Expiratory muscle strength training and detraining : effects on speech and cough production PDF
Preview Expiratory muscle strength training and detraining : effects on speech and cough production
EXPIRATORYMUSCLESTRENGTHTRAININGANDDETRAINING:EFFECTS ONSPEECHANDCOUGHPRODUCTION By SUSANE.BAKER ADISSERTATIONPRESENTEDTOTHEGRADUATESCHOOL OFTHEUNIVERSITYOFFLORIDAINPARTIALFULLFILLMENT OFTHEREQUIREMENTSFORTHEDEGREEOF DOCTOROFPHILOSOPHY UNIVERSITYOFFLORIDA Copyright2003 by SusanE.Baker ACKNOWLEDGEMENTS FirstandforemostIwouldliketothankmyadvisoranddissertationcommittee chair,ChristineSapienza,Ph.D. HermentoringhashelpedmeachievemorethanIever thoughtpossible. TheonlywayIknowhowtorepayherforherdedicationistopasson theknowledgeshehasgiventomeandprovideasimilarsupportiveenvironmentformy futurestudents. Iwouldliketoexpressmysincereappreciationtomydissertationcommittee members,W.S.Brown,Jr.,Ph.D.,HowardRothman,Ph.D.,andPaulDavenport,Ph.D. Theirsupportandguidancethroughoutmyentiredoctorateprogramhasbeen tremendous. Severalcolleaguesandfellowstudentsdeserveanoteofappreciationfortheir effortsonvariousstagesofthisprojectaswell. IwouldliketothankRahulShrivastav, Ph.D.forhishelpwithwritinganalgorithminMATLABforsomeofthedataanalysis. I wouldalsoliketothankseveraloftheundergraduatestudentsthatworkedinour laboratoryoverthepastyearthatdedicatedtheirtimetothisproject. Thesestudents includeMichelleVivaqua,SaraLancashire,JordanKelgren,andMichelleTroche. I wouldalsoliketothankmylabcolleaguesovertheyears,BariHoffmanRuddy,Ph.D., YaserNatour,Ph.D.,andJudyWingatefortheirsupportandfriendship. iii Finally,myloveandthanksisgiventomyfamilyfortheirsupportand encouragementthroughoutmyentireacademiccareer. IwouldalsoliketothankBonnie andPhilipAnkrimforbeingmy“GainesvilleFamily.” Iwillneverforgettheirkindness. IV TABLEOFCONTENTS page ACKNOWLEGEMENTS iii ACADEMICABSTRACT vii CHAPTER 1 GENERALINTRODUCTION 1 2 SPEECHPRODUCTIONWITHINCREASEDEXPIRATORY 7 MUSCLESTRENGTH Introduction 7 Methods 12 Results 17 Discussion 21 Tables 29 Figures 40 3 COUGH PRODUCTIONWITHINCREASEDEXPIRATORY 43 MUSCLESTRENGTH Introduction 43 Methods 47 Results 51 Discussion 54 Tables 57 Figures 65 4 STRENGTHTRAININGINEXPIRATORYMUSCLES 67 Introduction 67 Methods 72 Results 74 Discussion 76 Tables 80 Figures 82 V 5 DETRAININGOFEXPIRATORYMUSCLES 84 Introduction 84 Methods 87 Results 91 Discussion 92 Tables 97 Figures 99 6 GENERALDISCUSSION 101 APPENDIX PAPAPASSAGE 105 REFERENCELIST 106 BIOGRAPHICALSKETCH 115 VI AbstractofDissertationPresentedtotheGraduateSchool oftheUniversityofFloridainPartialFulfillmentofthe RequirementsfortheDegreeofDoctorofPhilosophy EXPIRATORYMUSCLESTRENGTHTRAININGANDDETRAINING:EFFECTS ONSPEECHANDCOUGHPRODUCTION By SusanE.Baker August2003 Chair: ChristineSapienza MajorDepartment: CommunicationSciencesandDisorders Reducedexpiratorymusclestrengthcompromisesthenecessarylungpressurefor taskssuchasspeechandcough. Itisknownthatexpiratorymusclestrengthcanbe increasedwithstrengthtrainingprograms.However,thereislimitedresearchontherate andmagnitudeofexpiratorymusclestrengthincrease,thephysiologicchangesinspeech andcoughfollowingtraining,andalterationstothesephysiologicchangesasafunction ofdetraining. Participantsincluded32(20females;12males)healthyindividualswithan averageageof25.2years. Amultivariaterepeatedmeasuresdesignwasusedinwhich measuresofexpiratorymusclestrength,speech,andcoughwereobtainedeachweek duringanexpiratorymusclestrengthtraining(EMST)program. Theparticipantswere dividedintotwotraininggroups. GroupItrainedforfourweeks. GroupIItrainedfor eightweeks. Maximumexpiratorypressure(MEP)wasusedasthemeasureof vii maximumexpiratorymusclesstrength. Speechmeasuresweretheratioofsubglottal pressure(Ps)toMEPandintraoralpressure(Po)toMEP,maximumPs,andpeakroot meansquare. Coughmeasuresweremaximumflowrate,compressiontime,andrise time.Allmeasureswerealsoobtainedduringaneight-weekdetrainingperiodto documenttherateandmagnitudeofthestrengthdecreaseaswellasthelossof physiologicchangesinspeechandcough. TheresultsdemonstratedasignificantincreaseinMEPinbothGroupIand GroupII,p<.05. Aplateauinstrengthincreasewasfoundfollowingthesixthweekof trainingandstayedconstantupuntiltheeighthweekoftraining. Asignificantdecrease inPs/MEPoccurredinGroupI,p<.05,butnotinGroupII. Asignificantdecreasein Pq/MEPwasfoundinbothGroupIandII,p<.05. Nosignificantalterationsincough werenotedwithtrainingexceptforasignificantdecreaseincompressiontimeinGroup II,p<.05. MEPremainedsignificantlyabovebaselineateightweekspost-trainingfor bothGroupIandII,p<.05. Thesegroupsdidnotsignificantlydifferindetrainingrates. TheresultsfurtherindicatethatinvestigationofEMSTmaybeofinterestinclinical populationswhichpresentwithexpiratorymuscleweakness. viii CHAPTER1 GENERALINTRODUCTION Respiratorymuscletrainingisatechniquethathashistoricallybeenutilizedto increasetheenduranceand/orstrengthoftherespiratorymusclesforthepurposeof improvedventilation. Thistechniquehasbeenstudiedinavarietyofpopulationsthat presentwithresistiveorobstructivediseasesoftherespiratorysystem. Ithasbeen hypothesized,andpreliminaryresultssuggest,thattheseincreasesinstrengthimprove functionsthatrequirehigherrespiratoryforcesuchasspeechandcoughproduction. Previously,wholebodygeneralexerciseandfitnessprogramswereusedtotarget improvementinventilatoryfunctioninpatientswithrespiratorydisease. Areviewof treatmentoutcomesfromtheseprogramswasprovidedbyShafferandcolleagues(1981). Thisreviewrevealedthatveryfewofthesestudiesdemonstratedasignificantincreasein mostventilatoryfunctionparameters. Whiletheseprogramsdemonstratedimprovement inventilatoryendurance,thesegainsappearedtobeduetoanincreasedabilitytouse compensatorybreathingpatterns(Powersetal.,1997). Othertrainingprogramshave useddeepbreathingexercises(Weinsetal,1999),abdominalmuscleexercises(not associatedwithrespiratorymaneuvers)(Simpson,1983;Vegeretetal.,1987),and abdominalweightstoimproveventilatoryfunction(Derricksonetal.,1992). Allofthese programsdemonstratedlimitedsuccessinsignificantlyimprovingventilatoryfunctionas theywerenottask-specifictorespirationand/orlackedtheabilitytoprovideasufficient loadtotherespiratorymusclestogeneratelargeincreasesinstrength. 1 2 In1976,LeithandBradleydemonstratedthatrespiratorymusclestrengthand endurancecouldbeincreasedusingexercisesthatweretask-specifictotherespiratory musculature. Theyusednormocapnichyperpneatoobtainincreasesinstrengthand endurance. Thistypeofrespiratorytrainingrequirestheparticipanttoventilatetoa higherdegreeoveraperiodof12to15minutesbyusingapartialrebreathingsystemthat maintainsaconstantCO2level. ThepresenceofahigherlevelofCO2intherebreathing systemcausestheindividualtobreathemorerapidlysothattheexcessCO2 (hyperventilation)canbeexpelled. Asafunctionofthistraining,a55%increasein respiratorymusclestrengthwasnotedinhealthyindividualsaftercompletingafive-week trainingprogram. Animportantprincipleofskeletalmusclestrengthtrainingisthatthetraining maneuvershouldbespecifictothetargetedmusclegrouptogainthegreatesteffect. LeithandBradley’strainingprocedurewasoneofthefirstprogramstospecificallytarget therespiratorymusculatureathighloads. Whilethisimportantworkdemonstratedthe potentialofrespiratorymuscletrainingasatreatmentmodalityforincreasingthestrength andenduranceoftherespiratorymuscles,itwasnotapracticaltrainingsystemasit requiredextensivemonitoringofthepatientinalaboratorysetting. Devicedrivenprogramsarenowpredominatelyusedtoincreaserespiratory musclestrength. Resistance-baseddeviceswereusedinitially,whichexposedthe respiratorymusclestomuchhigherloadsthanthoseobtainedwithabdominalordeep breathingexercises. Resistancetrainingrequiresanindividualtoinspireorexpire throughamouthpiecethatprovidesaresistancetotheflowofair. Inthelate1980’s, anotherrespiratorymuscletrainingtechniqueemergedcalledpressurethresholdtraining.
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