title: Voluntary upregulation of reflex cough is possible in healthy older adults and Parkinson's disease.
abstract: Cough is an airway-protective mechanism that serves to detect and forcefully eject aspirate material. Existing research has identified the ability of healthy young adults to suppress or modify cough motor output based on external cueing. However, no study has evaluated the ability of people with Parkinson's disease (PD) and healthy older adults (HOAs) to upregulate cough motor output. The goal of this study was to evaluate the ability of people with PD and healthy age-matched controls (HOAs) to upregulate reflex and voluntary cough function volitionally with verbal instruction and visual biofeedback of airflow targets. Sixteen participants with PD and twenty-eight HOAs (56-83 yr old) were recruited for this study. Experimental procedures used spirometry to evaluate1) baseline reflex cough (evoked with capsaicin) and voluntary sequential cough and2) reflex and voluntary cough with upregulation biofeedback. Cough airflow was recorded and repeated-measures ANOVA was used to analyze differences in cough airflow parameters. Cough peak expiratory airflow rate and cough expired volume were significantly greater in the cueing condition for both induced reflex (P< 0.001) and voluntary cough (P< 0.001) compared with baseline measures. This is the first study to demonstrate the ability of people with PD and HOAs to upregulate induced reflex and voluntary cough motor output volitionally. These results support the development of studies targeting improved cough effectiveness in patients with airway-protective deficits.NEW & NOTEWORTHYAspiration pneumonia is a leading cause of death in Parkinson's disease (PD) and results from concurrent dysphagia and dystussia (cough dysfunction). This is the first study to demonstrate that people with PD and healthy age-matched controls can volitionally upregulate induced reflex and voluntary cough effectiveness when presented with novel cueing strategies. Thus targeting upregulation of cough effectiveness via biofeedback may be a viable way to enhance airway protection in people with PD.
authors.affiliation: Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York.|Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Florida.|Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida.
authors.forename: Alexandra E
authors.initials: AE
authors.lastname: Brandimore
authors.affiliation: Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Florida.|Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida.|Department of Neurology, University of Florida, Gainesville, Florida; and.
authors.forename: Karen W
authors.initials: KW
authors.lastname: Hegland
authors.affiliation: Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Florida.|Department of Neurology, University of Florida, Gainesville, Florida; and.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Okun
authors.affiliation: Department of Physiological Sciences, University of Florida, Gainesville, Florida.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Davenport
authors.affiliation: Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York; mst2139@tc.columbia.edu.|Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Florida.
authors.forename: Michelle S
authors.initials: MS
authors.lastname: Troche
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003371:Cough / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D010366:Peak Expiratory Flow Rate / Q000502:physiology; D011446:Prospective Studies; D012018:Reflex / Q000502:physiology*; D014836:Volition / Q000502:physiology*
keywords: Parkinson’s disease; biofeedback; healthy older adults; reflex cough; voluntary cough