Expiratory Muscle Training for Swallowing Therapy (How to Improve Dysphagia)
Dysphagia is a medical term used to describe difficulty swallowing. Causes of dysphagia include but are not limited to: Parkinson’s disease, spinal cord injuries, stroke, ALS, and sudden neurological damage. There is evidence that shows that application of exercise physiology in therapies can improve deglutition (the act of swallowing); specifically expiratory muscle strength training.
The effects of EMST (Expiratory Muscle Strength Training) have been shown to increase the strength of respiratory muscles for improving cough, voice and swallow functions. EMST is conducted through breathing exercises and more effectively by using breathing exercisers like Expand-A-Lung. The Expand-A-Lung uses the principles of resistance based training to provide variable resistance on both the inhale and the exhale. So as your respiratory muscles become stronger you can change the resistance setting to make the exercise more challenging and continue to strengthen the muscles that help us cough and swallow.
Swallowing rehabilitation aims to improve neuromuscular plasticity (shaping the connection between our brains and our muscles) to obtain long-term imporvements in function through rehabilitative exercises. EMST (Expiratory Muscle Strength Training) is very effective in improving neuromuscular plasticity for swallowing rehab because it incorporates intensity, repetition, resistance, specificity and overload. These principles are applicable to both peripheral (muscle) and central (neural) plasticity.
Like any other exercise program muscles need to be challenged beyond typical activity in order to promote neuromuscular adaptations to improve function. EMST (Expiratory Muscle Strength Training) can help improve swallowing and coughing functions by incorporating intensity (through resistance), and repetition all of which can be trained using the Expand-A-Lung with particular focus and a slow and elongated exhale with every repetition. To improve swallowing function it is recommended that you use your Expand-A-Lung four to five times a week completing 2-4 sets of 10 repetitions. The force required for the exhalation caused by the resistance of air flow works to improve cough function. And although EMST is considered a non-swallow exercise there is evidence that respiratory strength training assists in the improvement in deglutition.
EMST for swallowing therapy was initially studied through use of surface electromyography (sEMG) and videoflouroscopy. In 2007, Dr. Wheeler Hegland and her co-investigators found an increase in the duration and amplitude of the submental muscles when subjects used the EMST device compared to a swallow5. In this study, the authors reported, “expiratory pressures associated with completing an EMST task coupled with maintaining a tight lip seal around the device mouthpiece require recruitment of the submental muscle group to transfer the expiratory pressure though the upper airway and into the device5.”
Swallow therapy with Expiratory Muscle Training has been shown to be effective via controlled studies in both stroke and Parkinson’s Disease but it is still recommended to consult with your physician and/or speech pathologist to see if incorporating this type of therapy will be beneficial for your particular case.
