Refining Cough Skill Training in Parkinson's Disease and Dysphagia

Study Overview
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Brief Summary
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Airway protection deficits (cough and swallowing) are prevalent and pervasive in Parkinson's disease (PD), contributing to adverse health outcomes like pneumonia. This study aims to refine cough skill training by examining whether variable versus constant practice conditions improve cough outcomes in people with PD. In addition, this study will provide insight into optimal respiratory adaptations that occur during training to support cough effectiveness, resulting in immediately translatable treatments to improve airway protection-related health outcomes in people with neurodegenerative disease.

Official Title
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Refining Cough Skill Training in Parkinson's Disease and Dysphagia

Conditions
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Parkinson Disease, Dysphagia

Intervention / Treatment
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* Behavioral: Cough Skill Training - with Variable Practice


Participation Criteria
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Eligibility Criteria
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Inclusion criteria: 40 years of age or older have dysphagia as documented by a penetration-aspiration score > 2 on a flexible endoscopic evaluation of swallowing have cough disorder as defined as a maximal voluntary cough peak flow < 5 L/s have no history of other neurological disorders, head and neck cancer, respiratory disease, smoking within 5 years, uncontrolled hypertension, or allergy to capsaicin (reflex cough stimulus) Exclusion criteria: unable to participate due to neuropsychological dysfunction (i.e., dementia with a score of < 19 on the Montreal Cognitive Assessment) actively participating in other cough or swallowing treatments

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Cough Skill Training<br>During cough skill training, participants will be seated in front of a computer with real-time visualization of their cough waveform. A target line will be provided, and participants will be instructed to perform a single voluntary cough so that their peak flow is within the target's range. Participants will be instructed to continue the cough training regardless of initial accuracy. | Behavioral: Cough Skill Training - with Variable Practice<br>* Variable practice will involve three targets that reflect a range of cough airflows, including strong, moderate, and weak coughs.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Peak Expiratory Flow Rate | Cough Strength | Before to after two sessions of cough variable practice training over two weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Respiratory Kinematics, specifically lung volume excursion |  | Before to after two sessions of cough variable practice training over two weeks |