Single-Session Feasibility of Cough Skill Training in Cerebellar Ataxia

Cerebellar ataxia (CA) is a heterogenous neurodegenerative disease affecting multiple neural structures. Individuals with CA exhibit difficulty coordinating voluntary movements and have a high prevalence of cough (dystussia) and swallowing (dysphagia) dysfunction. Although skill-based approaches to cough rehabilitation are efficacious for other neurogenerative diseases, the feasibility in CA remains unexplored. Seven people with genetically confirmed CA (6 female, 1 male) completed baseline voluntary cough assessments, followed by a single session of cough skill training (CST). Participants were instructed to cough with sufficient intensity to hit a target line set 25% above baseline maximum peak expiratory flow rate (PEFR). Metrics of feasibility included the percentage of trials completed, no adverse events, and duration of the treatment session. Bayesian multilevel models examined changes in three cough airflow outcomes: PEFR, cough expired volume (CEV), and cough inspired volume (CIV). All participants completed every trial of CST in less than one hour without any adverse events. PEFR improved by 0.77 L/s (95% CI: 0.37, 1.09) on single and 0.49 L/s (95% CI: 0.17, 0.76) on sequential voluntary cough. CEV increased by 0.36 L (95% CI: 0.11, 0.76) on single and 0.19 L (95% CI: 0.02, 0.46) on sequential voluntary cough. CIV showed no significant change. Individuals with CA demonstrated the ability to upregulate voluntary cough during a single session of CST within a manageable amount of time. These findings highlight the potential for modifiable cough outcomes in this population and support further research on the efficacy of CST in CA.