Abstract
Objective
To determine the effect of expiratory muscle strength training (EMST) on both cough
and swallow function in stroke patients.
Design
Prospective pre-post intervention trial with 1 participant group.
Setting
Two outpatient rehabilitation clinics.
Participants
Adults (N=14) with a history of ischemic stroke in the preceding 3 to 24 months.
Intervention
EMST. The training program was completed at home and consisted of 25 repetitions per
day, 5 days per week, for 5 weeks.
Main Outcome Measures
Baseline and posttraining measures were maximum expiratory pressure, voluntary cough
airflows, reflex cough challenge to 200μmol/L of capsaicin, sensory perception of
urge to cough, and fluoroscopic swallow evaluation. Repeated measures and 1-way analyses
of variance were used to determine significant differences pre- and posttraining.
Results
Maximum expiratory pressure increased in all participants by an average of 30cmH2O posttraining. At baseline, all participants demonstrated a blunted reflex cough
response to 200μmol/L of capsaicin. After 5 weeks of training, measures of urge to
cough and cough effectiveness increased for reflex cough; however, voluntary cough
effectiveness did not increase. Swallow function was minimally impaired at baseline,
and there were no significant changes in the measures of swallow function posttraining.
Conclusions
EMST improves expiratory muscle strength, reflex cough strength, and urge to cough.
Voluntary cough and swallow measures were not significantly different posttraining.
It may be that stroke patients benefit from the training for upregulation of reflex
cough and thus improved airway protection.
Keywords
List of abbreviations:
CVA (cough volume acceleration), EMST (expiratory muscle strength training), FEV1 (forced expiratory volume in the first second), FVC (forced vital capacity), MBSImP (Modified Barium Swallow Impairment Profile), PAS (Penetration-Aspiration Scale), PEFR (peak expiratory flow rate), PEFRT (peak expiratory flow rise time), PEMax (maximum expiratory pressure), RMANOVA (repeated-measures analysis of variance), UtC (urge to cough)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: April 26, 2016
Footnotes
Supported by the American Heart Association (grant no. 12CRP9010001).
Clinical Trial Registration No.: NCT01907321.
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
