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Expiratory Muscle Training for Persons With Neurodegenerative Disease (EMST)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00856518
Recruitment Status : Completed
First Posted : March 5, 2009
Results First Posted : November 29, 2016
Last Update Posted : February 10, 2017
University of Florida
Information provided by (Responsible Party):
VA Office of Research and Development

Brief Summary:
Respiratory difficulty is one of the primary factors leading to death in patients with Parkinson's Disease (PD) and Multiple Sclerosis. Both diseases are progressive degenerating diseases that cause difficulties in breathing, airway protection and swallowing. Patients with PD and MS typically become sedentary and lose endurance, maximal fitness levels and overall pulmonary function. Much of the research focus has been on the motor symptoms of PD and MS yet the pulmonary and swallowing complications are perhaps ultimately the most important disability as the diseases progress. The inability to generate adequate respiratory pressure is responsible for reduced cough magnitudes and cough response times. Cough is critical for the clearance of foreign materials in the airway helping to reduce infiltration of bacteria and subsequent respiratory infection. With reduced cough function an increased risk for pulmonary disease occurs due to a reduced ability to protect the airways. There are a number of promising outcomes from an expiratory strength-training program. By increasing expiratory muscle strength and expiratory pressure generation, effective breathing, clearance of the airway, and improved swallowing can occur. These explicit outcomes are predicted based on our experience with the use of an innovative device-driven, home-based expiratory strength training program focused on the expiratory muscles of respiration. This project focuses on following patients with PD and MS for an initial 5 weeks of strength training and them testing the outcome of a caregiver program for maintaining treatment effects.

Condition or disease Intervention/treatment Phase
Parkinson's Disease Multiple Sclerosis Device: EMST Device: Sham Phase 2 Phase 3

Detailed Description:

The proposed investigation will:

Determine if 5 weeks of Expiratory Muscle Strength Training (EMST) increases maximal expiratory driving pressure (MEP) and improves swallow, cough and breathing function in individuals with PD and MS. Following the post assessment of the 5 week EMST program we will then evaluate three different modules for monitoring the continuation of the treatment while assessing patient quality of life and caregiver burden/satisfaction. This will help us determine if one particular home training method results in different physiological and functional outcomes.

Aim 1. Determine the effects of an EMST program on swallow function, voluntary cough production and breathing function in individuals with PD and MS identified as below normal limits for their age and sex (via physiological measures).

Hypothesis 1: There will significant and positive treatment effects following 5 weeks of EMST on the measures of swallow, cough production and breathing function in those with PD and MS following 5 weeks of treatment.

Aim 2: Determine the outcome of three uniquely structured home treatment monitoring programs in maintaining the EMST post treatment effect for patients with MS and PD. These programs are referred to as: Education Module (A), Question Only (B), and Education Module plus Question (C). The monitoring system will be provided by VitelNet, a leading provider of home health monitoring, clinician-based telemedicine Hypothesis 2: Program C will provide greater maintenance of the EMST treatment effect for both patient groups compared to programs A and B.

Aim 3: Determine the effects of the home monitoring programs for improving patient quality of life and caregiver burden/satisfaction.

Hypothesis 3: Program C will provide greater improvements in patient quality of life and caregiver burden compared to programs A and B.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 42 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Expiratory Muscle Training for Persons With Neurodegenerative Disease
Study Start Date : March 2009
Actual Primary Completion Date : August 2014
Actual Study Completion Date : August 2014

Arm Intervention/treatment
Active Comparator: Arm 1: EMST
The experimental group receives five weeks of expiratory muscle strength training (EMST) using a positive pressure threshold device
Device: EMST
Pressure threshold device (Expiratory Muscle Strength Trainer) targeted at increase muscle force generation of expiratory and submental muscles.
Other Name: EMST 150

Sham Comparator: Arm 2: Sham group
The Sham group undergoes the same 5-week EMST exercise as the experimental group using the same device but without a spring for minimal pressure load
Device: Sham
The same device just like the EMST but does not provide a load on the target muscle group

Primary Outcome Measures :
  1. Maximum Expiratory Pressure (MEP) [ Time Frame: at baseline and again after 5-week EMST exercise ]
    Expiratory pressure generating capacity assessed via handheld manometer.

  2. Penetration-Aspiration Scale Score [ Time Frame: at baseline and again after 5-week EMST exercise ]
    The Penetration-Aspiration Scale (PAS) was used to measure swallow safety. PAS is an 8 point ordinal scale for quantification of penetration and aspiration. PAS measures the depth to which material enters the airway and if the material is expelled following penetration or aspiration. Categorical groupings of PAS scores include "normal to mild" (1-2), "moderate" (3-5) and "severe" (6-8, indicating that material has passed into the lower airway). These PAS scores may be useful in denoting clinically significant changes (e.g. moderate to mild) resulting from treatment or disease progression. The following table reports the percentage of participants (out of the respective total group participants in EMST and Sham) with changed PAS score of 1 point or more (improving or worsening) and without PAS score changes from pre- to post treatment. The data represent an exploratory quantification without statistical analysis.

  3. Swallow-related Quality of Life (SWAL-QOL) [ Time Frame: at baseline and after 5-week of EMST exercise ]
    The SWAL-QOL is a validated and standardized tool that measures burden; symptom status including pharyngeal, oral, and saliva; fear; and mental health subdomains. Responses are determined according to an ordinal scale where 1 equals a severe problem and 5 equals no problem. The SWAL-QOL provides an overall score as well as subscale scores. Subjects rate quality of life as follows (expressed as percentage of the possible perfect score): little to no impact (81% - 100%), mild impact (61% - 80%), moderate impact (41% - 60%), severe impact (21% - 40%), and profound impact (0% - 20%).

Information from the National Library of Medicine

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Ages Eligible for Study:   35 Years to 80 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Multiple Sclerosis Participants
  • Diagnosis of primary, secondary, or relapsing-remitting MS by a neurologist
  • Over 85% of the patient populations that come from the study sites demonstrate relapsing-remitting MS with an average relapse frequency of once every 3 years

Parkinson's Disease Participants

  • Hoehn & Yahr, stage II and III as indicated by certified movement disorders neurologist

All Participants

  • Between 35 and 80 years of age
  • Non-smoking or no smoking within the previous five years
  • No history of head and neck cancer, asthma or COPD, untreated hypertension
  • Sufficient facial muscle strength so as to achieve and maintain adequate lip closure around a circular mouthpiece
  • Cognition within normal limits as determined by the: Mini Mental Status Exam (MMSE; 1975No neurological (other than MS or PD) condition which adversely affects respiratory muscle or gas exchange system
  • Reduced MEP's compared to published normative data for age and sex
  • Reduced expiratory peak flow rates (6-8 L/s for young to middle age adults and 3.6 L/s for 65 and older) during voluntary cough production for age and sex (Bolser, personal communication; Smith-Hammond & Goldstein, 2006)
  • Participant report of symptoms related to swallow impairment

Exclusion Criteria:

  • DBS
  • COPD
  • Asthma
  • Smoking or smoking within preceding 5 years

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00856518

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United States, Florida
North Florida/South Georgia Veterans Health System, Gainesville, FL
Gainesville, Florida, United States, 32608
Sponsors and Collaborators
VA Office of Research and Development
University of Florida
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Principal Investigator: Janis J. Daly, PhD MS North Florida/South Georgia Veterans Health System, Gainesville, FL
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Responsible Party: VA Office of Research and Development Identifier: NCT00856518    
Other Study ID Numbers: B6576-R
First Posted: March 5, 2009    Key Record Dates
Results First Posted: November 29, 2016
Last Update Posted: February 10, 2017
Last Verified: December 2016
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Keywords provided by VA Office of Research and Development:
Multiple Sclerosis
Parkinson's disease
Additional relevant MeSH terms:
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Parkinson Disease
Multiple Sclerosis
Neurodegenerative Diseases
Pathologic Processes
Parkinsonian Disorders
Basal Ganglia Diseases
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Movement Disorders
Demyelinating Autoimmune Diseases, CNS
Autoimmune Diseases of the Nervous System
Demyelinating Diseases
Autoimmune Diseases
Immune System Diseases