Rehabilitation of Airway Protection in Individuals With Movement Disorders: A Telehealth Feasibility Study

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

Hypotussic cough in persons with dysphagia: biobehavioral interventions and pathways to clinical implementation

“…Some of the most promising investigations on EMST which have shown improvements in cough outcomes have been conducted in neurodegenerative disease. In Parkinson's disease, four and five weeks of EMST have been shown to improve various metrics of cough function ( 38 , 71 , 84 , 85 ). In a recent randomized controlled trial in Parkinson's disease, 5-weeks of EMST resulted in improvements in MEPs by 22 cmH2O, ( p < 0.001, d = 0.53) and/or voluntary cough strength by 0.17 L/s ( p < 0.001, d = 0.06) ( 38 ).…”

“…A growing body of research supports the feasibility and effectiveness of task-specific, skill-based rehabilitation of cough. Cough skill training encompasses a range of rehabilitation treatment approaches which have been shown to improve metrics of voluntary and reflex cough through task-specific behavioral upregulation of cough ( 38 , 85 , 94 – 96 ). This has been achieved using both gold-standard spirometry ( 38 , 94 , 95 ), as well as with pragmatic tools primed for easy dissemination into clinical settings, including digital and analog peak flow meters ( 38 , 85 , 96 ).…”

“…Cough skill training encompasses a range of rehabilitation treatment approaches which have been shown to improve metrics of voluntary and reflex cough through task-specific behavioral upregulation of cough ( 38 , 85 , 94 – 96 ). This has been achieved using both gold-standard spirometry ( 38 , 94 , 95 ), as well as with pragmatic tools primed for easy dissemination into clinical settings, including digital and analog peak flow meters ( 38 , 85 , 96 ). As there is a growing body of evidence on cough skill training, studies reviewed in this section will focus on randomized controlled trials, quasi-experimental investigations, cohort studies and single-subject experimental studies which report on objective cough outcome measures.…”

“…To date, four studies have examined voluntary cough skill training to rehabilitate cough dysfunction. Three of these studies have been completed in neurodegenerative diseases and one in healthy older adults ( 85 , 95 , 96 , 102 ). In the first study to demonstrate that people with Parkinson's disease could volitionally upregulate voluntary cough effectiveness, investigators measured baseline voluntary sequential cough as well as voluntary cough modulation in 16 individuals with Parkinson's disease and 28 healthy age-matched controls ( 95 ).…”

Telehealth Management of Dysphagia in Adults: A Survey of Speech Language Pathologists’ Experiences and Perceptions

“…Applications and websites to facilitate home treatment and enhance patient adherence have also started to emerge with overall positive outcomes in regard to patient satisfaction, adherence, and functional outcomes [ 17 – 24 ]. For adults with neurogenic dysphagia, there is preliminary evidence to support the implementation of compensatory strategies [ 25 ] and exercise-based treatments [ 26 ] via telehealth, with reported improvements in physiologic function [ 27 ], swallowing performance [ 26 ], and treatment adherence [ 24 , 26 ].…”