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.
Division of Movement Disorders, Department of Neurology, Columbia University Medical Center, New York, NY, 10032, USA.
Dysphagia. 2022 Feb;37(1):74-83. doi: 10.1007/s00455-021-10251-1. Epub 2021 Jan 30.
Progressive supranuclear palsy (PSP) is a neurodegenerative disease characterized by a high prevalence of dysphagia, cough dysfunction, and resultant aspiration pneumonia. Sensorimotor cough function is important for airway clearance in people with dysphagia. Upregulation of cough has been demonstrated in healthy adults and Parkinson's disease; however, the feasibility of cough rehabilitation in PSP is unknown. We sought to assess feasibility by examining the immediate effects of a novel sensorimotor training in airway protection (smTAP) on upregulation of cough function in PSP. Fifteen individuals with PSP enrolled in this study. Baseline voluntary and reflex cough testing were completed. During smTAP, participants were presented with subthreshold capsaicin and instructed to cough with sufficient intensity to hit a target line (set 25% above baseline reflex peak cough flow) via cough airflow visual biofeedback. Twenty-five repetitions were targeted within a single session. Wilcoxon signed-rank tests compared cough airflow measures between baseline voluntary cough testing, the initial five trials of smTAP, and final five trials. Mean peak expiratory flow rate (PEFR) significantly increased from initial to final smTAP trials (p < 0.001). Fourteen participants increased PEFR, with gains of more than 10% in 11 participants. Variability of PEFR (p = 0.01) and cough expired volume (p = 0.01) significantly decreased across smTAP trials. This study is the first to demonstrate the ability of people with PSP to immediately upregulate cough function, providing preliminary support for the feasibility of cough rehabilitation in this population with this novel treatment approach. Future research examining the effects of multiple sessions of smTAP on cough outcomes is warranted.
进行性核上性麻痹（PSP）是一种神经退行性疾病，其特点是吞咽困难、咳嗽功能障碍和由此导致的吸入性肺炎发生率高。感觉运动性咳嗽功能对于吞咽困难患者的气道清除至关重要。在健康成年人和帕金森病中已经证明了咳嗽的上调；然而，PSP 中咳嗽康复的可行性尚不清楚。我们通过检查新型感觉运动训练在气道保护（smTAP）对 PSP 咳嗽功能上调的即时影响来评估可行性。15 名 PSP 患者参与了这项研究。完成了基线自愿和反射咳嗽测试。在 smTAP 期间，向参与者呈现亚阈值辣椒素，并通过咳嗽气流视觉生物反馈指导他们以足够的强度咳嗽，以达到目标线（比基线反射峰咳嗽流量高 25%）。单次会议的目标是 25 次重复。Wilcoxon 符号秩检验比较了基线自愿咳嗽测试、smTAP 的初始五次试验和最后五次试验之间的咳嗽气流测量值。呼气峰流速（PEFR）均值从初始到最终 smTAP 试验显著增加（p<0.001）。14 名参与者的 PEFR 增加，11 名参与者的增加超过 10%。PEFR（p=0.01）和咳嗽呼气量（p=0.01）的变异性在 smTAP 试验中显著降低。这项研究首次证明了 PSP 患者能够立即上调咳嗽功能，为该人群通过这种新型治疗方法进行咳嗽康复的可行性提供了初步支持。需要进一步研究多次 smTAP 对咳嗽结果的影响。
