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Expiratory Muscle Strength Training
Transcript of Expiratory Muscle Strength Training
Increases in Suprahyoid Muscle Activity at 25% and 75% of Max Expiratory Pressure
(Burkhead, Sapienza, & Rosenbek, 2007)
No standardized protocol currently exists
Most experimental protocols range from 4-8 weeks. However, one 20 wk protocol was identified
1-6 days/week, 1x to 3x daily
Sessions of 10-30 minutes
Threshold ranges between 25% and 80% of PE Max
Load increase of 5% to 10% per cycle
EMST can be summarized as a respiratory/swallowing exercise that utilizes progressive resistance to maximize gains
Swallowing is submaximal activity: utilizing effort far below max force of associated musculature
In order to increase force of musculature involved, physiological load must exceed typical demand
Most swallowing exercises are unable to utilize quantifiable or progressive resistance
IOPI & EMST are current exemptions
Pt's exhale into a 1 way pressure release valve w/ an adjustable threshold
Improves swallow "through afferent stimulation to brain stem swallowing centers through peripheral sensory receptors in the tongue and oropharynx and by by strengthening oropharyngeal, laryngeal, and supralaryngeal muscles involved in swallowing" (Kim & Sapienza, 2005)
(Burkhead, Sapienza, & Rosenbek, 2007)
Effects on Cough and Swallow
With improved cough function, incidence of pneumonia decreased
Kojima et al. demonstrated improved cough function following EMST training by increased sputum weight
Chiara et al.: Participants w/ MS expressed positive improvements in cough and secretion management
Troche et al. used VFSS to investigate changes in swallow in pt's with PD
Participants had significantly decreased peneration/aspiration scores
Improvements were observed in hyolaryngeal movement
Effects on Expiratory Muscle Strength & Endurance
Weiner et al.
21% increase in max expiratory pressure in pt's with COPD
Increase in expiratory muscle endurance
19% increase in distance walked
Improvements in respiratory strength benefit multiple areas of activity
Saleem et al.
158% increase in in PE max from baseline in individual w/ Parkinson's Disease following 20 week program
Following 4 weeks detraining only 16% drop was observed
Dysphagia Management in Acute Care
(Laciuga, Rosenbek, Davenport, & Sapienza, 2014)
Effects on Speech
Jones et al.
Participants with Lance-Adams Syndrome demonstrated increased max phonation time, intelligibility, and communication effectiveness survey scores following EMST treatment
Chiara et al.
Participants with Multiple Sclerosis had improvements in sustained vowel prolongation, words per minute
Changes in Dysarthria were not significant
Indications and Contraindications
EMST has been established as a safe treatment in individuals with COPD, MS, PD, healthy persons, and professional voice users
The maker's of EMST 150 suggest that until intrathoracic and intracranial pressures are further examined pt's with acute cardiovascular concerns and CVA may not be candidates (emst150.com, 2014)
No adverse effects have been observed with EMST in populations studied
Pressures developed with respiratory training are lower than those produced by bowel movements or coughs
Laciuga et al. tested cardiovascular response to EMST in healthy individuals
No significant changes in blood pressure, heart rate, or SpO2 were observed
Anecdotal: In pt w/ impaired respiratory status, SpO2 was observed to drop significantly following minimal EMST training
A pilot study by Kulnik, Rafferty, Birring, Moxham, and Kalra is currently investigating EMST training in Acute stroke related to reduced pneumonia incidence
Respiratory Training Devices
48 Units: $2,039
Settings from 30 ml H2O
to 150 ml H20
10 units per case
20 levels of resistance
Case of 10: $33.75 ea
4 Levels Expiratory Resistance
5 Levels Insp. Resistance
Constant resistance provided during expiration
Acapella- Vibratory PEP Device
2 levels of resistance available
Helps to break up secretions
Lower resistance level for high level of debility
Burkhead, L. M., Sapienza, C. M., & Rosenbek, J. C. (2007).
Strength-training exercise in dysphagia rehabilitation: principles, procedures, and directions for future research. Dysphagia, 22(3), 251-265.
Chiara, T., Martin, A. D., Davenport, P. W., & Bolser, D. C. (2006).
Expiratory muscle strength training in persons with multiple sclerosis having mild to moderate disability: effect on maximal expiratory pressure, pulmonary function, and maximal voluntary cough. Archives of physical medicine and rehabilitation, 87(4), 468-473.
Jones, H. N., Donovan, N. J., Sapienza, C. M., Shrivastav, R., Fernandez, H. H., & Rosenbek, J.
C. (2006). Expiratory muscle strength training in the treatment of mixed dysarthria in a patient with Lance-Adams syndrome. JOURNAL OF MEDICAL SPEECH LANGUAGE PATHOLOGY, 14(3), 207.
Kojima, H., Yamada, T., Takeda, M., Itou, Y., Yoshida, M., & Kimura, M. (2006).
Effectiveness of cough exercise and expiratory muscle training: a meta-analysis. Journal of Physical Therapy Science, 18(1), 5-10.
Kulnik, S. T., Rafferty, G. F., Birring, S. S., Moxham, J., & Kalra, L. (2014).
A pilot study of respiratory muscle training to improve cough effectiveness and reduce the incidence of pneumonia in acute stroke: study protocol for a randomized controlled trial. Trials, 15(1), 123.
Laciuga H., Davenport P., Sapienza C. (2012). The acute effects of a single session of
expiratory muscle strength training on blood pressure, heart rate, and oxygen saturation in healthy adults. Front. Physio. 3:48 10.3389/fphys.2012.00048
Saleem AF, Sapienza CM, Okun MS. Respiratory muscle strength training: Treatment and response
duration in a patient with early idiopathic Parkinson’s disease. NeuroRehabilitation. 2005;20(4):323–33.
Troche M., Okun M., Rosenbek J., Musson N., Sapienza C. (2009).
Swallow outcomes following intervention with expiratory muscle strength training (Emst) in Parkinson’s disease: results of a randomized clinical trial. Dysphagia 24, 455–456
Weiner P, Magadle R, Beckerman M, Weiner M, Berar-Yanay N. Comparison of specific expiratory,
inspiratory, and combined muscle training programs in COPD. Chest. 2003;124(4):1357–64.