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. 2022 Nov 16;31(6):2741-2758.
doi: 10.1044/2022_AJSLP-22-00063. Epub 2022 Oct 24.

Rehabilitation of Airway Protection in Individuals With Movement Disorders: A Telehealth Feasibility Study

Jordanna S Sevitz  1 , James C Borders  1 , Avery E Dakin  1 , Brianna R Kiefer  2 , Roy N Alcalay  3   4 , Sheng-Han Kuo  3 , Michelle S Troche  1   3
Affiliations

Rehabilitation of Airway Protection in Individuals With Movement Disorders: A Telehealth Feasibility Study

Jordanna S Sevitz et al. Am J Speech Lang Pathol. .

Abstract

Purpose: Airway protective deficits (swallowing and cough) greatly reduce health and quality of life and are a pervasive consequence of neurodegenerative movement disorders. Expiratory muscle strength training (EMST) and cough skill training (CST) are two treatment approaches to improve airway protection; however, many patients are unable to access these treatments. Telehealth may improve access to care, but it remains unknown whether these treatments are feasible and efficacious via telehealth. This study aimed to determine the practical feasibility and preliminary treatment effect of EMST and CST via telehealth.

Method: Twenty participants with movement disorders completed 4 weeks of EMST and 2 weeks of CST, including two clinician-directed treatment sessions via telehealth and 3 days of home practice per week. Feasibility was calculated for each treatment. Practical feasibility was defined as completing treatment (EMST or CST) and obtaining the relevant outcome measures-a proxy of maximum expiratory pressure (pMEP) for EMST and peak expiratory flow rate (PEFR) for CST-within a 30-min session/period. Session factors that may have influenced feasibility were examined. Preliminary treatment effect was defined as changes in pMEP and PEFR.

Results: Time taken to obtain pMEP and complete EMST was 17.48 min, and time taken to obtain PEFR and complete CST was 17.69 min. pMEP, single voluntary cough PEFR, and sequential voluntary cough PEFR increased from pre- to posttreatment.

Conclusions: Findings suggest that the delivery of EMST and CST is feasible via telehealth and yield improvements to pMEP and PEFR. This has important implications for expanding service delivery of airway protective interventions and reducing health care disparities in people with neurodegenerative movement disorders.

Supplemental material: https://doi.org/10.23641/asha.21357669.

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Figures

Figure 1.
Figure 1.
Treatment protocol and devices. Participants completed expiratory muscle strength training and cough skill training treatment. pMEP = proxy of maximum expiratory pressure; PEFR = peak expiratory flow rate.
Figure 2.
Figure 2.
Change in proxy of maximum expiratory pressure (pMEP) pre–post treatment. pMEP increased after 4 weeks of expiratory muscle strength training. Pre = pretreatment; Post = post 4 weeks of treatment.
Figure 3.
Figure 3.
Change in peak expiratory flow rate (PEFR) pre–post treatment. PEFR increased after 2 weeks of cough skill training. This figure uses the mean PEFR for each participant to allow for a clearer visual representation of within-participant data. Pre = pretreatment; Post = post 2 weeks of treatment.
See this image and copyright information in PMC

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