Borders James C, Villarreal-Cavazos Katya, Huber Jessica E, Quinn Lori, Keller Bryan, Troche Michelle S
Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York City, New York, USA.
Speech Physiology Lab, Department of Communicative Disorders and Sciences, University at Buffalo, Buffalo, New York, USA.
Mov Disord Clin Pract. 2024 Dec;11(12):1500-1515. doi: 10.1002/mdc3.14218. Epub 2024 Oct 8.
When re-learning a motor skill, practicing a variety of treatment targets promotes error processing and the exploration of motor control strategies, which initially disrupts accuracy during training (motor performance), but ultimately enhances generalization, retention, and transfer (motor learning). Cough skill training (CST) is feasible and efficacious to improve cough strength; however, previous studies have used the same practice target during training.
Our goal was to examine the impact of CST with variable practice on motor performance, motor learning, and respiratory system adaptations.
The study was a prospective three-visit single group design. Twenty individuals with Parkinson's disease (PD) and concomitant dysphagia and dystussia completed two sessions of CST involving three randomized practice targets. Cough, lung volume, and airway clearance outcomes were assessed before and after treatment sessions with long-term retention evaluated after 1 month.
Peak expiratory flow rate improved after CST with variable practice for voluntary single (β = 0.35 L/s) and sequential (β = 0.22 L/s) cough, which were maintained after 1 month without treatment. The ability to expel material from the upper airway demonstrated a small magnitude of improvement (β = -1.87%). During CST, participants altered lung volume based on the treatment target and lung volume decreased during reflex cough after completing CST.
Individuals with PD demonstrated improvements in several aspects of motor learning after two sessions of CST with variable practice. Increasing lung volume may not be an implicit strategy to upregulate voluntary cough strength in this treatment paradigm. The findings support the need for larger investigations exploring the potential benefits of this CST approach.
在重新学习运动技能时，练习各种治疗目标可促进错误处理和运动控制策略的探索，这在训练（运动表现）初期会干扰准确性，但最终会提高泛化、保持和迁移能力（运动学习）。咳嗽技能训练（CST）对提高咳嗽强度是可行且有效的；然而，以往研究在训练过程中使用的是相同的练习目标。
我们的目标是研究采用可变练习的CST对运动表现、运动学习和呼吸系统适应性的影响。
该研究为前瞻性的单次组三访设计。20名患有帕金森病（PD）并伴有吞咽困难和构音障碍的个体完成了两阶段的CST，其中涉及三个随机的练习目标。在治疗阶段前后评估咳嗽、肺容量和气道清除结果，并在1个月后评估长期保持情况。
采用可变练习的CST后，自主单次咳嗽（β = 0.35升/秒）和连续咳嗽（β = 0.22升/秒）的呼气峰值流速有所改善，且在未经治疗的1个月后仍保持。从上呼吸道排出物质的能力有小幅改善（β = -1.87%）。在CST期间，参与者根据治疗目标改变肺容量，且在完成CST后反射性咳嗽期间肺容量下降。
患有PD的个体在进行两阶段可变练习的CST后，在运动学习的几个方面都有改善。在这种治疗模式下，增加肺容量可能不是上调自主咳嗽强度的内在策略。这些发现支持需要进行更大规模的研究来探索这种CST方法的潜在益处。
