Respiratory muscle training (RMT) is a relatively inexpensive and effective way to improve swallowing for certain patients. RMT targets the muscles involved with respiration, which can improve breathing, cough function, and speech. Research also shows that RMT can also improve swallowing ability. The primary source of the information presented here is Foundations of Respiratory Muscle Training: Dysphagia Therapy* by Brooke Richardson. You can also find a short list of podcast episodes, a tutorial, blog articles, and journal articles.
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Free DIRECT download: EMST and dysphagia (cheat sheet). (Email subscribers get free access to all the resources in the Free Subscription Library.)
Outline:
- What is respiratory muscle training (RMT)?
- How can expiratory muscle strength training (EMST) improve swallowing?
- Who may be a good candidate for EMST?
- What are the two types of EMST devices?
- Where can I learn more?
- Related Eat, Speak, & Think posts.
What is respiratory muscle training (RMT)?
Respiratory muscle training (RMT) involves an exercise program that seeks to improve the function of the respiratory system. RMT may involve expiratory muscle strength training, inspiratory muscle strength training, or both. This post focuses on expiratory muscle strength training or EMST.
EMST follows principles of strength training to improve the force, power, and endurance of the muscles used during exhalation.
How can expiratory muscle strength training (EMST) improve swallowing ability?
Research is ongoing, but the evidence we have indicates that EMST can have the following effects on the submental musculature:
- Increased and prolonged activation of submental musculature.
- Improved hyolaryngeal movement.
- Increased geniohyoid muscle mass.
EMST can improve airway protection, swallowing efficiency, and UES opening.
Who may be a good candidate for EMST?
In dysphagia treatment, EMST may be an appropriate intervention for people who have any of the following impairments:
- Reduced hyolaryngeal excursion.
- Penetration/aspiration during or after the swallow.
- Reduced UES opening.
it’s important to consider the cause of the dysphagia. We have evidence for the use of EMST to improve or maintain swallowing ability for people who have:
- ALS (amytrophic lateral sclerosis).
- COPD (chronic obstructive pulmonary disease).
- Head & neck cancer.
- Parkinson’s disease.
- Stroke.
What are the two types of EMST devices?
There are two types of EMST training devices: pressure threshold and resistive devices.
Pressure-threshold devices are precisely calibrated. If the device is set at 30 cmH2O, then your patient has to generate at least that much pressure to open the valve and allow air to pass through the device. The EMST-150* is one pressure-threshold device on the market.
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The other type of device that could be used for EMST is a resistive device, such as The Breather*. However, resistive devices have a drawback compared to pressure-threshold devices.
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Resistive devices do not offer a way to guarantee adequate exercise. They are what is called “flow dependent”, meaning that the amount of force required to breathe through the device changes, depending on how fast or slowly your patient exhales.
You can experience this for yourself if you have a straw with a very small diameter, like a coffee stirrer. Take a deep breath, then breath through the straw as quickly as you can. Then take another deep breath, but this time breath through the straw as slowly as you can. Notice a difference in your effort level?
Where can I learn more?
Brooke Richardson talks more about EMST on the Speech Uncensored podcast. You can also check out her courses on MedBridge:
- Foundations of Respiratory Muscle Training: Rehab Principles*.
- Foundations of Respiratory Muscle Training: Dysphagia Therapy*.
*This is an affiliate link. At no extra cost to you, you can help keep Eat, Speak, & Think sustainable if you subscribe through this link or use the code EatSpeakThink. Learn more about the discount.
The co-creator of the EMST-150 device, Dr. Christine Sapienza talks about the creation of the device on the Swallow Your Pride podcast. Dr. Sapienza begins talking about the difference between pressure-threshold devices and resistive devices at 31:00.
Dr. James Curtis (SLP) has a tutorial for EMST on his website, with videos. He also discusses pressure-threshold vs resistive devices.
Search ASHA’s Evidence Maps to find research on EMST. For instance, you can read the summaries of Expiratory Muscle Strength Training Improves Swallowing and Respiratory Outcomes in People with Dysphagia: A Systematic Review or Effect of Expiratory Muscle Strength Training on Swallowing and Cough Functions in Patients with Neurological Diseases: A Meta-Analysis.
Dysphagia Cafe explains the science behind EMST, research, and how to use it in therapy.
SLP Research & Review gives great summaries of research, including this one about EMST and drooling in Parkinson’s.
Related Eat, Speak, & Think posts
- ALS guide for speech-language pathologists.
- The SLP’s quick guide to dysphagia in COPD.
- 10 factors that increase risk of aspiration pneumonia.
Featured image by kaboompics from pixabay.
Free DIRECT download: EMST and dysphagia (cheat sheet). (Email subscribers get free access to all the resources in the Free Subscription Library.)
Lisa earned her M.A. in Speech-Language Pathology from the University of Maryland, College Park and her M.A. in Linguistics from the University of California, San Diego.
She participated in research studies with the National Institute on Deafness and other Communication Disorders (NIDCD) and the University of Maryland in the areas of aphasia, Parkinson’s Disease, epilepsy, and fluency disorders.
Lisa has been working as a medical speech-language pathologist since 2008. She has a strong passion for evidence-based assessment and therapy, having earned five ASHA Awards for Professional Participation in Continuing Education.
She launched EatSpeakThink.com in June 2018 to help other clinicians be more successful working in home health, as well as to provide strategies and resources to people living with problems eating, speaking, or thinking.
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