Pitts Teresa, Bolser Donald, Rosenbek John, Troche Michelle, Okun Michael S, Sapienza Christine
Brain Rehabilitation Research Center, Malcom Randall Veterans Affairs Medical Center, Gainesville, FL; Department of Communication Sciences and Disorders, University of Florida, Gainesville, FL.
Department of Physiological Sciences, University of Florida, Gainesville, FL.
Chest. 2009 May;135(5):1301-1308. doi: 10.1378/chest.08-1389. Epub 2008 Nov 24.
Cough provides high expiratory airflows to aerosolize and remove material that cannot be adequately removed by ciliary action. Cough is particularly important for clearing foreign particles from the airway in those with dysphagia who may be at risk for penetration/aspiration (P/A). Expiratory muscle strength training (EMST) was tested to improve cough and swallow function.
Ten male participants, diagnosed with Parkinson disease (PD), with videofluorographic evidence of penetration or with evidence for aspiration of material during swallow of a thin 30-mL bolus, completed 4 weeks of an EMST program to test the hypothesis that EMST would improve cough and/or swallow function. Measured parameters from an airflow waveform produced during voluntary cough, pre-EMST and post-EMST, included inspiration phase duration, compression phase duration (CPD), expiratory phase peak flow (EPPF), expiratory phase rise time (EPRT), and cough volume acceleration (VA) [ie, the EPPF/EPRT ratio]. The swallow outcome measure was the degree of P/A during the swallow task.
There was a significant decrease in the duration of the CPD and EPRT; the decrease in EPRT resulted in a significant increase in cough VA. Significant decreases in the P/A scores were found posttraining.
The results demonstrate that EMST is a viable treatment modality for a population of participants with PD at risk of aspiration.
咳嗽可产生高呼气气流，以雾化并清除无法通过纤毛运动充分清除的物质。咳嗽对于清除吞咽困难且有渗透/误吸（P/A）风险者气道中的外来颗粒尤为重要。呼气肌力量训练（EMST）已被测试用于改善咳嗽和吞咽功能。
10名被诊断为帕金森病（PD）的男性参与者，有吞咽30毫升稀薄食团时出现渗透的视频荧光造影证据或误吸物质的证据，完成了为期4周的EMST计划，以检验EMST可改善咳嗽和/或吞咽功能这一假设。在自愿咳嗽期间、EMST前和EMST后产生的气流波形中测量的参数包括吸气相持续时间、压缩相持续时间（CPD）、呼气相峰值流速（EPPF）、呼气相上升时间（EPRT）和咳嗽容积加速度（VA）[即EPPF/EPRT比值]。吞咽结果测量指标是吞咽任务期间的P/A程度。
CPD和EPRT的持续时间显著缩短；EPRT的缩短导致咳嗽VA显著增加。训练后P/A评分显著降低。
结果表明，EMST是对有误吸风险的PD参与者群体一种可行的治疗方式。
