Expiratory Muscle Strength Training (EMST)- An Overview

Expiratory Muscle Strength Training (EMST) or Respiratory Muscle Strength Training (RMST) can be used for with many people who experience abnormal respiratory function.

Respiratory challenges greatly impact activities of daily living and result in reduced breath support required for speech production and swallowing.

Conditions supported by EMST include stroke, Myasthenia Gravis, Multiple Sclerosis, Parkinson’s Disease, Sleep Apnea, Dysphagia, vocal fold pathologies and Motor Neurons Disease.

EMST targets a number of muscles of the upper respiratory tract - including the abdominal and intercostal muscles, muscles under the chin (which assist to move the larynx), muscles that assist with vocal fold movement and muscles of the soft palate, pharynx and larynx.

EMST has been proven to be extremely effective, resulting in a number of clinical outcomes:

· Strengthens both inspiratory and expiratory muscles

· Supports diaphragmatic breathing

· Supports movement of the hyolaryngeal complex

· Improves protective cough

· Assists with airway clearance

· Reduces shortness of breath

· Improves airflow through the vocal folds

How does EMST work?

EMST uses a pressure threshold device. Inside the device, there is a valve which you can change to increase or decrease the pressure

How does EMST improve Speech Pathology Goals?

1. Improved Cough Function Coughing plays an important role in expelling foreign substances, or excessive mucus, from the airway through the production of forced expiratory airflows. Coughing is controlled by coordinated activity of various respiratory muscles. EMST results in improved cough airflow production. Coughing prevents food and drink from going into the lungs (aspiration) which lead to pneumonia (aspiration pneumonia) which is a life threatening condition. EMST therefore reduces the risk of developing Aspiration Pneumonia.

2. Reduce symptoms of shortness of breath

3. Improve swallow safety by activating and strengthening muscles to coordinate a safe swallow, including increase in hyolaryngeal displacement, increase upper Esophageal sphincter opening (UES) duration

4. Improved speech production. EMST assists to generate greater subglottic pressure (pressure under the vocal folds) to enable production of louder voice.

5. Improved speech breathing

(Darling-White & Huber, 2017) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5945060/

Final considerations and summary of EMST

1. There is very strong evidence to suggest that it works

2. The program is simple and requires approximately 20-30 minutes of training 5 days a week

3. Can be performed seated

4. Effects continues after the program has finished

5. EMST is fairly cost effective, with less one-on-one Speech Pathology input / time

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Darling-White, M., & Huber, J. E. (2017). The Impact of Expiratory Muscle Strength Training on Speech Breathing in Individuals With Parkinson's Disease: A Preliminary Study. American journal of speech-language pathology, 26(4), 1159–1166. https://doi.org/10.1044/2017_AJSLP-16-0132