WithdrawnNot Applicable

Slow-Stream Expiratory Muscle Strength Training for Veterans With Dysphagia Living in Long-term Care

Stopped: PI employment change

Canada0Started 2022-09

Plain-language summary

Sunnybrook Veterans Centre (VC) is a long-term care (LTC) facility with many elderly residents living with swallowing disorders who are at high risk of developing pneumonia from aspirating food/liquid into their lungs. Expiratory muscle strength training (EMST) using a hand-held resistance device over a four week intensive program has been shown to have promising results in improving cough function and reducing aspiration during swallowing in older, community-dwelling adults. The purpose of this study is to explore whether a modified slow-stream protocol of EMST over eight weeks is an effective therapy for improving swallowing safety and lung clearance in elderly VC residents with swallowing disorders. Before and after the eight week therapy program, we will measure participants' cough under spirometry, swallowing under videofluoroscopy, and their swallowing-related quality of life and diet texture modification. A three month follow-up visit will measure swallowing-related quality of life again, as well as record incidence of respiratory tract infections requiring antibiotics in the last three months, to be compared with broader institutional data.

Who can participate

Age range85 Years – 110 Years

SexALL

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AI-rewrites the medical criteria so a patient or caregiver can understand them. Always confirm with the trial site.

Inclusion Criteria: * Fluent in the English language * Identified by their speech-language pathologist as at risk for laryngeal penetration/aspiration when drinking thin liquids * A Penetration Aspiration Scale score of 3+ on at least one thin liquid bolus during pre-test videofluoroscopy, as rated live at the time of test by the speech-language pathologist conducting the videofluoroscopy. * Cognitively and physically able to perform study tasks (spirometry, EMST). If assistance and/or cuing is required, the participant must have a support team who is agreeable to providing this for the duration of the study at time of consent. Support teams may consist of any combination of family, friends, private companions, and VC staff. * Medical clearance by the participant's most responsible physician (MRP) Exclusion Criteria: At time of consent * General medical exclusions: Any history of hernia, pneumothorax, perforated tympanic membrane, recent surgery, untreated gastroesophageal reflux disease or untreated hypertension. * Other medical conditions where increased intrathoracic pressure would be contraindicated, on an individual basis, as per participant's MRP * Cognitively and/or physically unable to perform study tasks, despite support * Participants who do not consent to videofluoroscopy or for whom videofluoroscopy is contraindicated After time of consent * Participants who score PAS \< 3 on pre-test videofluoroscopy * Inability to complete pre-post testing for at least one…

What they're measuring

Voluntary Cough Volume Acceleration

Timeframe: Pre-treatment baseline, 10 weeks after baseline

Penetration Aspiration Scale (PAS)

Timeframe: Pre-treatment baseline, 10 weeks after baseline

Trial details

NCT IDNCT04064333

SponsorSunnybrook Health Sciences Centre

Sponsor typeOTHER

Study typeINTERVENTIONAL

Primary completion2024-09