Eligibility CriteriaInclusion criteria Presence of neurogenic dysphagia Presence of impaired cough function
Exclusion criteria Episodes of acute pneumonia or diagnosis of pulmonary embolism at time of enrollment.
Previous history of chronic respiratory dysfunction or other systemic disorders that may impair respiratory function (ex,rheumatoid arthritis, chronic renal disorder, spinal cord injury) Episodes of diaphragm weakness due to peripheral polyneuropathy or phrenic nerve injury Concomitant diagnosis of myopathy, muscular dystrophy, or other neurodegenerative disorders.
Episodes of rib fracture within one year of enrollment. Chronic alcoholism Diagnosis of bullous emphysema Diagnosis of chronic renal failure