繼上次整理了EMST在吞嚥動作訓練的原理及喉部動作的文獻後
資料來源:
Abstract
Background: Cough provides high expiratory airflows to aerosolize and remove material that cannot be adequately removed by ciliary action. Cough is particularly important for clearing foreign particles from the airway in those with dysphagia who may be at risk for penetration/aspiration (P/A). Expiratory muscle strength training (EMST) was tested to improve cough and swallow function.
Methods: Ten male participants, diagnosed with Parkinson disease (PD), with videofluorographic evidence of penetration or with evidence for aspiration of material during swallow of a thin 30-mL bolus, completed 4 weeks of an EMST program to test the hypothesis that EMST would improve cough and/or swallow function.
Measured parameters from an airflow waveform produced during voluntary cough, pre-EMST and post-EMST, included inspiration phase duration, compression phase duration (CPD), expiratory phase peak flow (EPPF), expiratory phase rise time (EPRT), and cough volume acceleration (VA) [ie, the EPPF/EPRT ratio]. The swallow outcome measure was the degree of P/A during the swallow task.
Results: There was a significant decrease in the duration of the CPD and EPRT; the decrease in EPRT resulted in a significant increase in cough VA. Significant decreases in the P/A scores were found posttraining.
Conclusions: The results demonstrate that EMST is a viable treatment modality for a population of participants with PD at risk of aspiration.
咳嗽是我們的身體一個很重要的保護機制
當我們的食物不小心掉入呼吸道時，
可以藉由咳嗽的方式，將食物咳出來避免吸入性肺炎
我們是否擁有足夠的壓力以產生咳嗽是很重要的能力
咳嗽動作可以分成三個階段
(1)咳嗽前:
吸氣肌使我們做出一個吸氣動作，吸氣產生的壓力將成為我們咳嗽的力量。
(2)累積足夠的壓力:
聲門閉合，此時由肋間肌肉與腹部肌肉縮以維持一定的肺部容積壓力。
(3)咳嗽動作:
聲門突然開啟，在壓力差下，氣流從肺部快速衝出---也就是我們咳嗽。
呼吸肌力訓練的理論基礎為
藉由腹部肌肉和呼氣肌的訓練以改善最大呼氣壓力
基於以上的研究證實透過EMST的療程，
是可以改善咳嗽的力量,聲門下壓力以及吞嚥功能，
藉此降低penetration 或 aspiration的風險
關於EMST在吞嚥動作的原理及喉部動作情形
可以參考另一篇已整理之文獻資料
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