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Expiratory Muscle Strength Training in Multiple System Atrophy: A Pilot Study.

Martin Srp1, Tereza Bartosova1, Jiri Klempir1

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Expiratory muscle strength training (EMST) improved maximal expiratory pressure in multiple system atrophy (MSA) patients but did not significantly alter voluntary peak cough flow. A pulmonary dysfunction index shows promise for identifying cough impairment in MSA.

Keywords:
expiratory muscle strength trainingmaximum expiratory pressuremultiple system atrophyvoluntary peak cough flow

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Area of Science:

  • Neurology
  • Pulmonology
  • Rehabilitation Medicine

Background:

  • Multiple system atrophy (MSA) is a neurodegenerative disease affecting multiple bodily functions.
  • Expiratory muscle weakness is a common but understudied issue in MSA patients.
  • The impact of expiratory muscle strength training (EMST) on respiratory function in MSA has not been previously investigated.

Purpose of the Study:

  • To evaluate the effects of an 8-week home-based EMST program on expiratory muscle strength and voluntary peak cough flow (vPCF) in individuals with MSA.
  • To assess the utility of the pulmonary dysfunction index in identifying MSA patients with expiratory muscle weakness and reduced vPCF.

Main Methods:

  • An open-label, non-controlled study involving 15 MSA patients.
  • An 8-week intensive home-based EMST protocol.
  • Measurement of maximal expiratory pressure (MEP) and vPCF before and after the intervention.
  • Receiver operating characteristic (ROC) analysis to evaluate the diagnostic accuracy of the pulmonary dysfunction index.

Main Results:

  • Twelve of fifteen enrolled MSA patients completed the EMST protocol.
  • A statistically significant increase in MEP was observed post-training (P = 0.006).
  • No significant difference in vPCF was found after 8 weeks of EMST (P = 0.845).
  • ROC analysis demonstrated outstanding accuracy for the pulmonary dysfunction index in detecting at-risk patients for ineffective coughing and acceptable accuracy for detecting decreased expiratory muscle strength.

Conclusions:

  • Eight weeks of EMST did not lead to significant improvements in vPCF in MSA patients.
  • The pulmonary dysfunction index is a potentially valuable screening tool for identifying cough dysfunction in MSA.
  • Specific cut-offs of the index may guide the selection of appropriate respiratory physiotherapy interventions for MSA patients.