运用OPTIMAL理论优化健康成人和帕金森病患者的呼吸训练空气动力学。

文献信息

中文摘要

背景： OPTIMAL（通过内在动机和注意力优化学习表现）理论是一个运动学习框架，提出优化内在动机可以增强运动表现和学习。该理论确定了三个关键组成部分——增强期望（EE）、自主支持（AS）和外部注意力焦点（EF）——它们促进更高效、目标导向的运动。这些组成部分已被证明可以改善肢体任务中的运动结果；然而，它们在呼吸训练中的应用，特别是在帕金森病（pwPD）患者的声音和吞咽治疗等临床环境中，尚未得到系统探索。
目的： 本研究旨在调查在呼吸肌力量训练（RMST）任务中实施OPTIMAL理论策略是否能改善健康成人和pwPD的即时呼吸运动表现。此外，我们旨在检查这些策略对动机和认知参与的影响。
方法： 这项准随机、单次试验包括47名参与者：健康对照组（n = 17）、健康OPTIMAL组（n = 16）和PD OPTIMAL组（n = 14）。健康参与者被准随机分配到干预或对照条件，而pwPD仅完成干预。所有参与者完成了一次呼吸训练，包括基线、练习和保留阶段。结果测量包括峰值呼气流速、咳嗽峰值呼气流速、认知参与（基于脑电图的认知参与指数）和自我报告的动机问卷。
结果： 健康OPTIMAL组的呼气力量从基线到保留阶段有所改善（基线：M = 296 L/min；保留：M = 338 L/min；p < 0.001），PD OPTIMAL组也有所改善（基线：M = 315 L/min；保留：M = 370 L/min；p < 0.0001），但健康对照组没有改善（p > 0.05）。在任何组中均未观察到咳嗽强度的显著变化。认知参与与呼气力量或动机评分之间未发现相关性。然而，健康OPTIMAL组（问卷1：M = 57.2；问卷2：M = 60.7）和PD OPTIMAL组（问卷1：M = 60.1；问卷2：M = 62.8）的动机增加幅度大于健康对照组（问卷1：M = 61.1；问卷2：M = 62.5）。
结论： 实施OPTIMAL理论可增强健康参与者和pwPD的即时呼吸运动表现。OPTIMAL理论在声音和吞咽治疗中具有临床价值，尽管需要进一步研究以确定长期疗效和临床影响。
本文新增内容： 关于该主题已知的内容：动机是康复中的关键因素。OPTIMAL理论已被证明可以改善肢体任务中的动机和运动表现。然而，其对呼吸训练的影响此前尚未被研究。本文对现有知识的新增内容：本研究表明，在呼吸肌力量训练任务中应用OPTIMAL策略显著改善了健康成人和帕金森病患者的峰值呼气流速。这项工作的潜在或临床意义是什么？将OPTIMAL理论原则整合到呼吸治疗中可能会增强运动结果，支持声音、吞咽和咳嗽康复。

英文摘要

BACKGROUND: The OPTIMAL (Optimizing Performance Through Intrinsic Motivation and Attention for Learning) theory is a motor learning framework proposing that optimizing intrinsic motivation enhances motor performance and learning. The theory identifies three key components-Enhanced Expectancies (EE), Autonomy Support (AS) and External Focus of Attention (EF)-which facilitate more efficient, goal-directed movement. These components have been shown to improve motor outcomes in limb-based tasks; however, their application to respiratory training, particularly in clinical contexts such as voice and swallowing therapy in patients with Parkinson's disease (pwPD), has not yet been systematically explored.
AIMS: This study aimed to investigate whether implementing OPTIMAL theory strategies during a respiratory muscle strength training (RMST) task improves immediate respiratory motor performance in healthy adults and pwPD. Additionally, we aimed to examine the effects of these strategies on motivation and cognitive engagement.
METHODS: This quasi-randomized, single-session trial included 47 participants: Healthy CONTROL (n = 17), Healthy OPTIMAL (n = 16) and PD OPTIMAL (n = 14). Healthy participants were quasi-randomly assigned to either intervention or control conditions, whereas pwPD completed the intervention only. All participants completed a single respiratory session that included baseline, practice and retention phases. Outcome measures included peak expiratory flow, cough peak expiratory flow, cognitive engagement (EEG-based Cognitive Engagement Index) and self-administered motivation questionnaire.
OUTCOMES AND RESULTS: Exhalation force improved from baseline to retention in the Healthy OPTIMAL group (baseline: M = 296 L/min; retention: M = 338 L/min; p < 0.001) and the PD OPTIMAL group (baseline: M = 315 L/min; retention: M = 370 L/min; p < 0.0001), but not in the Healthy CONTROL group (p > 0.05). No significant changes in cough strength were observed in any group. No correlations were found between cognitive engagement and exhalation force or motivation scores. However, motivation increased more in the Healthy OPTIMAL group (Questionnaire 1: M = 57.2; Questionnaire 2: M = 60.7) and the PD OPTIMAL group (Questionnaire 1: M = 60.1; Questionnaire 2: M = 62.8) than in the Healthy CONTROL group (Questionnaire 1: M = 61.1; Questionnaire 2: M = 62.5).
CONCLUSIONS AND IMPLICATIONS: Implementing the OPTIMAL theory enhances immediate respiratory motor performance in both healthy participants and pwPD. OPTIMAL theory has clinical value in voice and swallowing therapy, although further research is needed to establish long-term efficacy and clinical impact.
WHAT THIS PAPER ADDS: What is already known on the subject Motivation is a critical factor in rehabilitation. The OPTIMAL theory has been shown to improve both motivation and motor performance in limb-based tasks. Its impact on respiratory training, however, has not been previously examined. What this paper adds to the existing knowledge This study shows that applying OPTIMAL strategies during a respiratory muscle strength training task significantly improved peak expiratory flow in both healthy adults and people with Parkinson's disease. What are the potential or clinical implications of this work? Integrating the OPTIMAL theory principles into respiratory therapy may enhance motor outcomes, supporting voice, swallowing and cough rehabilitation.