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


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 of EMST and CST via telehealth and the preliminary treatment effect.

Method: Twenty participants with movement disorders completed four weeks of EMST and two weeks of CST, including two clinician directed treatment sessions via telehealth and three 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 minute session/period. Treatment effect was defined as changes in pMEP and PEFR.

Results: Time taken to obtain pMEP and complete EMST was 17.48 minutes and to obtain PEFR and complete CST was 17.69 minutes. pMEP (p < .001), single voluntary cough PEFR (p < .001), and sequential voluntary cough PEFR (p < .001) increased from pre- to post-treatment.

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 healthcare disparities in people with neurodegenerative movement disorders.

American Journal of Speech-Language Pathology