Volume 38, Issue 2 p. 201-211
Research Article

Rehabilitating Cough Dysfunction in Parkinson's Disease: A Randomized Controlled Trial

Michelle S. Troche PhD, CCC-SLP

Corresponding Author

Michelle S. Troche PhD, CCC-SLP

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

Correspondence to: Dr. Michelle S. Troche, Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, New York, NY 10027, USA; E-mail: [email protected]

Search for more papers by this author
James A. Curtis PhD, CCC-SLP

James A. Curtis PhD, CCC-SLP

Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA

Search for more papers by this author
Jordanna S. Sevitz MS, CCC-SLP

Jordanna S. Sevitz MS, CCC-SLP

Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA

Search for more papers by this author
Avery E. Dakin MS, CCC-SLP

Avery E. Dakin MS, CCC-SLP

Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA

Search for more papers by this author
Sarah E. Perry PhD, CCC-SLP

Sarah E. Perry PhD, CCC-SLP

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

Search for more papers by this author
James C. Borders MS, CCC-SLP

James C. Borders MS, CCC-SLP

Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA

Search for more papers by this author
Alessandro A. Grande MPhil

Alessandro A. Grande MPhil

Department of Statistics, Columbia University, New York, New York, USA

Search for more papers by this author
Yuhan Mou MA, CCC-SLP

Yuhan Mou MA, CCC-SLP

Laboratory for the Study of Upper Airway Dysfunction, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida, USA

Search for more papers by this author
Nora Vanegas-Arroyave MD

Nora Vanegas-Arroyave MD

Department of Neurology, Baylor College of Medicine, Houston, Texas, USA

Search for more papers by this author
Karen W. Hegland PhD, CCC-SLP

Karen W. Hegland PhD, CCC-SLP

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

Search for more papers by this author
First published: 07 November 2022
Citations: 6

Relevant conflicts of interest/financial disclosures: The authors declare no conflicts of interest concerning the research related to the manuscript.

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.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.