Lauren Tabor-Gray1,2, Terrie Vasilopoulos3, Karen Wheeler-Hegland4, James Wymer5,6, Emily K Plowman5,6,7. 1. Department of Neurology, Holy Cross Hospital, Holy Cross Medical Group, Phil Smith Neuroscience Institute, 4725 N Federal Highway, Fort Lauderdale, FL, 33308, USA. Lauren.tabor@holy-cross.com. 2. Speech, Language and Hearing Science Department, Aerodigestive Research Core, University of Florida, Gainesville, FL, USA. Lauren.tabor@holy-cross.com. 3. Department of Anesthesiology and Orthopedics, College of Medicine, University of Florida, Gainesville, FL, USA. 4. Laboratory of Upper Airway Dysfunction, Department of Speech, Language and Hearing Science, University of Florida, Gainesville, FL, USA. 5. Speech, Language and Hearing Science Department, Aerodigestive Research Core, University of Florida, Gainesville, FL, USA. 6. Department of Neurology, University of Florida, Gainesville, FL, USA. 7. Department of Surgery, University of Florida, Gainesville, FL, USA.
Abstract
BACKGROUND: Progressive motor denervation in amyotrophic lateral sclerosis (ALS) leads to reduced expiratory cough flow and diminished airway clearance physiologic capacity. Although ALS is thought to primarily impact motor systems, preliminary data from our laboratory suggest degradation of afferent pathways that regulate reflexive cough responses to radiographically confirmed aspiration. We, therefore, aimed to delineate both sensory and motor responses to a tussigenic airway irritant in individuals with ALS compared to healthy controls. METHODS: Thirty-two individuals with ALS and 34 healthy age and gender-matched controls completed reflex cough testing. Capsaicin stimuli (0, 50, 100, 150, 200 μM) were presented in a randomized three-block design and motor (cough spirometry metrics) and sensory (patient-rated urge to cough, UtC) ratings collected. ALS patients underwent videofluoroscopy with penetration-aspiration ratings completed. Descriptives, Mann-Whitney U, and mixed models ANOVAs were performed. RESULTS: Sensory: Individuals with ALS demonstrated greater UtC sensitivity slopes (i.e., increased stimulus sensitivity) vs. healthy controls (p = 0.036). Within the ALS group, however, silent aspirators (PAS = 8) demonstrated blunted UtC sensitivity slopes compared to ALS patients who did not (PAS ≤ 7, p = 0.0001). Motor: Compared to healthy controls, ALS individuals demonstrated reduced peak expiratory flow rates (p = 0.004), longer peak expiratory rise time (p = 0.017), and lower cough volume acceleration (p = 0.000). CONCLUSIONS: ALS individuals demonstrated increased sensitivity to an upper airway irritant; however, they demonstrated slower and weaker expiratory cough motor output compared to healthy controls. In ALS silent aspirators, blunted sensorimotor responses were observed, suggesting that sensory degradation may occur at the final or most severe stage of bulbar disease progression.
BACKGROUND: Progressive motor denervation in amyotrophic lateral sclerosis (ALS) leads to reduced expiratory cough flow and diminished airway clearance physiologic capacity. Although ALS is thought to primarily impact motor systems, preliminary data from our laboratory suggest degradation of afferent pathways that regulate reflexive cough responses to radiographically confirmed aspiration. We, therefore, aimed to delineate both sensory and motor responses to a tussigenic airway irritant in individuals with ALS compared to healthy controls. METHODS: Thirty-two individuals with ALS and 34 healthy age and gender-matched controls completed reflex cough testing. Capsaicin stimuli (0, 50, 100, 150, 200 μM) were presented in a randomized three-block design and motor (cough spirometry metrics) and sensory (patient-rated urge to cough, UtC) ratings collected. ALSpatients underwent videofluoroscopy with penetration-aspiration ratings completed. Descriptives, Mann-Whitney U, and mixed models ANOVAs were performed. RESULTS: Sensory: Individuals with ALS demonstrated greater UtC sensitivity slopes (i.e., increased stimulus sensitivity) vs. healthy controls (p = 0.036). Within the ALS group, however, silent aspirators (PAS = 8) demonstrated blunted UtC sensitivity slopes compared to ALSpatients who did not (PAS ≤ 7, p = 0.0001). Motor: Compared to healthy controls, ALS individuals demonstrated reduced peak expiratory flow rates (p = 0.004), longer peak expiratory rise time (p = 0.017), and lower cough volume acceleration (p = 0.000). CONCLUSIONS:ALS individuals demonstrated increased sensitivity to an upper airway irritant; however, they demonstrated slower and weaker expiratory cough motor output compared to healthy controls. In ALS silent aspirators, blunted sensorimotor responses were observed, suggesting that sensory degradation may occur at the final or most severe stage of bulbar disease progression.
Authors: Asako Kaneoka; Jessica M Pisegna; Haruhi Inokuchi; Rumi Ueha; Takao Goto; Takaharu Nito; Cara E Stepp; Michael P LaValley; Nobuhiko Haga; Susan E Langmore Journal: Dysphagia Date: 2017-09-02 Impact factor: 3.438
Authors: Karen W Hegland; Michelle S Troche; Alexandra Brandimore; Michael S Okun; Paul W Davenport Journal: Dysphagia Date: 2015-10-23 Impact factor: 3.438
Authors: Katherine A Hutcheson; Martha P Barrow; Carla L Warneke; Yiqun Wang; George Eapen; Stephen Y Lai; Denise A Barringer; Emily K Plowman; Jan S Lewin Journal: Laryngoscope Date: 2017-11-08 Impact factor: 3.325
Authors: Deanna Britton; Joshua O Benditt; Albert L Merati; Robert M Miller; Cara E Stepp; Louis Boitano; Amanda Hu; Marcia A Ciol; Kathryn M Yorkston Journal: Dysphagia Date: 2014-07-19 Impact factor: 3.438
Authors: Ashley A Waito; Emily K Plowman; Carly E A Barbon; Melanie Peladeau-Pigeon; Lauren Tabor-Gray; Kelby Magennis; Raele Robison; Catriona M Steele Journal: J Speech Lang Hear Res Date: 2020-04-18 Impact factor: 2.297
Authors: James C Borders; James A Curtis; Jordanna S Sevitz; Nora Vanegas-Arroyave; Michelle S Troche Journal: Dysphagia Date: 2021-01-30 Impact factor: 3.438