Motivation strategies may boost lung rehabilitation in Parkinson’s
Study: OPTIMAL model shows promise for improving patient engagement
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- Parkinson's disease affects lung function and can lead to difficulty feeling motivated without help.
- It is important to incorporate strategies that enhance motivation in these patients during rehabilitation.
- Incorporating motivation-focused strategies significantly enhanced breathing performance.
Incorporating a theory focused on maximizing patients’ motivation may enhance the effectiveness of rehabilitation aimed at improving lung function in people with Parkinson’s disease, according to a new study.
“This study provides initial evidence that incorporating strategies [to maximize motivation] into respiratory training can enhance [lung function outcomes] in both healthy individuals and [people with Parkinson’s],” researchers wrote, adding that these findings “underscore the potential of motivational and attentional strategies to improve respiratory motor performance in respiratory tasks.”
The study, “Using the OPTIMAL Theory to Optimize Aerodynamics in Respiratory Training for Healthy Adults and Individuals With Parkinson’s Disease,” was published in the International Journal of Language and Communication Disorders.
OPTIMAL emphasizes participants’ expectations of improvement
Respiratory rehabilitation involves exercises that aim to strengthen the muscles responsible for pulling air in and out of the lungs. This type of therapy is commonly administered to help improve breathing ability among people with Parkinson’s.
When people are participating in any type of training, motivation plays a key role in how they perform. Motivation can be broadly conceptualized as either external — seeking to achieve something outside oneself, such as an award — or intrinsic, where the focus is on personal improvement and achievement.
A decade ago, researchers proposed a theoretical framework called Optimizing Performance Through Intrinsic Motivation and Attention for Learning, or OPTIMAL, that aims to maximize intrinsic motivation during rehabilitation. The theory emphasizes participants’ expectations of improvement, increases autonomy and choice, and directs focus toward the intended outcome rather than experiences within the body itself.
The OPTIMAL framework was originally developed for use during physical therapy aimed at strengthening the limbs. In this study, researchers wanted to see if the theory could also be applied to respiratory therapy in people with or without Parkinson’s. They noted that motivation-focused therapy may be especially useful for Parkinson’s patients because the disease’s effects on the brain often lead to difficulty feeling motivated without help.
Lung function measure improved in groups using motivational model
The study enrolled 33 healthy participants and 14 people with Parkinson’s. All participants underwent a 45- to 60-minute respiratory rehabilitation session, with lung function measured at the beginning and end of the session.
All of those with Parkinson’s received rehab using an OPTIMAL framework, where the therapist would provide guidance using the theory to maximize motivation. Half of the healthy participants also underwent rehab with the OPTIMAL framework. The other half underwent rehab with the therapist maintaining a neutral affect instead of using the motivation-focused framework.
Results showed that peak expiratory flow — that is, how quickly air can be blown out of the lungs — increased significantly after the therapy session in both healthy people and Parkinson’s patients who received therapy using the OPTIMAL framework. But in the control group that did not receive motivation-focused rehab, peak expiratory flow did not significantly improve over the course of the therapy session.
Both groups that underwent the OPTIMAL intervention — the healthy participants and those with [Parkinson’s] — showed improved respiratory performance … whereas no such changes were observed in the control group. In addition, both intervention groups demonstrated increased motivation and cognitive engagement.
Measures of motivation and cognitive engagement — assessed via questionnaires and brain activity sensors during rehab, respectively — showed overall improvements among participants receiving OPTIMAL-based rehabilitation, though statistically significant gains in motivation were observed only in healthy participants. Additionally, cognitive engagement remained lower overall in the Parkinson’s group compared to controls. Other measures, such as tests of cough strength, did not show notable improvements, which the researchers said “may be due to the brief, single-session nature of the intervention.”
“Overall, the findings reveal a consistent pattern across outcomes. Both groups that underwent the OPTIMAL intervention — the healthy participants and those with [Parkinson’s] — showed improved respiratory performance … whereas no such changes were observed in the control group. In addition, both intervention groups demonstrated increased motivation and cognitive engagement,” the researchers concluded.
These data indicate “that the OPTIMAL strategies … can improve respiratory motor performance, extending the relevance of the theory beyond limb-based tasks,” they added.
The researchers noted that this study was limited to a small number of people, so the results should be interpreted with appropriate caution. Still, they said their findings highlight the importance of considering participants’ motivation when delivering all types of rehabilitation therapies.
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