Improving airway protection via telehealth (Sevitz et al., 2022)
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 S1. Practical feasibility outcomes by care-partner status.
Supplemental Material S2. Treatment effect outcomes by care-partner status.
Sevitz, J. S., Borders, J. C., Dakin, A. E., Kiefer, B. R., Alcalay, R. N., Kuo, S.-H., & Troche, M. S. (2022). Rehabilitation of airway protection in individuals with movement disorders: A telehealth feasibility study. American Journal of Speech-Language Pathology. Advance online publication. https://doi.org/10.1044/2022_AJSLP-22-00063
Funding
Alcalay’s research is funded by the National Institutes of Health (NIH), Department of Defense, Parkinson’s Foundation, and Michael J. Fox Foundation. He has consulted for Caraway, Avrobio, Merck, GSK, Sanofi, and Ono Therapeutics. Kuo’s research is funded by the NIH and the National Ataxia Foundation. He has consulted for Praxis, Neurocrine, uniQure, and Sage Therapeutics. Troche’s research is funded by the Michael J. Fox Foundation and the Cure PSP Foundation. Briana Kiefer’s research is funded by the NIH (Grant F31DC019281-01).
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