F024 A single-case study of the provision of expiratory muscle strength training via telehealth for a male with mid-stage Huntington’s disease

<h3>Background</h3> Emerging evidence supports the use of Expiratory Muscle Strength Training (EMST) to treat swallowing, speech, and voice disorders in neurological conditions. Interventions in Huntington’s disease (HD) are limited. The COVID-19 pandemic limited in-person interventions, so this study assessed the efficacy of EMST in HD and telehealth service delivery. <h3>Case history</h3> A 75-year-old male with mid-stage HD, a history of aspiration pneumonia requiring hospital admission, and left subdural haematoma managed with burr hole surgery trialled EMS T. P1 transitioned to L2 mildly thickened fluids 12 months prior to intervention. A single pre- and post-intervention case study used the Repetitive Saliva Swallow Test, Swallow Quality of Life scale, maximum expiratory pressure (MEP), and an unstandardised Timed Water Swallow Test with L2 mildly thickened fluids. Videofluoroscopy (VFSS) was conducted pre-intervention and at week 14. Five EMST sessions were conducted per week for five weeks with follow-up at week six. The 12-week maintenance phase was abandoned after P1 developed unrelated elevated intraocular pressure. <h3>Conclusions</h3> EMST was efficacious in a highly motivated individual with HD, but telehealth delivery was inadequate. A support person is recommended to maintain compliance and manage device calibration. MEP improved from 52.5cm H20 to 60cm H20. Swallows per minute reduced; 12 to 9. Mean seconds-per-swallow reduced; 5.33 to 2.64. Subjective improvements were reported for cough strength, breath support control, confidence at mealtimes, and reduced drooling. VFSS showed improvement and recommended upgrading to L0 thin fluids. Future research should include a randomised controlled trial and validation of assessment tools across HD stages.