Sequential Voluntary Cough and Aspiration or Aspiration Risk in Parkinson’s Disease

Cough is an airway-protective mechanism that serves to detect and forcefully eject aspirate material. Existing research has identified the ability of healthy young adults to suppress or modify cough motor output based on external cueing. However, no study has evaluated the ability of people with Parkinson’s disease (PD) and healthy older adults (HOAs) to upregulate cough motor output. The goal of this study was to evaluate the ability of people with PD and healthy age-matched controls (HOAs) to upregulate reflex and voluntary cough function volitionally with verbal instruction and visual biofeedback of airflow targets. Sixteen participants with PD and twenty-eight HOAs (56–83 yr old) were recruited for this study. Experimental procedures used spirometry to evaluate 1) baseline reflex cough (evoked with capsaicin) and voluntary sequential cough and 2) reflex and voluntary cough with upregulation biofeedback. Cough airflow was recorded and repeated-measures ANOVA was used to analyze differences in cough airflow parameters. Cough peak expiratory airflow rate and cough expired volume were significantly greater in the cueing condition for both induced reflex ( P < 0.001) and voluntary cough ( P < 0.001) compared with baseline measures. This is the first study to demonstrate the ability of people with PD and HOAs to upregulate induced reflex and voluntary cough motor output volitionally. These results support the development of studies targeting improved cough effectiveness in patients with airway-protective deficits. NEW & NOTEWORTHY Aspiration pneumonia is a leading cause of death in Parkinson’s disease (PD) and results from concurrent dysphagia and dystussia (cough dysfunction). This is the first study to demonstrate that people with PD and healthy age-matched controls can volitionally upregulate induced reflex and voluntary cough effectiveness when presented with novel cueing strategies. Thus targeting upregulation of cough effectiveness via biofeedback may be a viable way to enhance airway protection in people with PD.

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Variability of Voluntary Cough Airflow in Healthy Adults and Parkinson’s Disease

Dysphagia ◽

10.1007/s00455-020-10190-3 ◽

2020 ◽

Author(s):

James C. Borders ◽

Alexandra E. Brandimore ◽

Michelle S. Troche

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Healthy Adults ◽

Voluntary Cough ◽

Cough Airflow

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Respiratory–Swallow Coordination Training and Voluntary Cough Skill Training: A Single-Subject Treatment Study in a Person With Parkinson's Disease

Journal of Speech Language and Hearing Research ◽

10.1044/2019_jslhr-19-00207 ◽

2020 ◽

Vol 63 (2) ◽

pp. 472-486 ◽

Cited By ~ 4

Author(s):

James A. Curtis ◽

Avery E. Dakin ◽

Michelle S. Troche

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Skill Training ◽

Effect Sizes ◽

Single Subject ◽

Voluntary Cough ◽

Respiratory Inductive Plethysmography ◽

Standard Mean Difference ◽

Coordination Training ◽

Future Work

Purpose Airway protective disorders are common in Parkinson's disease (PD), yet effective methods to rehabilitate these life-threatening impairments are limited. This study examined the effects of two skill-based treatments aimed at improving swallowing and cough in a severely dysphagic person with PD: respiratory–swallow coordination training (RSCT) and voluntary cough skill training (VCST). It was hypothesized that (a) RSCT would improve respiratory–swallow coordination and swallowing safety and efficiency and (b) VCST would improve reflex and voluntary cough effectiveness. Method An 81-year-old man with midstage PD and severe dysphagia was recruited for study participation. The study utilized a multiple-baseline ABACA experimental design with a 2-month delayed retention assessment. Measures of respiratory–swallow coordination, swallowing safety and efficiency, and cough effectiveness were collected at each assessment using respiratory inductive plethysmography, flexible endoscopic evaluations of swallowing, and spirometry. Data were analyzed descriptively using baseline corrected tau and standard mean difference effect sizes ( d ). Results Large effect sizes were observed immediately following RSCT for respiratory–swallow coordination ( d = 9.17), penetration–aspiration ( d = 12.88), vallecular residue ( d = 1.75), piriform residue ( d = 4.15), and overall dysphagia severity ( d = 1.83). Large effect sizes were also observed immediately following VCST for single voluntary cough ( d = 4.30), sequential voluntary cough ( d = 3.28), and reflex cough ( d = 5.58). Improvements were maintained 2 months later for all outcome measures except single voluntary cough. Discussion This is the first study to examine the effects of RSCT and VCST in a person with PD. Robust improvements in respiratory–swallow coordination and swallowing safety and efficiency were achieved following four sessions of RSCT, and significant improvements in reflex and voluntary cough strength were seen following four sessions of VCST. Future work is needed to study these treatments in larger cohorts of people with PD.

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Effects of repetitive transcranial magnetic stimulation on voice and speech in Parkinson's disease

The Journal of Laryngology & Otology ◽

10.1017/s0022215106002787 ◽

2005 ◽

pp. 1

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Transcranial Magnetic Stimulation ◽

Magnetic Stimulation ◽

Repetitive Transcranial Magnetic Stimulation ◽

Voice And Speech

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Emerging Drugs and Targets for Parkinson's Disease

10.1039/9781849737357 ◽

2013 ◽

Cited By ~ 3

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease

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Evaluation of Efferent Auditory System and Hearing Quality in Parkinson's Disease: Is the Difficulty in Speech Understanding in Complex Listening Conditions Related to Neural Degeneration or Aging?

Journal of Speech Language and Hearing Research ◽

10.1044/2020_jslhr-20-00337 ◽

2020 ◽

pp. 1-9

Author(s):

Nuriye Yıldırım Gökay ◽

Bülent Gündüz ◽

Fatih Söke ◽

Recep Karamert

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Auditory System ◽

Otoacoustic Emissions ◽

Pure Tone ◽

Pure Tone Audiometry ◽

Auditory Pathway ◽

Normal Hearing ◽

System Function ◽

Distortion Product

Purpose The effects of neurological diseases on the auditory system have been a notable issue for investigators because the auditory pathway is closely associated with neural systems. The purposes of this study are to evaluate the efferent auditory system function and hearing quality in Parkinson's disease (PD) and to compare the findings with age-matched individuals without PD to present a perspective on aging. Method The study included 35 individuals with PD (mean age of 48.50 ± 8.00 years) and 35 normal-hearing peers (mean age of 49 ± 10 years). The following tests were administered for all participants: the first section of the Speech, Spatial and Qualities of Hearing Scale; pure-tone audiometry, speech audiometry, tympanometry, and acoustic reflexes; and distortion product otoacoustic emissions (DPOAEs) and contralateral suppression of DPOAEs. SPSS Version 25 was used for statistical analyses, and values of p < .05 were considered statistically significant. Results There were no statistically significant differences in the pure-tone audiometry thresholds and DPOAE responses between the individuals with PD and their normal-hearing peers ( p = .732). However, statistically significant differences were found between the groups in suppression levels of DPOAEs and hearing quality ( p < .05). In addition, a statistically significant and positive correlation was found between the amount of suppression at some frequencies and the Speech, Spatial and Qualities of Hearing Scale scores. Conclusions This study indicates that medial olivocochlear efferent system function and the hearing quality of individuals with PD were affected adversely due to the results of PD pathophysiology on the hearing system. For optimal intervention and follow-up, tasks related to hearing quality in daily life can also be added to therapies for PD.

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