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
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The effect of pneumonia on mortality among patients hospitalized for acute stroke.Neurology. 2003; 60: 620-625
- Aspiration pneumonia. Pathophysiological aspects, prevention and management. A review.Panminerva Med. 2006; 48: 231-239
- Dysphagia in acute ischaemic stroke: severity, recovery and relationship to stroke subtype.J Clin Neurosci. 2007; 14: 630-634
- Swallowing function after stroke: prognosis and prognostic factors at 6 months.Stroke. 1999; 30: 744-748
- Readmission and death after hospitalization for acute ischemic stroke: 5-year follow-up in the Medicare population.Stroke. 2007; 38: 1899-1904
- Assessing the laryngeal cough reflex and the risk of developing pneumonia after stroke.Arch Phys Med Rehabil. 1999; 80: 150-154
- Aspiration in patients with acute stroke.Arch Phys Med Rehabil. 1998; 79: 14-19
- Initial clinical and demographic predictors of swallowing impairment following acute stroke.Dysphagia. 2001; 16: 208-215
- Clinical and cognitive predictors of swallowing recovery in stroke.J Rehabil Res Dev. 2006; 43: 301-310
- Predicting aspiration in patients with ischemic stroke: comparison of clinical signs and aerodynamic measures of voluntary cough.Chest. 2009; 135: 769-777
- Acute ischaemic hemispheric stroke is associated with impairment of reflex in addition to voluntary cough.Eur Respir J. 2010; 36: 1383-1390
- The effects of surface neuromuscular electrical stimulation on post-stroke dysphagia: a systemic review and meta-analysis.Clin Rehabil. 2016; 30: 24-35
- Effects of transcranial direct current stimulation (tDCS) on post-stroke dysphagia.Restor Neurol Neurosci. 2012; 30: 303-311
- Treatment of post-stroke dysphagia with repetitive transcranial magnetic stimulation.Acta Neurol Scand. 2009; 119: 155-161
- The effects of lingual exercise in stroke patients with dysphagia.Arch Phys Med Rehabil. 2007; 88: 150-158
- Examination of strength training and detraining effects in expiratory muscles.J Speech Lang Hear Res. 2005; 48: 1325-1333
- Expiratory muscle strength training: speech production outcomes in patients with multiple sclerosis.Neurorehabil Neural Repair. 2007; 21: 239-249
- Effect of expiratory muscle strength training on elderly cough function.Arch Gerontol Geriatr. 2009; 48: 361-366
- Impact of expiratory muscle strength training on voluntary cough and swallow function in Parkinson disease.Chest. 2009; 135: 1301-1308
- Does respiratory muscle training improve cough flow in acute stroke? Pilot randomized controlled trial.Stroke. 2015; 46: 447-453
- Aspiration and swallowing in Parkinson disease and rehabilitation with EMST: a randomized trial.Neurology. 2010; 75: 1912-1919
- Submental sEMG and hyoid movement during Mendelsohn maneuver, effortful swallow, and expiratory muscle strength training.J Speech Lang Hear Res. 2008; 51: 1072-1087
- Surface electromyographic activity of the submental muscles during swallow and expiratory pressure threshold training tasks.Dysphagia. 2007; 22: 108-116
- Cough expired volume and airflow rates during sequential induced cough.Front Physiol. 2013; 4: 167
- MBS measurement tool for swallow impairment—MBSImP: establishing a standard.Dysphagia. 2008; 23: 392-405
- A penetration-aspiration scale.Dysphagia. 1996; 11: 93-98
- Psychophysical assessment of the urge-to-cough.Eur Respir J. 2002; 12: 249-253
- Urge-to-cough: what can it teach us about cough?.Lung. 2008; 186: S107-S111
- The urge-to-cough and cough motor response modulation by the central effects of nicotine.Pulm Pharmacol Ther. 2009; 22: 82-89
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
