open access

Vol 89, No 3 (2021)
Brief communication
Published online: 2021-06-30
Submitted: 2020-12-08
Accepted: 2021-01-28
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A pilot study of the breath stacking technique associated with respiratory muscle endurance training in patients with amyotrophic lateral sclerosis: videofluoroscopic findings in the upper airway

Alessandra Dorça1, Max Sarmet23, Edna Maria de Sena Sousa Rocha1, Murilo Bufaiçal Marra1, Janae Lyon Million4, Denise Sisterolli Diniz1, Vinicius Maldaner35
DOI: 10.5603/ARM.a2021.0045
·
Pubmed: 34196381
·
Adv Respir Med 2021;89(3):284-290.
Affiliations
  1. Universidade Federal de Goiás, Department of Health Sciences, Goiânia, Brazil
  2. University of Brasília, Graduate Department of Health Sciences and Technologies, Brasília, Brazil
  3. Hospital de Apoio de Brasília, Tertiary Referral Center of Neuromuscular Diseases, Brasília, Brazil
  4. University of California Santa Cruz, Department of Human Biology, Santa Cruz, United States
  5. UniEvangélica, Human Movement and Rehabilitation Program, Anápolis, Brazil

open access

Vol 89, No 3 (2021)
BRIEF REPORT
Published online: 2021-06-30
Submitted: 2020-12-08
Accepted: 2021-01-28

Abstract

Introduction: Bulbar impairment represents a hallmark feature of amyotrophic lateral sclerosis (ALS) that significantly impacts survival and quality of life. Respiratory complications arise because of the weakness of the upper airway and respiratory muscles leading to respiratory failure, impaired swallowing, and reduced airway safety. Breath stacking and respiratory muscle endurance training are techniques that have been described to improve respiratory and bulbar function in patients with ALS. Considering the above, a respiratory technique named TR3 was developed. This study aimed to measure the acute effects of this technique on the upper airway through videofluoroscopy and to assess its clinical trial feasibility in patients with ALS.
Material and methods: In this cross-sectional study, we enrolled participants diagnosed with ALS to perform a single session of TR3. Epidemiological data and baseline assessments were collected. The assessments included kinematics from videofluoroscopy measuring the retropalatal airspace size, the size of the narrowest airway, and the pharyngeal area during rest and TR3.
Results: Eight participants were included. During TR3, an acute increase of 15% was observed in the retropalatal airspace size (t = 5.14, p < 0.01), a 123% increase was observed in the size of the narrowest airway (t = –4.18, p < 0.001), and a 277% increase was observed in the pharyngeal area (t = –5.34, p < 0.001).
Conclusions: During the intervention, TR3 showed acute effects in increasing pharyngeal constriction, pharyngeal expansion, retropalatal airspace size, and post-lingual narrowest airway size and is feasible for a larger research program. A clinical trial (NCT04226144) is already being conducted to assess the chronic therapeutic effects of this technique and its impact on the clinical evolution of ALS.

Abstract

Introduction: Bulbar impairment represents a hallmark feature of amyotrophic lateral sclerosis (ALS) that significantly impacts survival and quality of life. Respiratory complications arise because of the weakness of the upper airway and respiratory muscles leading to respiratory failure, impaired swallowing, and reduced airway safety. Breath stacking and respiratory muscle endurance training are techniques that have been described to improve respiratory and bulbar function in patients with ALS. Considering the above, a respiratory technique named TR3 was developed. This study aimed to measure the acute effects of this technique on the upper airway through videofluoroscopy and to assess its clinical trial feasibility in patients with ALS.
Material and methods: In this cross-sectional study, we enrolled participants diagnosed with ALS to perform a single session of TR3. Epidemiological data and baseline assessments were collected. The assessments included kinematics from videofluoroscopy measuring the retropalatal airspace size, the size of the narrowest airway, and the pharyngeal area during rest and TR3.
Results: Eight participants were included. During TR3, an acute increase of 15% was observed in the retropalatal airspace size (t = 5.14, p < 0.01), a 123% increase was observed in the size of the narrowest airway (t = –4.18, p < 0.001), and a 277% increase was observed in the pharyngeal area (t = –5.34, p < 0.001).
Conclusions: During the intervention, TR3 showed acute effects in increasing pharyngeal constriction, pharyngeal expansion, retropalatal airspace size, and post-lingual narrowest airway size and is feasible for a larger research program. A clinical trial (NCT04226144) is already being conducted to assess the chronic therapeutic effects of this technique and its impact on the clinical evolution of ALS.

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Keywords

amyotrophic lateral sclerosis, videofluoroscopy, pharyngeal constriction, expiratory muscle strength training, rehabilitation

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About this article
Title

A pilot study of the breath stacking technique associated with respiratory muscle endurance training in patients with amyotrophic lateral sclerosis: videofluoroscopic findings in the upper airway

Journal

Advances in Respiratory Medicine

Issue

Vol 89, No 3 (2021)

Article type

Brief communication

Pages

284-290

Published online

2021-06-30

DOI

10.5603/ARM.a2021.0045

Pubmed

34196381

Bibliographic record

Adv Respir Med 2021;89(3):284-290.

Keywords

amyotrophic lateral sclerosis
videofluoroscopy
pharyngeal constriction
expiratory muscle strength training
rehabilitation

Authors

Alessandra Dorça
Max Sarmet
Edna Maria de Sena Sousa Rocha
Murilo Bufaiçal Marra
Janae Lyon Million
Denise Sisterolli Diniz
Vinicius Maldaner

References (21)
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