Respiratory training in an individual with amyotrophic lateral sclerosis

Abstract

We examined the impact of expiratory muscle strength training on maximum expiratory pressure, cough spirometry, and disease progression in a 71‐year‐old male with amyotrophic lateral sclerosis. Maximum expiratory pressure declined 9% over an 8‐week sham training period, but subsequently improved by 102% following 8 weeks of expiratory muscle strength training. Improvements in cough spirometry and mitigated disease progression were also observed post expiratory muscle strength training. Improvements in maximum expiratory pressures were maintained 6 months following expiratory muscle strength training and were 79% higher than baseline data obtained 301 days prior. In this spinal‐onset amyotrophic lateral sclerosis patient, respiratory training improved subglottic air pressure generation and sequential cough generation.

Combined respiratory training in an individual with C9orf72 amyotrophic lateral sclerosis

“…We recently applied EMST in ALS patients to determine its feasibility, safety and impact on bulbar and respiratory outcomes and reported that a 5‐week program of EMST led to significant improvements in maximum expiratory pressure generation, and, in one individual, improved airway protection . We also reported a case study of an individual with ALS who underwent 8‐weeks of EMST with a noted 102% improvement in subglottic air pressure generation and improved cough production …”

Impact of expiratory strength training in amyotrophic lateral sclerosis: Results of a randomized, sham‐controlled trial

“…Impaired swallowing, cough, and respiratory function are common in amyotrophic lateral sclerosis (ALS), accounting for 91.4% of mortality via malnutrition, aspiration, pneumonia, and neuromuscular respiratory failure . Although the use of global exercise programs in ALS is still being explored, recent preliminary evidence suggests that mild‐to‐moderate intensity exercise, applied early in the disease, may have beneficial effects in both animal models and humans . As impaired airway defense mechanisms (dysfunctional expiratory phase of voluntary cough production) are associated with both dysphagia and tracheal aspiration in ALS, management strategies that improve or maintain subglottic air‐pressure generation, airway clearance ability, and peak cough flow may be beneficial …”

Differences in voluntary and reflexive cough strength in individuals with amyotrophic lateral sclerosis and healthy adults

“…Current evidence‐based recommendations include cough augmentation and ventilatory support, which are recommended once impairments in airway clearance and respiration are determined 15 . However, bulbar interventions, such as respiratory muscle strength training and lung volume recruitment, may be most efficacious when implemented earlier in the disease, while cough function is preserved 9,16,17 . Based on the neuroplasticity principles of transference and specificity, additional proactive bulbar interventions may include targeted upregulation of voluntary cough function to improve similar behaviors, such as reflexive cough responses to clear tracheal aspiration 18 …”