Rehabilitating Cough Dysfunction in Parkinson's Disease: A Randomized Controlled Trial

Area of Science:

• Neurology
• Pulmonology
• Speech-Language Pathology

Background:

• Airway protection deficits, including impaired cough and swallowing, are common in Parkinson's disease (PD), leading to aspiration pneumonia and mortality.
• Current treatment options lack robust comparative evidence, particularly regarding strength-based versus skill-based interventions.

Purpose of the Study:

• To compare the efficacy of expiratory muscle strength training (EMST) and sensorimotor training for airway protection (smTAP) in improving cough-related outcomes in individuals with PD.
• To evaluate the impact of these interventions on maximal expiratory pressure (MEP) and cough peak expiratory flow rate (PEFR).

Main Methods:

• A prospective, randomized, blinded controlled clinical trial involving 65 participants with PD and dysphagia.
• Intervention involved 5 weeks of either EMST or smTAP, with pre- and post-training assessments.
• Primary outcomes included MEP and voluntary cough PEFR, analyzed using mixed-effects models.

Main Results:

• Both EMST and smTAP significantly improved MEP and voluntary cough PEFR.
• The smTAP group demonstrated significant improvements in reflex cough PEFR, reflex cough expired volume, and urge to cough, which were not observed in the EMST group.
• Effect sizes for reflex cough outcomes were notably larger in the smTAP group.

Conclusions:

• Sensorimotor training for airway protection (smTAP) is effective in improving both voluntary and reflex cough function in individuals with Parkinson's disease.
• smTAP demonstrates superior efficacy compared to expiratory muscle strength training (EMST), suggesting it as a potentially more effective intervention for airway protection in PD.
• These findings support smTAP as an advanced therapeutic strategy, surpassing the current standard of care (EMST) for managing cough dysfunction in PD.