{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T11:15:54Z","timestamp":1790162154557,"version":"4.1.0"},"reference-count":56,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Lang &amp; Comm Disor"],"published-print":{"date-parts":[[2026,9]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n 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\u2014Enhanced Expectancies (EE), Autonomy Support (AS) and External Focus of Attention (EF)\u2014which facilitate more efficient, goal\u2010directed movement. These components have been shown to improve motor outcomes in limb\u2010based 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.<\/jats:p>\n <\/jats:sec>\n \n Aims<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This quasi\u2010randomized, single\u2010session trial included 47 participants: Healthy CONTROL (\n n<\/jats:italic>\n = 17), Healthy OPTIMAL (\n n<\/jats:italic>\n = 16) and PD OPTIMAL (\n n<\/jats:italic>\n = 14). Healthy participants were quasi\u2010randomly 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\u2010based Cognitive Engagement Index) and self\u2010administered motivation questionnaire.\n <\/jats:p>\n <\/jats:sec>\n \n Outcomes and Results<\/jats:title>\n \n Exhalation force improved from baseline to retention in the Healthy OPTIMAL group (baseline:\n M<\/jats:italic>\n = 296 L\/min; retention:\n M<\/jats:italic>\n = 338 L\/min;\n p<\/jats:italic>\n < 0.001) and the PD OPTIMAL group (baseline:\n M<\/jats:italic>\n = 315 L\/min; retention:\n M<\/jats:italic>\n = 370 L\/min;\n p<\/jats:italic>\n < 0.0001), but not in the Healthy CONTROL group (\n p<\/jats:italic>\n > 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:\n M<\/jats:italic>\n = 57.2; Questionnaire 2:\n M<\/jats:italic>\n = 60.7) and the PD OPTIMAL group (Questionnaire 1:\n M<\/jats:italic>\n = 60.1; Questionnaire 2:\n M<\/jats:italic>\n = 62.8) than in the Healthy CONTROL group (Questionnaire 1:\n M<\/jats:italic>\n = 61.1; Questionnaire 2:\n M<\/jats:italic>\n = 62.5).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Implications<\/jats:title>\n 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\u2010term efficacy and clinical impact.<\/jats:p>\n <\/jats:sec>\n \n WHAT THIS PAPER ADDS<\/jats:title>\n \n What is already known on the subject<\/jats:italic>\n \n \n Motivation is a critical factor in rehabilitation. The OPTIMAL theory has been shown to improve both motivation and motor performance in limb\u2010based tasks. Its impact on respiratory training, however, has not been previously examined.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n \n What this paper adds to the existing knowledge<\/jats:italic>\n \n \n 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.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n \n What are the potential or clinical implications of this work?<\/jats:italic>\n \n \n Integrating the OPTIMAL theory principles into respiratory therapy may enhance motor outcomes, supporting voice, swallowing and cough rehabilitation.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/1460-6984.70329","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T07:50:28Z","timestamp":1788853828000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Using the OPTIMAL Theory to Optimize Aerodynamics in Respiratory Training for Healthy Adults and Individuals With Parkinson's Disease"],"prefix":"10.1111","volume":"61","author":[{"given":"Lyle","family":"Tadmor","sequence":"first","affiliation":[{"name":"Department of Neurology, Faculty of Medicine and University Hospital Cologne University of Cologne Germany"},{"name":"IfL Phonetics, Faculty of Arts and Humanities University of Cologne Germany"},{"name":"Department of Communication Sciences and Disorders University of Haifa Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avia","family":"Gvion","sequence":"additional","affiliation":[{"name":"Department of Communication Sciences and Disorders Ono Academic College Israel"},{"name":"Reuth TLV Rehabilitation Hospital Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oshrat Sella","family":"Weiss","sequence":"additional","affiliation":[{"name":"Department of Communication Sciences and Disorders University of Haifa Israel"},{"name":"Schneider Children's Medical Center Petah Tikva Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/1612197X.2020.1854823"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.27902"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.humov.2020.102708"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1155\/2017\/9071568"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102466\u20106\u201014"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1044\/2021_JSLHR\u201021\u201000308"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.3758\/s13415\u2010014\u20100300\u20100"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2004.09.006"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102788.2012.01569.x"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gaitpost.2011.12.003"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cortex.2015.04.003"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.humov.2018.05.006"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/ejn.14723"},{"issue":"1","key":"e_1_2_10_15_1","first-page":"35","article-title":"Facilitating Neurorehabilitation Through Principles of Engagement","volume":"41","author":"Danzl M. 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