Expiratory Muscle Training in Patients With Parkinson's Disease
Condition: Parkinson's Disease
MeSH terms: Parkinson Disease
Study type: Interventional
Phase: Phase 1/Phase 2

Summary: 
      Respiratory difficulty is one of the primary factors leading to death in patients with
      Idiopathic Parkinson's Disease (IPD). The progressive degeneration of a family of segregated
      motor and non-motor circuits in the brain results in motor and non-motor dysfunction.
      Breathing and swallowing are well known to be affected in IPD, and attention to these
      functions is fitting since most patients eventually experience morbidity and even mortality
      as a result of this dysfunction. Patients with IPD typically become sedentary and lose
      endurance, maximal fitness levels and overall pulmonary function. Much of the research focus
      has been on the motor symptoms of IPD (tremor, rigidity, bradykinesia) yet the pulmonary
      complications are perhaps ultimately the most important disability. The inability to generate
      adequate respiratory pressure is responsible for reduced cough magnitudes and cough response
      times. Cough is critical for the clearance of foreign materials in the airway helping to
      reduce infiltration of bacteria and subsequent respiratory infection. With reduced cough
      function an increased risk for pulmonary disease due to a reduced ability to protect the
      airways occurs. Moreover, the recognized debilitating disruptions to voice and speech
      characteristics that limit communication, care taking, employment opportunities and social
      interactions are also a result of poor respiratory function. There are a number of promising
      outcomes from an expiratory strength-training program. By increasing expiratory muscle
      strength and expiratory pressure generation, effective breathing, clearance of the airway,
      production of a louder and clearer voice as well as improved swallowing can occur. These
      explicit outcomes are predicted based on our experience with the use of an innovative
      device-driven, home-based expiratory strength training program focused on the expiratory
      muscles of respiration.

      The aims of this study are to: 1) Investigate the activity of expiratory muscle strength
      training (EMT) in patients with idiopathic Parkinson's disease (IPD), 2) Determine the effect
      of increased expiratory force generation on breathing, cough magnitude, speech production,
      and swallowing, 3) Determine the effect of increased expiratory force generation on the
      patient's perception of speech change, 4) Determine the effect of Dopamine-replacement
      therapy (Parkinson's medications) on breathing, coughing, speaking, and swallowing measures.
    


Intervention name(s): EMST - Active Treatment; sham EMST
Intervention type(s): Device; Device
Intervention description(s): Hand held device used for strengthening expiratory muscles; Four week sham device training program
Other intervention name(s): Respiratory Muscle Strength Training
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Breathing; Cough; Speech; Swallow; Parkinson's disease