Respiratory–Swallow Coordination Training and Voluntary Cough Skill Training: A Single-Subject Treatment Study in a Person With Parkinson's Disease

Abstract

Purpose Airway protective disorders are common in Parkinson's disease (PD), yet effective methods to rehabilitate these life-threatening impairments are limited. This study examined the effects of two skill-based treatments aimed at improving swallowing and cough in a severely dysphagic person with PD: respiratory–swallow coordination training (RSCT) and voluntary cough skill training (VCST). It was hypothesized that (a) RSCT would improve respiratory–swallow coordination and swallowing safety and efficiency and (b) VCST would improve reflex and voluntary cough effectiveness. Method An 81-year-old man with midstage PD and severe dysphagia was recruited for study participation. The study utilized a multiple-baseline ABACA experimental design with a 2-month delayed retention assessment. Measures of respiratory–swallow coordination, swallowing safety and efficiency, and cough effectiveness were collected at each assessment using respiratory inductive plethysmography, flexible endoscopic evaluations of swallowing, and spirometry. Data were analyzed descriptively using baseline corrected tau and standard mean difference effect sizes ( d ). Results Large effect sizes were observed immediately following RSCT for respiratory–swallow coordination ( d = 9.17), penetration–aspiration ( d = 12.88), vallecular residue ( d = 1.75), piriform residue ( d = 4.15), and overall dysphagia severity ( d = 1.83). Large effect sizes were also observed immediately following VCST for single voluntary cough ( d = 4.30), sequential voluntary cough ( d = 3.28), and reflex cough ( d = 5.58). Improvements were maintained 2 months later for all outcome measures except single voluntary cough. Discussion This is the first study to examine the effects of RSCT and VCST in a person with PD. Robust improvements in respiratory–swallow coordination and swallowing safety and efficiency were achieved following four sessions of RSCT, and significant improvements in reflex and voluntary cough strength were seen following four sessions of VCST. Future work is needed to study these treatments in larger cohorts of people with PD.

Dysphagia management: Does structured training improve the validity and reliability of cervical auscultation?

“…Finally, recent research argues for training and optimising swallow-respiratory coordination to improve swallow function (Curtis, Dakin, & Troche, 2020;Martin-Harris et al, 2015;McFarland et al, 2016). The added swallow-respiratory information from CA may further contribute to rehabilitation programs that use dysphagia manoeuvres/strategies (modified Supraglottic swallow, chin tuck, extra swallows to clear pharyngeal residue) during a functional mealtime review, and further research in this area is warranted.…”

Simplified cough test can predict the risk for pneumonia in patients with acute stroke

“…made a strict flow chart for dysphagia and silent aspiration, which resulted in decreasing the frequency of pneumonia [ 27 ]. Also, in the point of rehabilitation, voluntary cough skill training is useful to improve the cough reflex in Parkinson’s disease rehabilitation [ 28 ]. In addition, the improvement of sensitivity of respiratory tract should be considered.…”

Autonomic Dysfunction in Parkinson's Disease

“…Expiratory muscle strength training (EMST) may be effective in improving swallowing safety in patients with PD [73], and the combination of postural techniques and EMST is even more effective [74]. Respiratory-swallow coordination training (RSCT) in combination with voluntary cough skill training (VCST) also has been reported to be effective in a recent single case report [75]. Improvement not only in speech but also in both subjective and some videofluoroscopic parameters of swallowing persisted up to 6 months following a course of Lee Silverman Voice Treatment (LSVT-LOUD) in a group of patients with mild PD [76].…”