Effectiveness of Expiratory Muscle Strength Training for Improving Communication in ALS

呼气肌力量训练对于改善 ALS 患者沟通的有效性

• 批准号: 10302267
• 负责人: Brianna Rose Kiefer
• 金额: $ 4.68万
• 依托单位: PURDUE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-01 至 2022-10-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10302267
• 关键词: Address; Aerobic; Affect; Age; Air Movements; Amyotrophic Lateral Sclerosis; Aspiration Pneumonia; Atrophic; Clinical Trials; Communication; Communication Methods; Coughing; Data; Deglutition; Devices; Disease Progression; Dysarthria; Eating; Effectiveness; Flaccid Dysarthrias; Goals; Impairment; Individual; Investigation; Language; Limb structure; Literature; Maintenance; Mediating; Mentors; Methods; Motor; Motor Neurons; Muscle; Muscular Atrophy; Neurodegenerative Disorders; Parkinson Disease; Pathologist; Patients; Pattern; Perception; Persons; Physiology; Population; Production; Progressive Muscular Atrophy; Protocols documentation; Quality of life; Reflex action; Research; Resistance; Respiration; Respiratory Tract Infections; Respiratory physiology; Science; Series; Speech; Speech Acoustics; Surveys; Testing; Training; Universities; alternative communication; career; clinical practice; communication device; experience; improved; kinematics; multilevel analysis; muscle strength; nervous system disorder; neuron loss; nutrition; preservation; pressure; psychosocial; respiratory; response; sex; skills; spasticity; strength training; therapy design; training opportunity

PROJECT ABSTRACT The goal of the proposed project is to provide Ms. Brianna Kiefer with training opportunities at Purdue and Columbia University from Drs. Jessica Huber, Michelle Troche, and Kristine Marceau – experts in speech science, respiration, cough physiology, and multilevel modeling. To achieve this goal, Ms. Kiefer will conduct a study of expiratory muscle strength training (EMST) in people with Amyotrophic Lateral Sclerosis (ALS). Progressive muscular atrophy is a detrimental consequence of motor neuronal death associated with ALS. Atrophy of the respiratory musculature is particularly harmful since speech and cough production require ample and coordinated respiratory support. Due to respiratory musculature atrophy, people with ALS are unable to generate sufficient subglottal pressures to support speech. People with ALS are also unable to generate strong expiratory forces to effectively expel foreign materials from the airway when they cough. Consequently, people with ALS often rely on alternative communication devices and alternative methods of nutrition. Losing the abilities to speak and eat independently significantly reduces quality of life for people with ALS. Recent investigations have found that implementing moderate intensity strength training paradigms in the early stages of ALS is safe and effective. EMST is a commonly used paradigm that strengthens the respiratory musculature to improve speech and cough production. While EMST has a large body of literature to support its use for people with other neurodegenerative diseases, only one study has examined the effectiveness of EMST for people with ALS. The proposed project aims to build upon Plowman and colleagues (2016) findings to address three broad aims. Specific aim 1 will define how the underlying respiratory support patterns mediating speech and cough production are altered by ALS. We suspect that individuals with ALS will utilize less efficient and effective respiratory support patterns during speech and cough production relative to age- and sex-matched controls. Specific Aim 2 will determine how moderate intensity EMST modifies the effectiveness and efficiency of speech and cough production. In a multiple baseline, delayed-treatment design, people with ALS will undergo a six-week moderate intensity EMST protocol. We suspect that EMST will improve the effectiveness and efficiency of speech and cough production. And finally, Specific Aim 3 will identify how EMST affects the psychosocial states of people with ALS. We suspect that improved speech and cough production will positively impact the psychosocial states of people with ALS. Together, results from the proposed study will provide much needed information to guide clinical practice in the treatment of dysarthria and dystussia associated with ALS. Through conducting this study and engaging with her mentors in a variety of activities, Ms. Kiefer will greatly expand her research skills. Specifically, she will gain experience with ALS, reflexive cough production, respiratory function, multilevel models, and clinical trial management.

项目摘要 拟议项目的目的是向布莱恩娜·基弗（Brianna Kiefer）女士提供普渡大学的培训机会 哥伦比亚大学博士。杰西卡·休伯（Jessica Huber），米歇尔·特洛奇（Michelle Troche）和克里斯汀·马科（Kristine Marceau） - 演讲专家 科学，呼吸，Coug生理和多级建模。为了实现这一目标，基弗女士将进行 肌萎缩性侧索硬化症患者（ALS）的呼气肌肉力量训练（EMST）的研究。 进行性肌肉萎缩是与ALS相关的运动神经元死亡的有害后果。 呼吸肌肉的萎缩特别有害，因为语音和咳嗽需要充足 和协调的呼吸支持。由于呼吸肌肉萎缩，ALS的人无法 产生足够的次值压力以支持语音。 ALS的人也无法产生强大 呼应力在咳嗽时有效地从气道中排出外来材料。因此，人 ALS通常依靠替代性通信设备和替代营养方法。失去 说话和饮食的能力可显着降低ALS患者的生活质量。最近的 调查发现，在早期实施现代强度强度训练范例 ALS的安全有效。 EMST是一种常用的范式，可以强调呼吸肌肉 改善言语和咳嗽的产生。尽管Emst有大量文献来支持其使用 患有其他神经退行性疾病的人，只有一项研究检查了EMST的有效性 患有ALS的人。拟议的项目旨在建立Plowman及其同事（2016年）的发现，以解决 三个广泛的目标。特定目标1将定义如何介导的基础呼吸支持模式 言语和咳嗽的产生被ALS改变。我们怀疑ALS的个人会更少使用 相对于年龄和年龄和咳嗽产生期间的高效有效呼吸支持模式 性别匹配的对照。特定的目标2将确定中等强度EMST如何修改 言语和美洲狮的有效性和效率。在多个基线，延迟治疗 设计，患有ALS的人将接受六周的现代强度EMST协议。我们怀疑Emst 将提高语音和咳嗽的有效性和效率。最后，特定的目标3将 确定EMST如何影响ALS患者的社会心理状态。我们怀疑演讲的改善 咳嗽的生产将对ALS患者的社会心理状态产生积极影响。一起，结果 拟议的研究将提供急需的信息，以指导临床实践 构造障碍和与ALS相关的障碍物。通过进行这项研究并与她的导师互动 Kiefer女士将大大扩展她的研究技能。具体来说，她会获得经验 使用ALS，反身咳嗽产生，呼吸功能，多级模型和临床试验管理。

项目成果

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

运动障碍患者气道保护的康复：远程医疗可行性研究。

• DOI: 10.1044/2022_ajslp-22-00063
• 发表时间: 2022
• 期刊: American journal of speech-language pathology
• 影响因子: 2.6
• 作者: Sevitz,JordannaS;Borders,JamesC;Dakin,AveryE;Kiefer,BriannaR;Alcalay,RoyN;Kuo,Sheng-Han;Troche,MichelleS
• 通讯作者: Troche,MichelleS