Kasey is a graduating senior in the Communication Sciences & Disorders program at the University of Florida. Upon graduation, Kasey will be pursuing her Master’s degree in Speech-Language Pathology. She is specifically interested in dysphagia management in individuals with neurodegenerative disease. She currently works as a Research Assistant in Dr. Emily Plowman’s Aerodigestive Research Core laboratory and presides over UF’s chapter of the National Student Speech Language Hearing Association. She spends her free time exercising, and cooking.
Predictors of Voluntary Cough Strength in Amyotrophic Lateral Sclerosis.
Kasey L. McElheny
Jennifer Chapin, MS, CCC-SLP
Lauren Tabor Gray Ph.D., CCC-SLP
Lauren DiBiase, MS, CCC-SLP
Amber Anderson, MS, CCC-SLP
Terrie Vasilopoulos, Ph.D.
James Wymer, MD, Ph.D., CPI, FAAN
Emily K. Plowman, Ph.D., CCC-SLP
BACKGROUND: Disordered cough (dystussia) is prevalent in amyotrophic lateral sclerosis (ALS) leading to a reduction in the physiologic capacity to defend the airway from tracheal aspirate (Niimi, 2003; Chaudri, 2002). Indeed, reduced peak expiratory flow rate (i.e. cough strength) increases risk of unsafe swallowing in individuals with ALS (Plowman, 2016). Given this noted relationship; we aimed to determine independent predictors of voluntary cough peak expiratory flow rate in individuals with ALS.
METHODS: 137 individuals with a diagnosis of ALS (El-Escorial criteria) attended a single testing session and completed the Amyotrophic Lateral Sclerosis Functional Rating Scale- Revised (ALSFRS-R) and underwent standard pulmonary function testing (maximum inspiratory pressure, maximum expiratory pressure, forced vital capacity) and voluntary cough spirometry.
LabChart software was utilized to obtain peak inspiratory and expiratory flow rates (PIF, PEF). Statistical analysis included a Pearson’s correlation and multivariable linear regression model with backward elimination. Alpha was set at 0.05.
RESULTS: Three independent predictors of PEF were identified and included: cough peak inspiratory flow (B(SE)= -1.25(0.19), p<.0001), maximum inspiratory pressure (B= 0.2(0.01), p=0.002), and ALSFRS-R Bulbar subscale score (B= 0.13(0.06), p=0.046).
CONCLUSIONS: Higher flow rates during the inspiratory phase of voluntary cough likely provide a mechanical advantage to an individual with ALS given that they have greater airflow to utilize during the expulsive phase of cough.