Rehabilitation of swallowing and cough functions following stroke: an expiratory muscle strength training trial

Publication date: Available online 26 April 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Karen Wheeler Hegland, Paul W. Davenport, Alexandra E. Brandimore, Floris F. Singletary, Michelle S. Troche
ObjectiveTo determine the effect of expiratory muscle strength training on both cough and swallow function in stroke patients.DesignProspective pre-post intervention trial with one participant group.SettingTwo outpatient rehabilitation clinicsParticipantsFourteen adults with a history of ischemic stroke in the preceding 3 – 24 months participated in this study.InterventionExpiratory muscle strength training (EMST). The training program was completed at home and consisted of 25 repetitions per day, 5 days per week, for 5 weeks.Main outcome measuresBaseline and post-training measures were: maximum expiratory pressure, voluntary cough airflows, reflex cough challenge to 200μM capsaicin, sensory perception of urge-to-cough, and fluoroscopic swallow evaluation. Repeated measures and one-way analyses of variance were used to determine significant differences pre/post training.ResultsMaximum expiratory pressure increased in all participants by an average of 30cmH2O post training. At baseline, all participants demonstrated a blunted reflex cough response to 200 μM capsaicin. Following 5 weeks of training, measures of urge to cough and cough effectiveness increased for reflex cough, however voluntary cough effectiveness did not increase. Swallow function was minimally impaired at baseline, and there were no significant changes in the measures of swallow function post training.ConclusionsExpiratory muscle strength training improves both expiratory muscle strength, reflex cough strength and urge-to-cough. Voluntary cough and swallow measures were not significantly different post training. It may be that stroke patients benefit from the training for up-regulation of reflex cough and thus improved airway protection.



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