Expiratory muscle strength training improves swallowing and respiratory outcomes in people with dysphagia: A systematic review

Brooks, Marinda; McLaughlin, Emma; Shields, Nora

doi:10.1080/17549507.2017.1387285

Cited by 29 publications

(27 citation statements)

References 26 publications

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“…This important feature would make ToTo a unique easy-to-use point-of-care tool for tongue rehabilitation, potentially synergistically coupled with other intra-oral devices (e.g., Abilex*), in patients without any specific neural disorder. In contrast, namely when apraxia occurs, patients are not able to intentionally use the tongue musculature, and ToTo may be used in combination with other approaches, such as the expiratory muscle strength training, usually employed in this scenario [21].…”

Section: Discussionmentioning

confidence: 99%

Tongue Rehabilitation Device for Dysphagic Patients

Milazzo

Panepinto

Sabatini

et al. 2019

Sensors

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Dysphagia refers to difficulty in swallowing often associated with syndromic disorders. In dysphagic patients’ rehabilitation, tongue motility is usually treated and monitored via simple exercises, in which the tongue is pushed against a depressor held by the speech therapist in different directions. In this study, we developed and tested a simple pressure/force sensor device, named “Tonic Tongue (ToTo)”, intended to support training and monitoring tasks for the rehabilitation of tongue musculature. It consists of a metallic frame holding a ball bearing support equipped with a sterile disposable depressor, whose angular displacements are counterbalanced by extensional springs. The conversion from angular displacement to force is managed using a simple mechanical model of ToTo operation. Since the force exerted by the tongue in various directions can be estimated, quantitative assessment of the outcome of a given training program is possible. A first prototype of ToTo was tested on 26 healthy adults, who were trained for one month. After the treatment, we observed a statistically significant improvement with a force up to 2.2 N (median value) in all tested directions of pushing, except in the downward direction, in which the improvement was slightly higher than 5 N (median value). ToTo promises to be an innovative and reliable device that can be used for the rehabilitation of dysphagic patients. Moreover, since it is a self-standing device, it could be used as a point-of-care solution for in-home rehabilitation management of dysphasia.

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Section: Discussionmentioning

confidence: 99%

Tongue Rehabilitation Device for Dysphagic Patients

Milazzo

Panepinto

Sabatini

et al. 2019

Sensors

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“…forces deployed at the mouth to train muscles involved in forceful expiration. It has been shown to improve subglottic air pressure generation and airway clearance abilities in several groups of people living with neurological disease including stroke [15] and Parkinson's disease [16,17] as well improve aspects of swallowing [15,16] Data from these studies showed that EMST improved strength of the trained muscles, improved airway safety during swallowing in people with dysphagia, was well tolerated, and safe [18].…”

Section: Expiratory Muscle Strength Training (Emst) Is An Exercise Technique Which Uses Resistivementioning

confidence: 99%

Expiratory muscle strength training improves measures of pressure generation and cough strength in a patient with myotonic dystrophy type 1

Allen

Astin

Smith

et al. 2020

Neuromuscular Disorders

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Expiratory muscle strength training (EMST) exercise programmes aim to improve respiratory function by increasing the force generating capability of expiratory muscles by resistance training. In neuromuscular conditions, in which cough flow generation is often decreased, there is increasing interest in EMST as a therapeutic intervention. We present data showing efficacy of EMST in a patient with adult onset Myotonic Dystrophy Type 1 (DM1). A domiciliary training programme (5 days per week over 32 weeks) resulted in increases in maximum expiratory mouth pressure (from 15cmH 2 O to 38cmH 2 O) and peak cough flow (300L/min to 390L/min). Improvements were also seen in maximum inspiratory mouth pressure (26cmH 2 O to 52cmH 2 O) and sniff nasal inspiratory pressure (40cmH 2 O to 69cmH 2 O). No changes were detected in speech or swallowing. This novel study demonstrates that cough flow generation in DM1 may be increased by a programme of expiratory muscle training. A clinical trial of EMST in DM1 is warranted.

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“…[8][9][10][11] Within the past years, few studies indicated a potential benefit in swallowing function by performing expiratory muscle strength training (EMST) with the goal of increasing force generation capacity of pharyngeal muscles. [12][13][14] Regarding swallowing dysfunction in PD, 1 randomized, controlled trial was able to show that a 4-week EMST could improve swallowing safety with positive, albeit mild effects on the penetrationaspiration scale, 15 measured by videofluoroscopic swallow study. Furthermore, a potential detraining effect was described.…”

Section: Introductionmentioning

confidence: 99%

Expiratory Muscle Strength Training for Therapy of Pharyngeal Dysphagia in Parkinson's Disease

et al. 2021

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A BS TRACT: Background: Pharyngeal dysphagia in Parkinson's disease (PD) is a common and clinically relevant symptom associated with poor nutrition intake, reduced quality of life, and aspiration pneumonia. Despite this, effective behavioral treatment approaches are rare. Objective: The objective of this study was to verify if 4 week of expiratory muscle strength training can improve pharyngeal dysphagia in the short and long term and is able to induce neuroplastic changes in cortical swallowing processing. Methods: In this double-blind, randomized, controlled trial, 50 patients with hypokinetic pharyngeal dysphagia, as confirmed by flexible endoscopic evaluation of swallowing, performed a 4-week expiratory muscle strength training. Twenty-five participants used a calibrated ("active") device, 25 used a sham handheld device. Swallowing function was evaluated directly before and after the training period, as well as after a period of 3 month using flexible endoscopic evaluation of swallowing. Swallowing-related cortical activation was measured in 22 participants (active: sham; 11:11) using whole-head magnetencephalography. Results: The active group showed significant improvement in the flexible endoscopic evaluation of swallowing-based dysphagia score after 4 weeks and after 3 months, whereas in the sham group no significant changes from baseline were observed. Especially, clear reduction in pharyngeal residues was found. Regarding the cortical swallowing network before and after training, no statistically significant differences were found by magnetencephalography examination. Conclusions: Four-week expiratory muscle strength training significantly reduces overall dysphagia severity in PD patients, with a sustained effect after 3 months compared with sham training. This was mainly achieved by improving swallowing efficiency. The treatment effect is probably caused by peripheral mechanisms, as no changes in the cortical swallowing network were identified.

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Expiratory muscle strength training improves swallowing and respiratory outcomes in people with dysphagia: A systematic review

Abstract: Speech-language pathologists might consider using expiratory muscle strength training to improve airway safety in adults with swallowing disorders.

Cited by 29 publications

References 26 publications

Tongue Rehabilitation Device for Dysphagic Patients

Tongue Rehabilitation Device for Dysphagic Patients

Expiratory muscle strength training improves measures of pressure generation and cough strength in a patient with myotonic dystrophy type 1

Expiratory Muscle Strength Training for Therapy of Pharyngeal Dysphagia in Parkinson's Disease

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