indexed: 02/15/2023] Open
Abstract
Upper airway obstruction, reduced maximal expiratory and inspiratory flows, reduced lung volumes, abnormal ventilatory control, and diaphragmatic dyskinesias are reported in patients with Parkinson's disease (PD). Inspiratory muscle training (IMT) has been reported to be effective in improving respiratory functions; however, no studies have compared the effects of the incentive spirometer (IS) with the threshold inspiratory muscle trainer (TIMT) in patients with PD. The study aimed to compare the effects of IS and TIMT on maximum inspiratory pressure (MIP), 6-min walk distance (6-MWD), forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and peak expiratory flow rate (PEFR) in patients with stage 1-3 according to the Hoehn and Yahr scale. 18 patients were randomly assigned to two groups, i.e., incentive spirometer (IS) and threshold inspiratory muscle trainer (TIMT) group. The IS group received IMT with volume-based IS, and the TIMT group received IMT with TIMT. MIP, 6-MWD, FVC, FEV1, and PEFR were measured before and after six weeks of training. In IS group: A significant increase (p < 0.05) was observed in MIP and 6-MWD by 18.13 and 5%, respectively. In the TIMT group: A significant increase (p < 0.05) was observed in MIP and 6-MWD by 30.15 and 8.94%, respectively. Both groups observed no significant difference (p > 0.05) in FVC, FEV1, and PEFR. When the two groups were compared, a greater increase (p < 0.05) was observed in the MIP and 6-MWD in the TIMT group compared to IS group. IMT with IS or TIMT for six weeks effectively increased MIP and 6-MWD in patients with stage 1-3 (Hoehn and Yahr scale) of PD. No improvement was observed in FVC, FEV1, or PEFR with any of the techniques. TIMT is more effective than IS in improving MIP and 6-MWD.
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Affiliation(s)
| | - Anjali Bhise
- Government Physiotherapy College, Government Spine Institute, Civil Hospital, Ahmedabad, Gujarat, India
| | - Shibili Nuhmani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ahmad H Alghadir
- Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Masood Khan
- Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
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Troche MS, Curtis JA, Sevitz JS, Dakin AE, Perry SE, Borders JC, Grande AA, Mou Y, Vanegas-Arroyave N, Hegland KW. Rehabilitating Cough Dysfunction in Parkinson's Disease: A Randomized Controlled Trial. Mov Disord 2023; 38:201-211. [PMID: 36345090 DOI: 10.1002/mds.29268] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/19/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Disorders of airway protection (cough and swallowing) are pervasive in Parkinson's disease (PD) resulting in a high incidence of aspiration pneumonia and death. However, there are no randomized controlled trials comparing strength and skill-based approaches to improve airway protection in PD. OBJECTIVES The aim of this study was to compare expiratory muscle strength training (EMST) and sensorimotor training for airway protection (smTAP) to improve cough-related outcomes in people with PD. METHODS Participants with PD and dysphagia were recruited for this prospective phase II randomized-blinded controlled clinical trial. Participants completed baseline assessment, 5 weeks of EMST or smTAP, and a post-training assessment. Primary outcome measures included maximum expiratory pressure (MEP) and voluntary cough peak expiratory flow rate (PEFR). Mixed effects models were used to assess the effects of EMST and smTAP on outcomes. RESULTS A total of 65 participants received either EMST (n = 34) or smTAP (n = 31). MEP improved from pre- to post-treatment for smTAP (P < 0.001, d = 0.19) and EMST (P < 0.001, d = 0.53). Voluntary PEFR increased from pre- to post-treatment for smTAP (P < 0.001, d = 0.19) and EMST (P < 0.001, d = 0.06). Moreover, reflex cough PEFR (P < 0.001, d = 0.64), reflex cough expired volume (P < 0.001, d = 0.74), and urge to cough (P = 0.018, OR = 2.70) improved for the smTAP group but not for the EMST group. CONCLUSIONS This clinical trial confirmed the efficacy of smTAP to improve reflex and voluntary cough function, above and beyond EMST, the current gold standard. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA.,Division of Movement Disorders, Department of Neurology, Columbia University Medical Center, New York, New York, USA
| | - James A Curtis
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Jordanna S Sevitz
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Avery E Dakin
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Sarah E Perry
- University of Canterbury Rose Centre for Stroke Recovery and Research at St. George's Medical Centre, Christchurch, New Zealand.,Department of Medicine, University of Otago, Christchurch, New Zealand.,New Zealand Brain Research Institute, Christchurch, New Zealand
| | - James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | | | - Yuhan Mou
- Laboratory for the Study of Upper Airway Dysfunction, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida, USA
| | | | - Karen W Hegland
- Laboratory for the Study of Upper Airway Dysfunction, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida, USA.,Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA
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Fırat M, Boşnak-Güçlü M, Şişmanlar-Eyüboğlu T, Aslan AT. Aerobic exercise capacity, cough strength, posture, and depression in primary ciliary dyskinesia. Pediatr Pulmonol 2023; 58:73-80. [PMID: 36114723 DOI: 10.1002/ppul.26158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/11/2022] [Accepted: 09/14/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Assessment of exercise capacity is important for information about lung function and prognosis in primary ciliary dyskinesia (PCD). In addition, deterioration in the pulmonary system may affect cough efficiency, posture, and thoracoabdominal mobility. In turn, this deterioration may also disturb the psychological function of patients with PCD. Therefore, this study aimed to compare exercise capacity, cough strength, thoracoabdominal mobility, posture, and depression in children with PCD and healthy peers. METHODS Twenty-seven patients with PCD and 28 healthy peers were included. Aerobic exercise capacity (3-min step test), cough strength (peak expiratory flow meter), thoracoabdominal mobility (upper chest, lower chest, and abdomen), posture (Corbin postural assessment scale), and depression (Children's Depression Inventory) were evaluated. RESULTS Patients' number of steps completed, cough strength, and thoracoabdominal mobility were significantly decreased; total posture and depression scores were higher compared with healthy controls (p< 0.05). There was a significant relationship between cough strength and maximal expiratory strength (r = 0.541, p= 0.004) and total number of steps (r = 0.509, p= 0.007) in the patients. CONCLUSION Aerobic exercise capacity, cough strength, and thoracoabdominal mobility were impaired, posture was deteriorated, and depression perception elevated in children with PCD compared to healthy peers. Furthermore, aerobic exercise capacity and maximal expiratory strength are related to cough strength in these patients. Rehabilitation programs including aerobic and resistive exercise training, deep breathing and postural exercise, and nutrition counseling may improve these results and better be investigated. Trial registration: Clinicaltrials.gov: NCT03370029; December 12, 2017.
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Affiliation(s)
- Merve Fırat
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Meral Boşnak-Güçlü
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | | | - Ayşe Tana Aslan
- Department of Pediatric Pulmonology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Borders JC, Grande AA, Troche MS. Statistical Power and Swallowing Rehabilitation Research: Current Landscape and Next Steps. Dysphagia 2022; 37:1673-1688. [PMID: 35226185 DOI: 10.1007/s00455-022-10428-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/14/2022] [Indexed: 12/16/2022]
Abstract
Despite rapid growth in the number of treatments to rehabilitate dysphagia, studies often demonstrate mixed results with non-significant changes to functional outcomes. Given that power analyses are infrequently reported in dysphagia research, it remains unclear whether studies are adequately powered to detect a range of treatment effects. Therefore, this review sought to examine the current landscape of statistical power in swallowing rehabilitation research. Databases were searched for swallowing treatments using instrumental evaluations of swallowing and the penetration-aspiration scale as an outcome. Sensitivity power analyses based on each study's statistical test and sample size were performed to determine the minimum effect size detectable with 80% power. Eighty-nine studies with 94 treatment comparisons were included. Sixty-seven percent of treatment comparisons were unable to detect effects smaller than d = 0.80. The smallest detectable effect size was d = 0.29 for electrical stimulation, d = 0.49 for postural maneuvers, d = 0.52 for non-invasive brain stimulation, d = 0.61 for combined treatments, d = 0.63 for respiratory-based interventions, d = 0.70 for lingual strengthening, and d = 0.79 for oral sensory stimulation. Dysphagia treatments examining changes in penetration-aspiration scale scores were generally powered to reliably detect larger effect sizes and not smaller (but potentially clinically meaningful) effects. These findings suggest that non-significant results may be related to low statistical power, highlighting the need for collaborative, well-powered intervention studies that can detect smaller, clinically meaningful changes in swallowing function. To facilitate implementation, a tutorial on simulation-based power analyses for ordinal outcomes is provided ( https://osf.io/e6usd/ ).
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Affiliation(s)
- James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA.
| | | | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
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Sevitz JS, Borders JC, Dakin AE, Kiefer BR, Alcalay RN, Kuo SH, Troche MS. Rehabilitation of Airway Protection in Individuals With Movement Disorders: A Telehealth Feasibility Study. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2741-2758. [PMID: 36279509 PMCID: PMC9911128 DOI: 10.1044/2022_ajslp-22-00063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/02/2022] [Accepted: 07/28/2022] [Indexed: 05/03/2023]
Abstract
PURPOSE Airway protective deficits (swallowing and cough) greatly reduce health and quality of life and are a pervasive consequence of neurodegenerative movement disorders. Expiratory muscle strength training (EMST) and cough skill training (CST) are two treatment approaches to improve airway protection; however, many patients are unable to access these treatments. Telehealth may improve access to care, but it remains unknown whether these treatments are feasible and efficacious via telehealth. This study aimed to determine the practical feasibility and preliminary treatment effect of EMST and CST via telehealth. METHOD Twenty participants with movement disorders completed 4 weeks of EMST and 2 weeks of CST, including two clinician-directed treatment sessions via telehealth and 3 days of home practice per week. Feasibility was calculated for each treatment. Practical feasibility was defined as completing treatment (EMST or CST) and obtaining the relevant outcome measures-a proxy of maximum expiratory pressure (pMEP) for EMST and peak expiratory flow rate (PEFR) for CST-within a 30-min session/period. Session factors that may have influenced feasibility were examined. Preliminary treatment effect was defined as changes in pMEP and PEFR. RESULTS Time taken to obtain pMEP and complete EMST was 17.48 min, and time taken to obtain PEFR and complete CST was 17.69 min. pMEP, single voluntary cough PEFR, and sequential voluntary cough PEFR increased from pre- to posttreatment. CONCLUSIONS Findings suggest that the delivery of EMST and CST is feasible via telehealth and yield improvements to pMEP and PEFR. This has important implications for expanding service delivery of airway protective interventions and reducing health care disparities in people with neurodegenerative movement disorders. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21357669.
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Affiliation(s)
- Jordanna S Sevitz
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Avery E Dakin
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Brianna R Kiefer
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Roy N Alcalay
- Department of Neurology, Columbia University Irving Medical Center, New York, NY
- Department of Neurology, Tel Aviv Sourasky Medical Center, Israel
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University Irving Medical Center, New York, NY
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
- Department of Neurology, Columbia University Irving Medical Center, New York, NY
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McRae J, Morgan S, Wallace E, Miles A. Oropharyngeal Dysphagia in Acute Cervical Spinal Cord Injury: A Literature Review. Dysphagia 2022:10.1007/s00455-022-10535-0. [DOI: 10.1007/s00455-022-10535-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022]
Abstract
AbstractDysphagia (swallowing impairment) is a frequent complication of cervical spinal cord injury (cSCI). Recently published national guidance in the UK on rehabilitation after traumatic injury confirmed that people with cSCI are at risk for dysphagia and require early evaluation while remaining nil by mouth [National Institute for Health and Care Excellence. Rehabilitation after traumatic injury (NG211), 2022, https://www.nice.org.uk/guidance/ng21]. While the pathogenesis and pathophysiology of dysphagia in cSCI remains unclear, numerous risk factors have been identified in the literature. This review aims to summarize the literature on the risk factors, presentation, assessment, and management of dysphagia in patients with cSCI. A bespoke approach to dysphagia management, that accounts for the multiple system impairment in cSCI, is presented; the overarching aim of which is to support effective management of dysphagia in patients with cSCI to prevent adverse clinical consequences.
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Malandraki GA, Mitchell SS, Hahn Arkenberg RE, Brown B, Craig BΑ, Burdo-Hartman W, Lundine JP, Darling-White M, Goffman L. Swallowing and Motor Speech Skills in Unilateral Cerebral Palsy: Novel Findings From a Preliminary Cross-Sectional Study. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:3300-3315. [PMID: 35952392 PMCID: PMC9913219 DOI: 10.1044/2022_jslhr-22-00091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/25/2022] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Our purpose was to start examining clinical swallowing and motor speech skills of school-age children with unilateral cerebral palsy (UCP) compared to typically developing children (TDC), how these skills relate to each other, and whether they are predicted by clinical/demographic data (age, birth history, lesion type, etc.). METHOD Seventeen children with UCP and 17 TDC (7-12 years old) participated in this cross-sectional study. Feeding/swallowing skills were evaluated using the Dysphagia Disorder Survey (DDS) and a normalized measure of mealtime efficiency (normalized mealtime duration, i.e., nMD). Motor speech was assessed via speech intelligibility and speech rate measures using the Test of Children's Speech Plus. Analyses included nonparametric bootstrapping, correlation analysis, and multiple regression. RESULTS Children with UCP exhibited more severe (higher) DDS scores (p = .0096, Part 1; p = .0132, Part 2) and reduced speech rate than TDC (p = .0120). Furthermore, in children with UCP, total DDS scores were moderately negatively correlated with speech intelligibility (words: r = -.6162, p = .0086; sentences: r = -.60792, p = .0096). Expressive language scores were the only significant predictor of feeding and swallowing performance, and receptive language scores were the only significant predictor of motor speech skills. CONCLUSIONS Swallowing and motor speech skills can be affected in school-age children with UCP, with wide variability of performance also noted. Preliminary cross-system interactions between swallowing, speech, and language are observed and might support the complex relationships between these domains. Further understanding these relationships in this population could have prognostic and/or therapeutic value and warrants further study.
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Affiliation(s)
- Georgia A. Malandraki
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN
| | - Samantha S. Mitchell
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | | | - Barbara Brown
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Bruce Α. Craig
- Department of Statistics, Purdue University, West Lafayette, IN
| | - Wendy Burdo-Hartman
- Nationwide Children's Hospital, Columbus, OH
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus
| | - Jennifer P. Lundine
- Nationwide Children's Hospital, Columbus, OH
- Department of Speech and Hearing Sciences, The Ohio State University, Columbus
| | - Meghan Darling-White
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson
| | - Lisa Goffman
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson
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van de Wetering-van Dongen VA, Nijkrake MJ, Koenders N, van der Wees PJ, Bloem BR, Kalf JG. Experienced Respiratory Symptoms and the Impact on Daily Life from the Perspective of People with Parkinson's Disease: A Grounded Theory. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1677-1691. [PMID: 35634852 PMCID: PMC9398081 DOI: 10.3233/jpd-213121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Abnormal respiratory function tests can be observed early in the course of Parkinson's disease (PD). A better understanding of the impact of respiratory dysfunction on daily life in PD is needed to prevent later occurring complications as a (aspiration) pneumonia. OBJECTIVE To explain which respiratory symptoms people with PD or a form of atypical parkinsonism experience and how these symptoms impact on their daily lives. METHODS This qualitative study used a grounded theory approach. A purposeful sample strategy was used to capture information-rich cases. Data were collected in semi-structured interviews with participants diagnosed with either PD (n = 11) or atypical parkinsonism (n = 3), all of whom had confirmed respiratory symptoms. Data were analyzed using grounded theory analysis by creating codes, categories, theoretical themes, and, ultimately, a conceptual model. RESULTS Four respiratory profiles emerged, describing different types of respiratory dysfunction, with various positive and negative influencing factors. First, a loss of breathing automatism was experienced. Second, episodes of breathlessness or a rapid, shallow breathing pattern were triggered by either physical exertion, fatigue, or postural deformities. Third, stress and anxiety also triggered episodes of breathlessness. Fourth, a decreased cough strength and frequent coughing. Based on these findings, we constructed a conceptual model that visualizes the relations between these four types of respiratory dysfunction and their impact on daily life, with 'discomfort' and 'avoidance of social activities' as crucial elements. CONCLUSION A tailored approach for each profile of respiratory dysfunction is recommended to improve respiratory dysfunction and to reduce its social impact in people with PD.
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Affiliation(s)
- Veerle A van de Wetering-van Dongen
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, the Netherlands
| | - Maarten J Nijkrake
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, the Netherlands
| | - Niek Koenders
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Rehabilitation, Nijmegen, the Netherlands
| | - Philip J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Rehabilitation and IQ Healthcare, Nijmegen, the Netherlands
| | - Bastiaan R Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - Johanna G Kalf
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, the Netherlands
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Abstract
PURPOSE OF REVIEW This review aims to describe how the clinical manifestations of sarcoidosis may be shaped by the effects of sex hormones and by age dependent changes in immune functions and physiology This review is intended to highlight the need to consider the effects of sex and sex in future studies of sarcoidosis. RECENT FINDINGS The clinical manifestations of sarcoidosis differ based on sex and gender There is emerging evidence that female and male hormones and X-linked genes are important determinants of immune responses to environmental antigens, which has important implications for granuloma formation in the context of sarcoidosis Furthermore, sex hormone levels predictably change throughout adolescence and adulthood, and this occurs in parallel with the onset immune senescence and changes in physiology with advanced age. SUMMARY Recent studies indicate that sex and age are important variables shaping the immune response of humans to environmental antigens We posit herein that sex and age are important determinants of sarcoidosis clinical phenotypes Many gaps in our understanding of the roles played by sex and gender in sarcoidosis, and these need to be considered in future studies.
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Affiliation(s)
- Arindam Singha
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University, Columbus, Ohio
| | - Marina Kirkland
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Wonder Drake
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Elliott D Crouser
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University, Columbus, Ohio
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Zhuang J, Jia J. Effects of Respiratory Muscle Strength Training on Respiratory-Related Impairments of Parkinson's Disease. Front Aging Neurosci 2022; 14:929923. [PMID: 35847666 PMCID: PMC9281879 DOI: 10.3389/fnagi.2022.929923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022] Open
Abstract
In addition to typical motor dysfunction, Parkinson's disease is also characterized by respiratory-related dysfunction. As a means of rehabilitation, respiratory muscle strength training (RMST) has been applied to restore Parkinson's disease (PD) functions. However, the current clinical value of RMST in the application for PD has not been widely established. This article aims to review the research progress of the application of RMST in PD rehabilitation to provide new sight into respiratory-related impairments management in people with PD.
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Affiliation(s)
- Jinyang Zhuang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Jia
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- *Correspondence: Jie Jia
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Yang MX, Wang J, Zhang X, Luo ZR, Yu PM. Perioperative respiratory muscle training improves respiratory muscle strength and physical activity of patients receiving lung surgery: A meta-analysis. World J Clin Cases 2022; 10:4119-4130. [PMID: 35665118 PMCID: PMC9131220 DOI: 10.12998/wjcc.v10.i13.4119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/07/2022] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The clinical role of perioperative respiratory muscle training (RMT), including inspiratory muscle training (IMT) and expiratory muscle training (EMT) in patients undergoing pulmonary surgery remains unclear up to now.
AIM To evaluate whether perioperative RMT is effective in improving postoperative outcomes such as the respiratory muscle strength and physical activity level of patients receiving lung surgery.
METHODS The PubMed, EMBASE (via OVID), Web of Science, Cochrane Library and Physiotherapy Evidence Database (PEDro) were systematically searched to obtain eligible randomized controlled trials (RCTs). Primary outcome was postoperative respiratory muscle strength expressed as the maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). Secondary outcomes were physical activity, exercise capacity, including the 6-min walking distance and peak oxygen consumption during the cardio-pulmonary exercise test, pulmonary function and the quality of life.
RESULTS Seven studies involving 240 participants were included in this systematic review and meta-analysis. Among them, four studies focused on IMT and the other three studies focused on RMT, one of which included IMT, EMT and also combined RMT (IMT-EMT-RMT). Three studies applied the intervention postoperative, one study preoperative and the other three studies included both pre- and postoperative training. For primary outcomes, the pooled results indicated that perioperative RMT improved the postoperative MIP (mean = 8.13 cmH2O, 95%CI: 1.31 to 14.95, P = 0.02) and tended to increase MEP (mean = 13.51 cmH2O, 95%CI: -4.47 to 31.48, P = 0.14). For secondary outcomes, perioperative RMT enhanced postoperative physical activity significantly (P = 0.006) and a trend of improved postoperative pulmonary function was observed.
CONCLUSION Perioperative RMT enhanced postoperative respiratory muscle strength and physical activity level of patients receiving lung surgery. However, RCTs with large samples are needed to evaluate effects of perioperative RMT on postoperative outcomes in patients undergoing lung surgery.
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Affiliation(s)
- Meng-Xuan Yang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jiao Wang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xiu Zhang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ze-Ruxin Luo
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Peng-Ming Yu
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Borders JC, Troche MS. Voluntary Cough Effectiveness and Airway Clearance in Neurodegenerative Disease. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:431-449. [PMID: 34936376 DOI: 10.1044/2021_jslhr-21-00308] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Voluntary cough dysfunction is highly prevalent across multiple patient populations. Voluntary cough has been utilized as a screening tool for swallowing safety deficits and as a target for compensatory and exercise-based dysphagia management. However, it remains unclear whether voluntary cough dysfunction is associated with the ability to effectively clear the airway. METHOD Individuals with neurodegenerative disorders performed same-day voluntary cough testing and flexible endoscopic evaluations of swallowing (FEES). Participants who were cued to cough after exhibiting penetration to the vocal folds and/or aspiration with thin liquids during FEES met inclusion criteria. One-hundred and twenty-three trials were blinded, and the amount of residue before and after a cued cough on FEES was measured with a visual analog scale. Linear and binomial mixed-effects models examined the relationship between cough airflow during voluntary cough testing and the proportion of residue expelled. RESULTS Peak expiratory flow rate (p = .004) and cough expired volume from the entire epoch (p = .029) were significantly associated with the proportion of aspiration expelled from the subglottis. Peak expiratory flow rate values of 3.00 L/s, 3.50 L/s, and 5.30 L/s provided high predicted probabilities that ≥ 25%, ≥ 50%, and ≥ 80% aspirate was expelled. Accounting for depth of aspiration significantly improved model fit (p < .001). CONCLUSIONS These findings suggest that voluntary cough airflow is associated with cough effectiveness to clear aspiration from the subglottis, although aspiration amount and depth may play an important role in this relationship. These findings provide further support for the clinical utility of voluntary cough in the management of dysphagia.
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Affiliation(s)
- James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
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Kaneko H, Suzuki A, Horie J. Effects of Cough Training and Inspiratory Muscle Training on Cough Strength in Older Adults: A Randomized Controlled Trial. Lung 2022; 200:49-57. [PMID: 35050397 DOI: 10.1007/s00408-022-00509-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/24/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE While the need for preventive strategies to reduce the incidence of aspiration pneumonia has been indicated, it is also important to investigate effective training methods to improve cough function, which is associated with the development of aspiration pneumonia. This study aimed to investigate whether a 4-week home-based unsupervised cough training (CT) or inspiratory muscle training (IMT) program was effective in improving cough strength in older adults. METHODS Fifty-three ambulatory older adults without airflow limitations were randomly assigned to one of three groups: a CT group (n = 18), an IMT group (n = 18), or a control group (n = 17). The CT and IMT groups performed home-based unsupervised training with a device for 4 weeks. Cough strength (cough peak flow), forced vital capacity, and respiratory muscle strength were assessed at the 4-week and 16-week follow-up. Intention-to-treat analyses were performed to investigate differences between the three groups using linear mixed models. RESULTS At the 4-week follow-up, the CT group showed significant increases in cough peak flow and forced vital capacity compared with the control group, while the IMT group showed significant increases in inspiratory muscle strength compared with the cough training and control groups. At the 16-week follow-up, the CT group showed a significant increase in cough peak flow compared with the IMT group. CONCLUSION These preliminary results suggest that a 4-week home-based CT program may have short-term effectiveness in improving cough peak flow in ambulatory older adults. TRIAL REGISTRATION This trial was registered on UMIN-CTR on 01/05/2018 (UMIN000031656).
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Affiliation(s)
- Hideo Kaneko
- Department of Physical Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare, 137-1 Enokizu, Okawa-shi, Fukuoka, 831-8501, Japan.
| | - Akari Suzuki
- Department of Physical Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare, 137-1 Enokizu, Okawa-shi, Fukuoka, 831-8501, Japan
| | - Jun Horie
- Department of Physical Therapy, School of Health Sciences, Kyoto Tachibana University, Kyoto, Japan
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Palmer PM, Padilla AH. Risk of an Adverse Event in Individuals Who Aspirate: A Review of Current Literature on Host Defenses and Individual Differences. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:148-162. [PMID: 34731584 DOI: 10.1044/2021_ajslp-20-00375] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE The presence of oropharyngeal dysphagia increases the likelihood of prandial aspiration, and aspiration increases the likelihood of a dysphagia-related pulmonary sequelae such as aspiration pneumonia, acute respiratory distress syndrome, pulmonary fibrosis, and even death. Although these outcomes are unfortunate, it is important to point out that these consequences are not solely determined by the presence of aspiration. The purpose of this tutorial is to provide current information on pulmonary defenses and the variables that increase risk of an adverse outcome in individuals who aspirate. METHOD This tutorial reviews the basics of lung defenses and summarizes the literature to make the case that the host is a central theme in dysphagia management. Case studies are employed to highlight the key variables. RESULTS Based on a literature review, a series of questions are proposed for consideration in dysphagia management. These questions, which take the focus away from the presence of aspiration and toward the associated risks within an individual, are then applied to two case studies. CONCLUSIONS A guiding framework is proposed to encourage clinicians to assess more than the presence of aspiration and consider the individual's ability to cope with the aspirated material. In the presence of aspiration, clinicians are urged to focus on the risk factors that can lead to a negative consequence, identify which factors are modifiable, and determine when a level of risk is acceptable.
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Affiliation(s)
- Phyllis M Palmer
- Department of Speech and Hearing Sciences, The University of New Mexico, Albuquerque
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Gandhi P, Steele CM. Effectiveness of Interventions for Dysphagia in Parkinson Disease: A Systematic Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:463-485. [PMID: 34890260 PMCID: PMC9159671 DOI: 10.1044/2021_ajslp-21-00145] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/18/2021] [Accepted: 09/10/2021] [Indexed: 05/31/2023]
Abstract
PURPOSE Dysphagia is a common sequela of Parkinson disease (PD) and is associated with malnutrition, aspiration pneumonia, and mortality. This review article synthesized evidence regarding the effectiveness of interventions for dysphagia in PD. METHOD Electronic searches were conducted in Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and speechBITE. Of the 2,015 articles identified, 26 met eligibility criteria: interventional or observational studies with at least five or more participants evaluating dysphagia interventions in adults with PD-related dysphagia, with outcomes measured using videofluoroscopic swallowing study (VFSS), fiberoptic endoscopic evaluation of swallowing (FEES), or electromyography (EMG). Risk of bias (RoB) was evaluated using the Evidence Project tool and predetermined criteria regarding the rigor of swallowing outcome measures. RESULTS Interventions were classified as follows: pharmacological (n = 11), neurostimulation (n = 8), and behavioral (n = 7). Primary outcome measures varied across studies, including swallowing timing, safety, and efficiency, and were measured using VFSS (n = 17), FEES (n = 6), and EMG (n = 4). Critical appraisal of study findings for RoB, methodological rigor, and transparency showed the majority of studies failed to adequately describe contrast media used, signal acquisition settings, and rater blinding to time point. Low certainty evidence generally suggested improved swallow timing with exercises with biofeedback and deep brain stimulation (DBS), improved safety with DBS and expiratory muscle strength training, and improved efficiency with the Lee Silverman Voice Treatment and levodopa. CONCLUSIONS Studies with lower RoB and greater experimental rigor showed potential benefit in improving swallowing efficiency but not safety. Further research investigating discrete changes in swallowing pathophysiology post-intervention is warranted to guide dysphagia management in PD. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.17132162.
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Affiliation(s)
- Pooja Gandhi
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute—University Health Network, Ontario, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Catriona M. Steele
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute—University Health Network, Ontario, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Ontario, Canada
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Cocks N, Rafols J, Embley E, Hill K. Expiratory Muscle Strength Training for Drooling in Adults with Parkinson's Disease. Dysphagia 2022; 37:1525-1531. [PMID: 35171321 PMCID: PMC9643176 DOI: 10.1007/s00455-022-10408-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/19/2022] [Indexed: 02/07/2023]
Abstract
One of the most debilitating symptoms of advanced Parkinson's disease is drooling. Currently, the main treatment that is offered for drooling is botulinum toxin injections to the saliva glands which have a number of side effects and do not treat the causes of drooling, such as impaired swallowing and lip closure. This study explored the effect of an alternative therapy approach for drooling that aimed at improving the swallow, expiratory muscle strength training (EMST). Sixteen participants received EMST over a 6- to 8-week period. Measurements were taken pre- and post-training for drooling (Sialorrhea Clinical Scale for Parkinson's Disease; SCS-PD), swallowing, lip strength and peak cough flow. Measures of drooling, swallowing and peak cough flow were stable over pre-training assessments and improved following training (p < 0.01). The most conservative estimate of the within-group change for SCS-PD was - 2.50 (95% confidence interval - 3.22 to - 1.22). No adverse effects were reported and participants gave high satisfaction ratings for the training. A programme of EMST offers promise as a therapy to reduce drooling for people with Parkinson's disease. Adequately powered randomised controlled trials of EMST are now needed.
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Affiliation(s)
- Naomi Cocks
- Curtin School of Allied Health, Curtin University, Perth, WA 6000 Australia ,ParkC Collaborative, Perth, WA Australia
| | - Jonathan Rafols
- Royal Perth Bentley Group, East Metropolitan Health Service, Perth, WA Australia
| | - Elizabeth Embley
- Royal Perth Bentley Group, East Metropolitan Health Service, Perth, WA Australia
| | - Kylie Hill
- Curtin School of Allied Health, Curtin University, Perth, WA 6000 Australia
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Aquino YC, Cabral LM, Miranda NC, Naccarato MC, Falquetto B, Moreira TS, Takakura AC. Respiratory disorders of Parkinson's disease. J Neurophysiol 2022; 127:1-15. [PMID: 34817281 DOI: 10.1152/jn.00363.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Parkinson's disease (PD) is characterized by the progressive loss of dopaminergic neurons in the substantia nigra, mainly affecting people over 60 yr of age. Patients develop both classic symptoms (tremors, muscle rigidity, bradykinesia, and postural instability) and nonclassical symptoms (orthostatic hypotension, neuropsychiatric deficiency, sleep disturbances, and respiratory disorders). Thus, patients with PD can have a significantly impaired quality of life, especially when they do not have multimodality therapeutic follow-up. The respiratory alterations associated with this syndrome are the main cause of mortality in PD. They can be classified as peripheral when caused by disorders of the upper airways or muscles involved in breathing and as central when triggered by functional deficits of important neurons located in the brainstem involved in respiratory control. Currently, there is little research describing these disorders, and therefore, there is no well-established knowledge about the subject, making the treatment of patients with respiratory symptoms difficult. In this review, the history of the pathology and data about the respiratory changes in PD obtained thus far will be addressed.
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Affiliation(s)
- Yasmin C Aquino
- Department of Pharmacology, Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, São Paulo, Brazil
| | - Laís M Cabral
- Department of Pharmacology, Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, São Paulo, Brazil
| | - Nicole C Miranda
- Department of Pharmacology, Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, São Paulo, Brazil
| | - Monique C Naccarato
- Department of Pharmacology, Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, São Paulo, Brazil
| | - Bárbara Falquetto
- Department of Pharmacology, Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, São Paulo, Brazil
| | - Thiago S Moreira
- Department of Physiology and Biophysics, Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, São Paulo, Brazil
| | - Ana C Takakura
- Department of Pharmacology, Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, São Paulo, Brazil
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Brennan M, McDonnell M, Duignan N, Gargoum F, Rutherford R. The use of cough peak flow in the assessment of respiratory function in clinical practice- A narrative literature review. Respir Med 2022; 193:106740. [DOI: 10.1016/j.rmed.2022.106740] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/05/2022] [Accepted: 01/09/2022] [Indexed: 12/12/2022]
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Félix-Lusterman CC, Joseph ME, Daniels SK. Update on Exercise-Based Rehabilitation Approaches for Neurogenic Dysphagia. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00333-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Consensus on the treatment of dysphagia in Parkinson's disease. J Neurol Sci 2021; 430:120008. [PMID: 34624796 DOI: 10.1016/j.jns.2021.120008] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dysphagia is common in Parkinson's disease (PD). The effects of antiparkinsonian drugs on dysphagia are controversial. Several treatments for dysphagia are available but there is no consensus on their efficacy in PD. OBJECTIVE To conduct a systematic review of the literature and to define consensus statements on the treatment of dysphagia in PD and related nutritional management. METHODS A multinational group of experts in the field of neurogenic dysphagia and/or Parkinson's disease conducted a systematic evaluation of the literature and reported the results according to PRISMA guidelines. The evidence from the retrieved studies was analyzed and discussed in a consensus conference organized in Pavia, Italy, and the consensus statements were drafted. The final version of statements was subsequently achieved by e-mail consensus. RESULTS The literature review retrieved 64 papers on treatment and nutrition of patients with PD and dysphagia, mainly of Class IV quality. Based on the literature and expert opinion in cases where the evidence was limited or lacking, 26 statements were developed. CONCLUSIONS The statements developed by the Consensus panel provide a guidance for a multi-disciplinary treatment of dysphagia in patients with PD, involving neurologists, otorhinolaryngologists, gastroenterologists, phoniatricians, speech-language pathologists, dieticians, and clinical nutritionists.
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Huang CC, Lai YR, Wu FA, Kuo NY, Cheng BC, Tsai NW, Kung CT, Chiang YF, Lu CH. Detraining Effect on Pulmonary and Cardiovascular Autonomic Function and Functional Outcomes in Patients With Parkinson's Disease After Respiratory Muscle Training: An 18-Month Follow-Up Study. Front Neurol 2021; 12:735847. [PMID: 34744975 PMCID: PMC8566819 DOI: 10.3389/fneur.2021.735847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The effect of 3-month respiratory muscle training (RMT) on pulmonary and autonomic function and functional outcomes has been demonstrated in patients with Parkinson's disease (PD); however, there is a paucity of information on the durability of the training effect. In this study, we monitored the pulmonary and cardiovascular autonomic function and clinical severity scales until 18 months after the cessation of RMT to elucidate the detraining effect after RMT. Methods: All patients with PD receiving RMT were assessed with clinical severity scales as well as pulmonary and autonomic function tests at four different stages (baseline on enrollment, immediately after 3 months of RMT, and 6 and 18 months after cessation of RMT). A control group of PD patients who did not receive RMT was also recruited for comparison. Pulmonary function parameters, including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP), were assessed. Cardiovascular autonomic function was assessed using measures including heart rate response to deep breathing (HRDB), Valsalva ratio, and baroreflex sensitivity. Clinical severity scores were also measured using the Hoehn and Yahr staging and the Unified Parkinson's Disease Rating Scale (UPDRS). Results: The results showed significant improvements in MIP, MEP, HRDB, and UPDRS immediately after RMT. Despite some decay, the improvements in pulmonary function (MIP and MEP) and functional outcomes (UPDRS) remained significant until 6 months of detraining (9 months after enrollment). However, the improvement in cardiovascular autonomic function (HRDB) was reversed after 6 months of detraining. Conclusions: Based on these findings, we recommend that RMT may be repeated after at least 6 months after previous session (9 months after enrollment) for patients with PD to maintain optimal therapeutic effects.
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Affiliation(s)
- Chih-Cheng Huang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yun-Ru Lai
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Fu-An Wu
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Nai-Ying Kuo
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ben-Chung Cheng
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Nai-Wen Tsai
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Te Kung
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Fang Chiang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Hsien Lu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Biological Science, National Sun Yat-sen University, Kaohsiung, Taiwan.,Department of Neurology, Xiamen Chang Gung Memorial Hospital, Xiamen, China
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Van Stan JH, Whyte J, Duffy JR, Barkmeier-Kraemer J, Doyle P, Gherson S, Kelchner L, Muise J, Petty B, Roy N, Stemple J, Thibeault S, Tolejano CJ. Voice Therapy According to the Rehabilitation Treatment Specification System: Expert Consensus Ingredients and Targets. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2169-2201. [PMID: 34464550 PMCID: PMC8702840 DOI: 10.1044/2021_ajslp-21-00076] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/27/2021] [Accepted: 05/19/2021] [Indexed: 05/09/2023]
Abstract
Purpose Clinical trials have demonstrated that standardized voice treatment programs are effective for some patients, but identifying the unique individual treatment ingredients specifically responsible for observed improvements remains elusive. To address this problem, the authors used a taxonomy of voice therapy, the Rehabilitation Treatment Specification System (RTSS), and a Delphi process to develop the RTSS-Voice (expert consensus categories of measurable and unique voice treatment ingredients and targets). Method Initial targets and ingredients were derived from a taxonomy of voice therapy. Through six Delphi Rounds, 10 vocal rehabilitation experts rated the measurability and uniqueness of individual treatment targets and ingredients. After each round, revisions (guided by the experts' feedback) were finalized among a primary reader (a voice therapy expert) and two external readers (rehabilitation experts outside the field of voice). Consensus was established when the label and definition of an ingredient or target reached a supramajority threshold (≥ 8 of 10 expert agreement). Results Thirty-five target and 19 ingredient categories were agreed to be measurable, unique, and accurate reflections of the rules and terminology of the RTSS. Operational definitions for each category included differences in the way ingredients are delivered and the way individual targets are modified by those ingredients. Conclusions The consensus labels and operationalized ingredients and targets making up the RTSS-Voice have potential to improve voice therapy research, practice, and education/training. The methods used to develop these lists may be useful for other speech, language, and hearing treatment specifications. Supplemental Material https://doi.org/10.23641/asha.15243357.
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Affiliation(s)
- Jarrad H. Van Stan
- Harvard Medical School, Boston, MA
- Massachusetts General Hospital Center for Laryngeal Surgery and Voice Rehabilitation, Boston
- MGH Institute of Health Professions, Boston, MA
| | - John Whyte
- Moss Rehabilitation Research Institute, Elkins Park, PA
| | | | | | | | | | | | - Jason Muise
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
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Han JW, Kim YM, Kim K. Effect of resistance exercises applying maximum expiration on the respiratory muscle strength of elderly women. J Back Musculoskelet Rehabil 2021; 34:307-312. [PMID: 33459692 DOI: 10.3233/bmr-181166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Respiratory-muscle weakness is an important clinical problem. The respiratory system's health is a decisive factor in the physical and social life of the elderly. Changes in respiratory muscular strength and function activate the torso's adjustment ability, which affects daily activities. OBJECTIVE This study aimed to investigate the effects of resistance exercises combined with breathing exercises on the respiratory-muscle strength of elderly women. METHOD This study included 26 elderly woman, who were randomly divided into two sub-groups of 13 participants each. The experimental group performed breathing exercises and dynamic upper- and lower-extremity exercises, and the control group practiced only dynamic upper- and lower-extremity exercises. The maximum expiratory pressure (MEP) and maximum inspiratory pressure (MIP) were measured both before and at the end of the six-week study. RESULTS In both groups, both the post-test MIPs and MEPs were significantly higher than the pre-intervention ones (p< 0.05). For MIPs, the between-group difference was not statistically significant, either before the intervention or post-test (p> 0.05). For MEPs, the between-group difference was statistically significant at post-intervention points (p< 0.05). CONCLUSION The results showed that resistance exercises applying maximum expiration improved the respiratory-muscle strength of elderly women. These findings indicate that resistance exercises applying maximum expiration as described here in should be considered in patients who require breathing therapy, because the combination seems to significantly increase the strength of the respiratory muscles.
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LaTour D, Crawley B, Krishna P, Hahn R, Murry T. Effects of Cough Suppression Therapy on Voice Disorder Severity. Laryngoscope 2021; 131:2747-2751. [PMID: 34165792 DOI: 10.1002/lary.29705] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/02/2021] [Accepted: 06/17/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES//HYPOTHESIS To determine changes in voice severity when treating chronic cough refractory to medical treatment with cough suppression therapy (CST) in patients with chronic cough and voice complaints. Chronic cough has been reported to be refractory to medical treatment and frequently co-occurs with voice disorders. The possible effects of CST on self-assessed changes in chronic cough and voice disorders have not been demonstrated. STUDY DESIGN Retrospective analysis of the effects of cough suppression therapy (CST) on self-assessed changes in chronic cough and voice disorder severity in patients with both chronic cough and voice disorders. METHODS Forty-three adult patients with the primary complaint of chronic refractory cough underwent pre- and post-treatment diagnostic examinations, completed pre- and post-treatment Voice Handicap Index-10 (VHI-10) and Cough Severity Index assessments, and were treated by a licensed speech-language pathologist using CST. Twenty-seven subjects were assigned to the cough (C) group and 16 to the cough-voice (CV) group based on the severity of their VHI-10 scores. RESULTS Post-test analysis showed significant improvement in cough severity for both groups and significant improvement in voice severity for the CV group. The VHI-10 scores for the C group did not change significantly. The median number of treatment sessions was 3, with a range of 1-13 sessions. Correlation between changes in severity and number of treatment sessions was not found to be significant at the tested level. CONCLUSIONS CST represents a unifying approach for treatment of patients with CRC and comorbid voice disorders. CST offered cross-over effects to the voice when subjects were treated for their primary complaint of chronic cough. This treatment of the primary complaint improves function in systems that share a common pathway. LEVEL OF EVIDENCE IV Laryngoscope, 2021.
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Affiliation(s)
- Donn LaTour
- School of Medicine, Loma Linda University, Loma Linda, California, U.S.A
| | - Brianna Crawley
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California, U.S.A
| | - Priya Krishna
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California, U.S.A
| | - Rachel Hahn
- School of Medicine, Loma Linda University, Loma Linda, California, U.S.A
| | - Thomas Murry
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, U.S.A
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Using Ultrasound to Document the Effects of Expiratory Muscle Strength Training (EMST) on the Geniohyoid Muscle. Dysphagia 2021; 37:788-799. [PMID: 34132896 DOI: 10.1007/s00455-021-10328-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 06/08/2021] [Indexed: 10/21/2022]
Abstract
Expiratory muscle strength training (EMST) is an exercise program designed to strengthen the muscles of expiration by increasing expiratory load during breathing exercises using either resistive or pressure threshold devices. Previous research has shown that EMST may increase submental suprahyoid muscle activity as measured with surface electromyography. The impact of EMST on submental muscles is of interest to those who treat dysphagia. The purpose of this study was to determine whether the cross-sectional area of the geniohyoid muscle changes as observed with ultrasound during a 5-week EMST program performed at 75% of maximum expiratory strength using the EMST150 device in healthy adults. Ten healthy adults participated in the 5-week program. Maximum expiratory pressure (MEP) and cross-sectional area of the geniohyoid muscle were measured weekly. Geniohyoid cross-sectional area was measured from ultrasound images recorded in the coronal plane. Repeated Measures ANOVA was used to determine whether there were significant changes among the dependent variables over the study period. Both MEP and geniohyoid area increased significantly in response to a 5-week program of EMST. EMST in healthy adults is effective at strengthening the geniohyoid muscle as reflected by significantly increased cross-sectional area measured with B-mode ultrasound. This is the first study to document weekly change in muscle morphology as a result of EMST. Increasing geniohyoid muscle mass and consequent strength through a program of EMST may be beneficial for persons with pharyngeal stage dysphagia resulting from reduced hyolaryngeal elevation, reduced laryngeal closure, or reduced UES opening.
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Docu Axelerad A, Stroe AZ, Arghir OC, Docu Axelerad D, Gogu AE. Respiratory Dysfunctions in Parkinson's Disease Patients. Brain Sci 2021; 11:brainsci11050595. [PMID: 34064360 PMCID: PMC8147845 DOI: 10.3390/brainsci11050595] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/22/2021] [Accepted: 05/02/2021] [Indexed: 11/16/2022] Open
Abstract
Respiratory dysfunctions have been associated with Parkinson's disease since the first observations of the disease in 1817. Patients with Parkinson's disease frequently present respiratory disorders with obstructive ventilatory patterns and restrictive modifications, as well as limitations in respiratory volumes. In addition, respiratory impairments are observed due to the rigidity and kyphosis that Parkinson's disease patients experience. Subsidiary pulmonary complications can also appear as side effects of medication. Silent aspiration can be the cause of pneumonia in Parkinson's disease. Pulmonary dysfunction is one of the main factors that leads to the morbidity and mortality of patients with Parkinson's disease. Here, we performed a narrative review of the literature and reviewed studies on dyspnea, lung volumes, respiratory muscle function, sleep breathing disorders, and subsidiary speech and swallow impairments related to pulmonary dysfunction in patients with Parkinson's disease.
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Affiliation(s)
- Any Docu Axelerad
- Department of Neurology, General Medicine Faculty, Ovidius University, 900470 Constanta, Romania;
| | - Alina Zorina Stroe
- Department of Neurology, General Medicine Faculty, Ovidius University, 900470 Constanta, Romania;
- Correspondence:
| | - Oana Cristina Arghir
- Department of Pneumology, Faculty of Medicine, Ovidius University of Constanta, 900470 Constanta, Romania;
| | | | - Anca Elena Gogu
- Department of Neurology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania;
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Emirza C, Aslan GK, Kilinc AA, Cokugras H. Effect of expiratory muscle training on peak cough flow in children and adolescents with cystic fibrosis: A randomized controlled trial. Pediatr Pulmonol 2021; 56:939-947. [PMID: 33421333 DOI: 10.1002/ppul.25259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cough is an important defense and airway clearance mechanism for removing thick and viscous secretions in cystic fibrosis (CF). The primary aim of this study was to investigate the effect of expiratory muscle training (EMT) on peak cough flow (PCF) and secondly on respiratory muscle functions, functional exercise capacity, and quality of life (QoL) in CF. METHODS Thirty patients were randomized as training and sham groups. Both groups were trained with the EMT protocol, which involved twice per day for at least 5 days per week for 6 weeks. The training intensity in the training group was 30% of the maximal expiratory pressure (MEP). In the sham group, it remained at the lowest pressure (5 cmH2 O). The primary outcome was PCF. The secondary outcomes were MEP, maximal inspiratory pressure (MIP), spirometric measures, six-minute walking distance (6MWD), and QoL (Cystic Fibrosis Questionnaire-Revised). RESULTS Twenty-eight patients completed the study. Changes in PCF (p = .041) and MEP (p = .003) were higher in the training group than the sham group. Also, treatment burden (p = .008), digestive symptoms (p = .019), and vitality (p = .042) in QoL were more improved in the training group. MIP (p = .028) and 6MWD (p = .035) changed significantly only in the training group. Spirometric measurements did not change (p > .05). CONCLUSIONS The results of the study show that EMT could improve PCF, MEP, treatment burden, digestive symptoms, and vitality domains of QoL in patients with CF. Moreover, MIP and functional exercise capacity improved in the training group with EMT.
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Affiliation(s)
- Cigdem Emirza
- Division of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpaşa, Istanbul, Turkey.,Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Bilgi University, Istanbul, Turkey
| | - Goksen Kuran Aslan
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ayse Ayzit Kilinc
- Department of Pediatric Pulmonology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Haluk Cokugras
- Department of Pediatric Pulmonology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Claus I, Muhle P, Czechowski J, Ahring S, Labeit B, Suntrup-Krueger S, Wiendl H, Dziewas R, Warnecke T. Expiratory Muscle Strength Training for Therapy of Pharyngeal Dysphagia in Parkinson's Disease. Mov Disord 2021; 36:1815-1824. [PMID: 33650729 DOI: 10.1002/mds.28552] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/27/2021] [Accepted: 02/08/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Pharyngeal dysphagia in Parkinson's disease (PD) is a common and clinically relevant symptom associated with poor nutrition intake, reduced quality of life, and aspiration pneumonia. Despite this, effective behavioral treatment approaches are rare. OBJECTIVE The objective of this study was to verify if 4 week of expiratory muscle strength training can improve pharyngeal dysphagia in the short and long term and is able to induce neuroplastic changes in cortical swallowing processing. METHODS In this double-blind, randomized, controlled trial, 50 patients with hypokinetic pharyngeal dysphagia, as confirmed by flexible endoscopic evaluation of swallowing, performed a 4-week expiratory muscle strength training. Twenty-five participants used a calibrated ("active") device, 25 used a sham handheld device. Swallowing function was evaluated directly before and after the training period, as well as after a period of 3 month using flexible endoscopic evaluation of swallowing. Swallowing-related cortical activation was measured in 22 participants (active:sham; 11:11) using whole-head magnetencephalography. RESULTS The active group showed significant improvement in the flexible endoscopic evaluation of swallowing-based dysphagia score after 4 weeks and after 3 months, whereas in the sham group no significant changes from baseline were observed. Especially, clear reduction in pharyngeal residues was found. Regarding the cortical swallowing network before and after training, no statistically significant differences were found by magnetencephalography examination. CONCLUSIONS Four-week expiratory muscle strength training significantly reduces overall dysphagia severity in PD patients, with a sustained effect after 3 months compared with sham training. This was mainly achieved by improving swallowing efficiency. The treatment effect is probably caused by peripheral mechanisms, as no changes in the cortical swallowing network were identified. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Inga Claus
- Department of Neurology with Institute of Translational Neurology, University Hospital of Muenster, Muenster, Germany
| | - Paul Muhle
- Department of Neurology with Institute of Translational Neurology, University Hospital of Muenster, Muenster, Germany.,Institute for Biomagnetism and Biosignal Analysis, University Hospital Muenster, Muenster, Germany
| | - Judith Czechowski
- Department of Neurology with Institute of Translational Neurology, University Hospital of Muenster, Muenster, Germany
| | - Sigrid Ahring
- Department of Neurology with Institute of Translational Neurology, University Hospital of Muenster, Muenster, Germany
| | - Bendix Labeit
- Department of Neurology with Institute of Translational Neurology, University Hospital of Muenster, Muenster, Germany.,Institute for Biomagnetism and Biosignal Analysis, University Hospital Muenster, Muenster, Germany
| | - Sonja Suntrup-Krueger
- Department of Neurology with Institute of Translational Neurology, University Hospital of Muenster, Muenster, Germany.,Institute for Biomagnetism and Biosignal Analysis, University Hospital Muenster, Muenster, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University Hospital of Muenster, Muenster, Germany
| | - Rainer Dziewas
- Department of Neurology with Institute of Translational Neurology, University Hospital of Muenster, Muenster, Germany
| | - Tobias Warnecke
- Department of Neurology with Institute of Translational Neurology, University Hospital of Muenster, Muenster, Germany
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