Our objective was to study the intensity and duration of the effects of lung volume recruitment, a manual breath stacking technique, on pulmonary function and coughing in individuals with amyotrophic lateral sclerosis (ALS). Twenty-nine individuals with ALS participated in this study. A cross-over research design was used to compare effects of lung volume recruitment to a control condition. Treatment outcome measures included forced vital capacity (FVC), sniff nasal pressure (SnP) and peak cough flow (PCF). Results demonstrated that LVR had a significantly positive effect on FVC for up to 15 min following treatment but did not have a facilitative effect on SnP at any time-point. LVR had a significantly positive effect on PCF during unassisted coughing at both 15 min and 30 min following treatment, and there was no significant decrease in flow rates from baseline to 30 min later. In conclusion, lung volume recruitment may be an effective treatment for improving coughing and pulmonary function in individuals with ALS. Future research should be focused on determining patient characteristics that contribute to response to treatment, as well as randomized controlled trials of the technique.

have no financial or nonfinancial relationships related to the content of this article. Amyotrophic lateral sclerosis (ALS) is a rapidly degenerative disease involving upper motor neuron (UMN) and lower motor neuron (LMN) impairments, for which there is currently no cure. It is necessary for speech-language pathologists to understand the underlying neurological pathophysiology and philosophy of care for individuals with ALS in order to facilitate effective assessment and intervention in this population. The authors of this article review the characteristics of ALS, as well as the general philosophy of care for individuals with ALS. The article covers the topics of assessment and intervention within the context of a multidisciplinary ALS clinic; surgical and pharmacological interventions; and monitoring disease progression, including tracking respiratory status. Periodic multidisciplinary assessment aids in appropriate medical and therapeutic interventions, symptom management, and quality of life. Periodic assessment of respiratory function is especially important to aid in timely delivery of appropriate interventions. Amyotrophic lateral sclerosis (ALS) is a degenerative motor neuron disease for which there is currently no cure. The cause of ALS is not known, and survival is, on average, approximately 3 years following symptom onset (Corcia & Gordon, 2012). The purpose of this article is to summarize the characteristics of ALS and related types of motor neuron disease (MND), as well as the current philosophy of care for individuals with ALS. Characteristics of ALS ALS is a rapidly degenerative disease involving motor neurons in the brain, brainstem, and spinal cord. It is commonly known as Lou Gehrig's disease in the United States, motor neuron disease (MND) in Great Britain, and Charot's disease in France. Typically, the first symptom is weakness; about two-thirds of patients first experience spinal muscle weakness in either the upper or lower extremities, while one-quarter of patients have bulbar weakness and initial dysarthria and dysphagia. Respiratory symptoms are rarely a first sign of disease (Gautier et al., 2010), yet breathing difficulties are a serious complication for almost all patients with ALS, regardless of whether primary weakness is spinal or bulbar.

Given the limited life expectancy of individuals diagnosed with amyotrophic lateral sclerosis (ALS) and the high likelihood that patients will suffer from a breathing difficulty and an encumbered airway, promoting the highest level in the ability to maintain an open and clear airway is of the utmost importance to patients and their families. In this article, authors describe the basic mechanisms of neuromuscular-induced respiratory failure and explain the underlying physiological rationale for four commonly used respiratory treatments in cases of advanced ALS. The article also includes research on the use of manual breath stacking to improve coughing and airway clearance while swallowing.

Introduction/Aims: In this study we evaluated the effects of lung volume recruitment treatment (LVR), a low-tech, low-cost, manual "breath-stacking" technique used to help people cough with enough force to clear their airways, thereby reducing the risk of aspiration and choking, on five volitional airway clearance and protection behaviors used by people living with amyotrophic lateral sclerosis (PwALS). Methods: Using a repeated-measures cross-over design, 29 PwALS performed five volitional airway clearance and protection behaviors in LVR treatment and in notreatment, control conditions. Peak cough flow (PCF) was used to measure maximum expiratory rate during forced expiration, throat clearing, hawking, post-swallow coughing, and the supraglottic swallowing maneuver. Comparisons were made as a function of condition (treatment or control) and three time-points (pretreatment, and 15 and 30 minutes posttreatment).Results: LVR treatment had a significant positive effect on maximum expiratory rates during all tested airway clearance and protection behaviors. Increased PCF values lasted for up to 30 minutes post-LVR for all tested behaviors in the treatment condition.Discussion: We found that LVR treatment could increase control over airway clearance in PwALS, as well as provide improved airway protection for up to 30 minutes, the duration of a typical meal. This study has implications for patient care. These include offering patients control over some of the most feared symptoms of ALS, particularly choking during activities of daily living, and enhanced ALS respiratory care in low-resource settings. Findings may have implications for other neurodegenerative disorders in which dysphagia occurs with retained sensory function.