man eating

Expiratory Muscle Strength Training For Dysphagia is one of a few therapies that provide exercises to help people who find it difficult to swallow. A speech and language therapist (SLT) or physiotherapist may prescribe EMST for dysphagia as part of your swallowing therapy.

In our blog, What Is Expiratory Muscle Strength Training? we explain that expiratory muscle training (EMT) is a form of respiratory muscle training (RMT) along with IMT. Inspiratory Muscle Training (IMT) targets your main inspiratory muscle, the diaphragm, whereas EMT targets your main expiratory muscle, the rectus abdominis.

What is Dysphagia

Dysphagia is a condition that makes it difficult to swallow. Generally speaking, this difficulty swallowing is likely to result from another health condition that affects the nervous system. Such conditions include head injury, stroke, MS, dementia or gastro-oesophageal reflux disease (GORD). But difficulty swallowing may also occur with age. This is because the ‘swallowing’ muscles become weaker. In fact, muscle loss is a natural part of ageing. The medical term for this age-related muscle loss is sarcopenia.

It is important to help relieve the symptoms of dysphagia otherwise a person might experience choking, dehydration and weight loss. It may also mean that a person suffers from numerous chest infections. This is because food or liquid may enter the lungs.

It is important to have difficulty swallowing checked out by your medical professional for a diagnosis and rule out something more serious, such as cancer.

Neurological causes of Dysphagia

Difficulty swallowing can occur after a person experiences nervous system damage. This is because brain and spinal cord damage can interfere with the nerves that are responsible for this action.

Inspiratory muscle training is an exercise that researchers already find useful to help patients with neurological damage such as stroke, multiple sclerosis, myasthenia gravis and other neuromuscular diseases. It is also a therapy that is beneficial to older adults because Aging Reduces Breathing Muscle Strength. But research also shows that expiratory muscle training is also beneficial.

photo of lady using POWERbreathe Medic

Effects of expiratory muscle strength training for dysphagia

A systematic review finds that

expiratory muscle strength training improves swallowing and respiratory outcomes in people with dysphagia.

M. Brooks et al.

It explains how speech-language pathologists might consider using EMST to improve airway safety in adults with swallowing disorders.

EMT for dysphagia in stroke

Researchers investigating the effects of EMST on the activity of suprahyoid muscles (the muscles that contribute to swallowing and mastication) in stroke patients with dysphagia find it to be an effective treatment. It also identifies improvements in aspiration.

In another study, findings show

EMST to be an effective intervention for impaired swallowing function in acute stroke patients with dysphagia.

Jong Hoon Moon et al.

EMST for dysphagia in Parkinson’s disease

Aspiration is something that starts to occur as Parkinson’s disease progresses and swallowing becomes more difficult. When food or liquid finds its way into the lungs or airway and cannot be coughed up, it can lead to chest infections and aspiration pneumonia. This is the leading cause of death in patients with Parkinson’s disease. Therefore, a treatment that will help to clear food from the airways is beneficial. Coughing is the body’s natural method of expelling foreign particles. However, a patient with Parkinson’s disease often has a weak cough. It is therefore thought that strengthening expiratory airflow will improve cough strength.

This is exactly what researchers investigate in this study. In fact, their results demonstrate that EMST is a feasible treatment for Parkinson’s disease patients who are at risk of aspiration. Furthermore, a 2021 study finds that

four weeks of EMST reduces overall dysphagia severity significantly in patients with Parkinson’s disease, even after 3 months.

Inga Claus, et al.

Dysphagia in the elderly

Muscle loss is a natural process associated with ageing. It not only affects limb muscles but also breathing muscles and the muscles that control swallowing. This is why swallow rehabilitation is useful. Expiratory muscle strength training is one such approach as it strengthens swallowing subsystems and the muscles of expiration. Additionally, this study concludes that EMST could improve the effects of dysphagia observed in post-stroke elderly patients based on swallowing function.

Lady smiling outdoors

Dysphagia in patients with neurological diseases

Being able to swallow and cough is essential. This is because as you swallow a flap of tissue, known as the epiglottis, folds over your voice box and the top of the windpipe. As a result, food and drink is not able to ‘go down the wrong way’ and into your lungs. Next, what should happen is for the esophagus to move food and drink towards the stomach. And as for coughing, well this is the body’s natural way of expelling something that shouldn’t be there, such as preventing food and drink from entering the lungs.

The brain is responsible for coordinating breathing, eating and drinking and therefore preventing food or liquid from getting into the airways. However, in people with neurological disorders, the brain and nerves throughout the body are affected. This means that they are at risk of inhaling food and drink into the lungs. This can cause choking and pneumonia. Therefore treating impaired coughing and swallowing is important.

In this 2019 meta-analysis, researchers investigate the Effect of Expiratory Muscle Strength Training on Swallowing and Cough Functions in Patients With Neurological Diseases. They conclude that

expiratory muscle strength training might improve swallowing function in patients with neurological diseases.

Wang, Zhuo et al.