Expiratory Muscle Strength Training Research Articles

Validation of SPECT-CT to assess improvement in airway clearance following expiratory muscle strength training (EMST) to reduce chronic aspiration in patients with head and neck cancer treatment related dysphagia

Validation of SPECT-CT to assess improvement in airway clearance following expiratory muscle strength training (EMST) to reduce chronic aspiration in patients with head and neck cancer treatment related dysphagia

Efficacy of swallowing rehabilitative therapies for adults with dysphagia: a network meta-analysis of randomized controlled trials.

Dysphagia leads to poor swallowing function and high risk of aspiration; swallowing rehabilitative therapies including jaw exercises, tongue exercises, chin tuck against resistance (CTAR), Shaker exercises, effortful swallow training (EST), traditional dysphagia therapy (TDT), and respiratory muscle training (RMT) including inspiratory muscle strength training (IMST) and expiratory muscle strength training (EMST) are a crucial part of dysphagia rehabilitation. However, limited evidence exists on the comparative efficacy of swallowing rehabilitative therapies in adults with dysphagia. This is the first network meta-analysis (NMA) to investigate the comparative efficacy of swallowing rehabilitative therapies for adults with dysphagia. Web of Science, Embase, CINAHL, Cochrane Library, and PubMed were comprehensively searched until September, 2024. The Frequentist NMA model was performed in R-Software presenting standardized mean differences with corresponding 95% confidence interval (95% CI) for swallowing function and aspiration. Cochrane Q, τ2, and I2 statistics estimated heterogeneity and full design-by-treatment interaction random-effects and node-splitting models determined transitivity. Ranking of the swallowing rehabilitative therapies used the netrank function. The search yielded 7697 studies from which 25 randomized controlled trials with 1020 adults with dysphagia were included. The study findings revealed that CTAR + TDT (SMD = 3.44 [95% CI 2.42, 4.47]), EMST + TDT (SMD = 2.92 [95% CI 1.59, 4.25]), Shaker + TDT (SMD = 2.83 [95% CI 1.81, 3.84]), JE + TDT (SMD = 2.52 [95% CI 1.21, 3.83]), TE + TDT (SMD = 2.19 [95% CI 1.26, 3.12]), RMT + TDT (SMD = 2.14 [95% CI 1.36, 2.93]), and TDT (SMD = 1.92 [95% CI 1.42, 2.42]) showed very-large to huge effect in improving swallowing function. CTAR + TDT (0.93) demonstrated superior improvements for better swallowing function. Additionally, CTAR + TDT (SMD = - 1.82 [95% CI - 2.89, - 0.75]), Shaker + TDT (SMD = - 1.32 [95% CI - 2.36, - 0.27]), EMST (SMD = - 1.23 [95% CI, - 2.01, - 0.45]), and EMST + TDT (SMD = - 1.10 [95% CI - 2.15, - 0.04]) revealed very-large to large effect in preventing aspiration. CTAR + TDT (0.96) and Shaker + TDT (0.76) demonstrated superior improvements for reduced aspiration. The combination of swallowing rehabilitative therapies including CTAR + TDT and Shaker + TDT offers a more comprehensive approach for dysphagia management in adults. Study registration is PROSPERO: CRD42022321345.

Effects of various oral exercises on swallowing function in the elderly: A systematic review

Oral exercises as a rehabilitation strategy can be performed by the elderly at any time and place without any complications or financial burden. Therefore, an oral exercise that is easy to perform and follow in daily life, can effectively improve the oral health of the elderly. This systematic review was conducted to investigate the effect of oral exercises on swallowing function in the elderly. A comprehensive systematic search was conducted on international electronic databases such as Scopus, PubMed, Web of Science, as well as on Iranian electronic databases such as Iranmedex, and Scientific Information Database from the earliest to April 1, 2023. The Joanna Briggs Institute (JBI) critical appraisal checklist was used to assess the quality of randomized control trials and quasi-experimental studies. A total of 728 elderly people participated in fourteen studies. Based on the results of the present systematic review, ten interventions including “lingual resistance exercise with Iowa oral performance instrument”, “exercise for swallowing”, “oral exercise”, “expiratory muscle strength training”, “swallow resistance exercise”, “swallowing exercises”, “oral neuromuscular training”, “simple oral exercise (SOE)”, “tongue strengthening exercise”, “SOE and chewing gum exercise with SOE” improved swallowing function in the elderly. However, the other four interventions including “swallowing exercises”, “resistance training”, “effortful swallowing exercise”, and “oral exercises” did not affect improving swallowing function in the elderly. Health managers and policymakers can improve the swallowing performance of the elderly by implementing training protocols related to oral exercise in addition to routine interventions.

The impact of expiratory muscle strength training on voluntary cough effectiveness in Huntington's disease.

Dysfunction of the airway defence system in Huntington's disease (HD) is a significant but often overlooked problem. Although expiratory muscle strength training (EMST) is frequently utilized in cough effectiveness treatment, its specific impact in HD patients has not yet been explored. This study investigated the effects of EMST on voluntary peak cough flow (vPCF) in HD patients and evaluated the retention of potential gains post-intervention. In this prospective case-controlled trial, 29 HD patients completed an 8-week wait-to-start period, which served to identify the natural development of expiratory muscle strength and vPCF. This was followed by 8 weeks of EMST training and an additional 8 weeks of follow-up. The study's outcome parameters, vPCF and maximum expiratory pressure (MEP), were measured against those of age- and sex-matched healthy controls. Huntington's disease patients had significantly lower MEP (p < 0.001) and vPCF (p = 0.012) compared to healthy controls at baseline. Following the EMST, significant improvements in MEP (d = 1.39, p < 0.001) and vPCF (d = 0.77, p = 0.001) were observed, with HD patients reaching the cough performance levels of healthy subjects. However, these gains diminished during the follow-up, with a significant decline in vPCF (d = -0.451, p = 0.03) and in MEP (d = -0.71; p = 0.002). Expiratory muscle strength training improves expiratory muscle strength and voluntary cough effectiveness in HD patients, but an ongoing maintenance programme is necessary to sustain the improvements.

Expiratory muscle strength training reduces oxidative stress and systemic inflammation in men with obstructive sleep apnea syndrome: a double-blinded, randomized parallel trial

Abstract Study Objectives This study aimed to evaluate and compare the effects of high and low-intensity expiratory muscle strength training (EMST) on disease severity, systemic inflammation, oxidative stress, respiratory muscle strength, exercise capacity, symptoms, daytime sleepiness, fatigue severity, and sleep quality in male patients with obstructive sleep apnea syndrome (OSAS). Methods Thirty-one male patients diagnosed with moderate OSAS were included in this double-blind, randomized, parallel study. Patients were randomized into two groups: High-EMST and Low-EMST groups. EMST was used at home 7 days/week, once a day, for 25 breaths, 12 weeks. Respiratory muscle strength was measured using a mouth pressure device. Disease severity (Apnea–Hypopnea Index [AHI]) and, respiratory sleep events by polysomnography, total oxidant level(TOS), total antioxidant level(TAS), oxidative stress index (OSI), C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) levels by blood serum were evaluated. Results The percentage of AHI change in the high-EMST group(50.8%) was significantly higher than in the low-EMST group(6.3%; p = .002, d = 1.31). In general, as MEP increased by one unit, AHI decreased by 0.149 points (b = −0.149; CR = −3.065; p = .002), and as AHI increased by one unit, ODI increased by 0.746 points (b = 0.746; CR = 10.604; p &amp;lt; .001). TOS, OSI, TNF-α and IL-6 levels decreased at similar rates in both groups. Conclusions EMST significantly reduces systemic inflammation and oxidative stress while improving expiratory muscle strength in male patients with moderate OSAS. High-EMST is more effective in enhancing the severity of disease than low-EMST. EMST is a practical, effective, and promising treatment for pulmonary rehabilitation in patients with moderate OSAS. Clinical Trials Effect of EMST systemic inflammation and oxidative stress in patients with moderate OSAS, https://clinicaltrials.gov/study/NCT05242406, with the number NCT05242406.

Effects of Expiratory Muscle Strength Training on Oropharyngeal Swallow Physiology in Persons with Obstructive Sleep Apnea (OSA): A Preliminary Study

Effects of Expiratory Muscle Strength Training on Oropharyngeal Swallow Physiology in Persons with Obstructive Sleep Apnea (OSA): A Preliminary Study

The effect of expiratory muscle strength training on oxidative stress and functional exercise capacity in patients with obstructive sleep apnea syndrome

The effect of expiratory muscle strength training on oxidative stress and functional exercise capacity in patients with obstructive sleep apnea syndrome

Body Mass Index and Thoracic Expansion in Post-COVID Dyspnea: A Secondary Analysis.

Dyspnea secondary to lung impairment can persist following the acute phase of COVID-19. Thoracic expansion measurements have been used as a diagnostic tool to evaluate chest wall mobility, respiratory function, and the effects of respiratory muscle strength training. Changes in chest wall mobility may occur because of altered chest biomechanics in individuals with respiratory diseases and an elevated body mass index (BMI). The purpose of this secondary analysis was to evaluate whether BMI influences thoracic expansion or forced expiratory volume over 1 second (FEV1) in individuals with persistent dyspnea following COVID-19. This study assessed the relationship between BMI and thoracic expansion, pulmonary symptoms, and exercise capacity following a home-based pulmonary rehabilitation intervention. A secondary data analysis was conducted with a sample of 19 adults with persistent dyspnea following COVID-19 infection who participated in a 12-week, home-based pulmonary rehabilitation study. Participants received expiratory muscle strength training devices and were instructed to perform pulmonary rehabilitation exercises three times per week over the study period. Pulmonary function, pulmonary symptoms, exercise capacity, and BMI measurements were collected. For analysis, study participants were divided into obese (BMI > 30 kg/m2) or nonobese (BMI < 30 kg/m2) categories. Correlations using the change scores from baseline to 12 weeks between thoracic expansion, FEV1, pulmonary symptoms, and exercise capacity were assessed. In addition, the minimal detectable change (MDC) in thoracic expansion was explored. Thoracic expansion was significantly improved after 12 weeks of training (p = .012) in the nonobese group. There was a significant correlation between the change in walking distance and pulmonary symptoms (r = -.738, p < .001) and in thoracic expansion (r = .544, p = .020), and walking distance, when controlling for BMI, but no change in FEV1. Average MDC was 1.28 for inspiration and 0.91 for expiration. Measurements of thoracic expansion were significantly lower in post-COVID individuals with an increased BMI. Individuals with persistent dyspnea and a higher BMI may require additional measures to increase chest mobility or to detect pulmonary changes following COVID-19.

Instrumental Assessment of Aero-Resistive Expiratory Muscle Strength Rehabilitation Devices.

Expiratory muscle strength training (EMST) is increasingly being used to treat voice, cough, and swallowing deficits in a wide range of conditions. However, a multitude of aero-resistive EMST models are commercially available, and the absence of side-by-side comparative data interferes with clinicians' ability to assess which model is best suited to a particular client's needs. The primary aim of this research was to test and compare the pressure and flow parameters of six currently available EMST models to help inform clinical decision making. We identified and tested five devices of each of six different EMST models to generate benchmark data for minimum trigger pressures across settings. The reliability was tested within each device and between five devices of the same model across settings using coefficient of variation. All six models required higher pressures to initiate flow at the highest setting compared to the lowest setting, as expected. Detailed descriptive statistics for each model/setting combination include average flow-triggering pressure for each model/setting and the variability across trials within a device and across devices of the same model. From these, ranked order of the least to most stable EMST model was derived. Systematic testing of several commercially available expiratory resistance training devices yielded clinical benchmarks and reliability data to aid clinicians in selecting an appropriate therapy device and regimen for a client based on their available airflow and air pressure as well as reliability of the device. These findings allow clinicians to directly compare key parameters across EMST devices.

Effect of Expiratory Muscle Strength Training on the Performance of Professional Male Trumpet Players.

Many trumpet players use breathing training devices in addition to their daily practice routine. Playing a brass instrument requires, besides many other skills, a controlled air stream to generate the necessary air pressures. On the trumpet, high intraoral pressures are needed, especially during high and loud notes. Therefore, it is not uncommon in trumpet pedagogy to teach that the use of breathing training devices enhances physical strength so that the required pressures can be produced with less effort. However, to date, no systematic assessment of the use of breathing training devices among trumpet players exists and their effect on playing performance is still unclear. In this a pre-post, within-subject repeated measure study, we investigated the influence of a 5-week expiratory muscle strength training (EMST) upon trumpet performance. Twenty-four male professional trumpet players were allocated to either a control or intervention group. The intervention group (n =13) trained with an EMST device against a set resistance of 55% of their maximum expiratory pressure (MEP) for 5 weeks on 5 days per week. The control group (n =11) did no intervention. All participants underwent the same measures (MEP and rate of perceived exertion [RPE]) and played the same tasks (maximum long note, maximum high note, maximum dynamics and phrasing in high register) prior to and after the 5 weeks. After EMST, MEP increased significantly (13%, p = 0.049) in the intervention group, whereas no significant change was found in the control group. Performance parameters did not change in either of the groups, also after EMST. Despite the increase in MEP, we found no evidence that EMST has an influence on trumpet performance. We conclude that EMST seems unnecessary for the enhancement of trumpet playing, at least in a population of male professionals who already demonstrate excellent respiratory condition and control.

RESP-FIT: A Technology-Enhanced Combined Inspiratory and Expiratory Muscle Strength Training Intervention for Adults With COPD.

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disease associated with respiratory muscle weakness and activity-limiting symptoms such as dyspnea. Respiratory muscle strength training (RMST) is an empirically validated therapy to increase respiratory muscle strength. The theoretically-informed, technology-enhanced RESP-FIT intervention for COPD is a 6-week combined inspiratory and expiratory muscle strength training program with symptom measurement in real time via ecological momentary assessment (EMA). In addition to hypothesis generating purposes, the purpose of this randomized control pilot study was to explore whether observed effects (on symptoms, patient-reported outcomes, and respiratory muscle strength) support carrying out a future large-scale trial of RESP-FIT. Thirty adults with COPD were randomized to intervention (n=15) or control, with intervention group undergoing 6 weeks of mHealth-enhanced RMST. Daily symptom data were collected in real time over the 6-week intervention period using EMA. Compared to the control group, participants in the intervention group reported decreased dyspnea and anxiety, increased happiness, and improved respiratory muscle strength (PIMax). However, reports of fatigue and sleep disturbance increased in the intervention group compared to the control group. Results support the hypothesis that the 6-week RESP-FIT program will improve respiratory muscle strength, emotional state (anxiety and happiness), and breathlessness in COPD but may contribute to fatigue, at least in the short-term. Future work is needed to determine efficacy of RESP-FIT, determine mechanisms of action on dyspnea and fatigue, and conduct within-subject comparisons of EMA data to explore individual or environmental fluctuations in COPD symptoms.

Maximal Expiratory Pressure and Its Link With Cough Airflow Before and After Expiratory Muscle Strength Training in Parkinson's Disease

Purpose: Expiratory muscle strength training (EMST) improves maximal expiratory pressure (MEP), and several researchers have reported improvements to voluntary cough airflow in people with Parkinson's disease (PD). However, the link between the change in MEP and cough and whether patient-specific factors impact the training response is not well understood. Therefore, study aims were to examine (a) the relationship between MEP and cough pre- and post-EMST, (b) the associations between the change in MEP and change in cough, and (c) if patient-specific factors predict the change MEP. Method: This is a secondary analysis of data from 30 people with PD who completed MEP and voluntary and reflex cough testing via spirometry pre– and post–5 weeks of EMST. Pearson's r correlations were used for Aims 1 and 2. Multivariable linear regression was used for Aim 3. Results: Pre-EMST correlations between MEP and cough as well as correlations between the change in MEP and change in cough were nonsignificant. Post-EMST, MEP was correlated with voluntary cough expired volume (CEV, r = .58 , p &lt; .001), peak expiratory flow rate (PEFR, r = .56 , p = .001), and cough volume acceleration ( r = .47 , p = .009 ) , as well as reflex CEV ( r = .5, p = .005). Patient-specific factors did not predict the change in MEP. Conclusions: This study showed that there was a larger correlation between expiratory muscle strength and cough airflow post-EMST than pre-EMST for voluntary and reflex cough in PD; however, the correlation between the change was small. Future research is needed to identify additional physiologic changes that are impacting cough airflow after EMST. Supplemental Material: https://doi.org/10.23641/asha.24602565

Effectiveness of Expiratory Muscle Strength Training on Dysphagia Risk in Pre-Frail Elderly

Pre-frail dan frail elderly are susceptible to dysphagia. Dysphagia leads to vulnerability to aspiration pneumonia, undernutrition, and dehydration, which negatively affect physical condition and quality of life. Expiratory muscle strength training (EMST) is an intervention for dysphagia. However, the effects of EMST on pre-frail elderly are still unclear. This study aimed to investigate effectiveness of expiratory muscle training on dysphagia risk of pre-frail elderly. The study design was a randomized clinical trial. Twenty-four pre-frail elderly at Rindang Asih I and II Elderly Social Service Institution randomly assigned into experimental group (n=12) or control group (n=12). The experimental group received expiratory muscle training using PEP Threshold® device 5 times per week for 6 weeks. Both of group also received typical multicomponent exercise for elderly 3 times per week for 6 weeks. Outcome measure was risk of dysphagia assessed using Swallowing Disturbance Questionnaire (SDQ). The intra-group analysis showed significant differences pre- and post-intervention in experimental group but not in control group (p&lt;0,001 and p=0,107, respectively). Inter-group analysis showed significant differences between experimental and control group post-intervention (p&lt;0,001). This finding indicate that expiratory muscle training effective on reducing dysphagia risk in pre-frail elderly.

Effect of expiratory muscle strength training on voice and speech: An exploratory study in persons with Parkinson’s disease or multiple sclerosis

Purpose This study explored how respiration, voice, and speech were affected following expiratory muscle strength training (EMST) and maintenance training in persons with Parkinson’s disease (PD) or multiple sclerosis (MS). Method Nine participants with PD and six with MS participated in a randomised study, where the effects of EMST, sham, and maintenance treatment were investigated. Outcome measures included maximum expiratory pressure (MEP); maximum phonation time (MPT); intelligibility; verbal diadochokinesis (DDK); speech rate; a self-report form on voice, speech, and communication; and open questions about how the participants experienced the intervention. Group comparisons were performed within and between groups. Result The PD and the MS groups both improved significantly in MEP, and this improvement remained after 3 months of maintenance EMST. An improvement was also seen in DDK. Post-EMST, 33% of the PD group and 80% of the MS group reported a positive effect on communication. Conclusion The results of this study support previous evidence that EMST has positive effects on expiratory pressure in persons with PD or MS, but its effect on voice and speech remains unclear. Since subjective reports of the intervention and effects on communication were predominantly positive, further research is needed on larger groups to explore appropriate outcome measures.

Improvement in Swallowing Function in Patients with Previous Irradiation for Nasopharyngeal Carcinoma by Expiratory Muscle Strength Training.

Dysphagia and chronic aspiration are common post-irradiation complications in nasopharyngeal carcinoma (NPC) survivors. Expiratory Muscle Strength Training (EMST) is a simple device-driven exercise therapy for swallowing training. This study investigates the effectiveness of EMST in a group of post-irradiated NPC patients. This prospective cohort, including twelve patients with previous irradiation for NPC and with swallowing disturbance, was performed between 2019 and 2021 in a single institution. Patients were trained with EMST for 8weeks. Non-parametric analyses examined effects of EMST on primary outcome, maximum expiratory pressure. Secondary outcomes were measured with Penetration-aspiration scale, Yale pharyngeal residue severity rating scale (YPRSRS) by flexible endoscopic evaluation of swallowing, and Eating Assessment Tool (EAT-10) and M.D. Anderson Dysphagia Inventory questionnaire. Twelve patients, with a mean (SD) age of 64.3 (8.2) were recruited. There was no patient dropout with 88.9% overall compliance of training. Maximum expiratory pressure improved by 41% (median 94.5 to 133.5 cmH2O, p = 0.003). There was reduction in Penetration-aspiration scale with thin liquid (median 4 to 3, p = 0.026), and in YPRSRS at pyriform fossa with mildly thick liquid (p = 0.021) and at vallecula with thin liquid (p = 0.034), mildly thick liquid (p = 0.014) and pureed meat congee (p = 0.016). Questionnaire scores did not significantly change statistically. EMST is an easy-to-use and effective exercise therapy to improve airway safety and swallowing function in post-irradiated NPC survivors.

Expiratory Muscle Strength Training in Multiple System Atrophy: A Pilot Study.

The effects of expiratory muscle strength training (EMST) has not yet been investigated in MSA patients. The primary objective was to test the effects of EMST on expiratory muscle strength and voluntary peak cough flow (vPCF) in patients with multiple system atrophy (MSA). The secondary objective was to assess the suitability of the pulmonary dysfunction index as a tool for identifying MSA patients with expiratory muscle weakness and reduced voluntary peak cough flow. This was an open label, non-controlled study, with an 8-week intensive home-based EMST protocol. The outcome measures included: maximal expiratory pressure (MEP) and vPCF. The sensitivity and specificity of the index of pulmonary dysfunction in the respiratory diagnostic process were assessed using receiver operating characteristic (ROC) analysis. Fifteen MSA patients were enrolled in the study. Twelve MSA patients completed the training period. After the training period, MEP significantly increased (P = 0.006). Differences in vPCF were not significant (P = 0.845). ROC analysis indicated that the overall respiratory diagnostic accuracy of the index of pulmonary dysfunction had an outstanding capability to detect patients at risk of less effective coughing and an acceptable capability of detecting patients with decreased expiratory muscle strength. These findings indicate non-significant differences in vPCF after 8 weeks of EMST. The index of pulmonary dysfunction appears to be a promising prognostic screening tool for identifying altered cough efficacy in MSA patients. Test cut-offs may be used to select an appropriate respiratory physiotherapy technique.

Home-Based Pilot Pulmonary Program for Dyspneic Patients Post-COVID-19.

It is estimated that at least 10% of people who have had COVID-19 will experience ongoing symptoms such as shortness of breath, fatigue, and cognitive disturbances. Pulmonary exercise has demonstrated improved dyspnea outcomes in other respiratory conditions. Thus, the purpose of this study was to assess the efficacy of a home-based pulmonary rehabilitation program in post-COVID-19 survivors who continue to experience dyspnea. This was a longitudinal, single group pilot study in which 19 patients received a home-based expiratory muscle strength training program over 12 weeks. Outcomes measured at baseline, 6 weeks, and 12 weeks included pulmonary symptoms, functional performance, thoracic expansion, forced expiratory volume, and expiratory resistance measures. Significant improvements were found in pulmonary symptoms (p < .001), functional performance (p = .014), and progressive expiratory resistance capabilities (p < .001). A home-based pulmonary program may be an inexpensive strategy for post-COVID-19 survivors who continue to experience dyspnea.

Rehabilitation of Airway Protection in Individuals With Movement Disorders: A Telehealth Feasibility Study.

Airway protective deficits (swallowing and cough) greatly reduce health and quality of life and are a pervasive consequence of neurodegenerative movement disorders. Expiratory muscle strength training (EMST) and cough skill training (CST) are two treatment approaches to improve airway protection; however, many patients are unable to access these treatments. Telehealth may improve access to care, but it remains unknown whether these treatments are feasible and efficacious via telehealth. This study aimed to determine the practical feasibility and preliminary treatment effect of EMST and CST via telehealth. Twenty participants with movement disorders completed 4 weeks of EMST and 2 weeks of CST, including two clinician-directed treatment sessions via telehealth and 3 days of home practice per week. Feasibility was calculated for each treatment. Practical feasibility was defined as completing treatment (EMST or CST) and obtaining the relevant outcome measures-a proxy of maximum expiratory pressure (pMEP) for EMST and peak expiratory flow rate (PEFR) for CST-within a 30-min session/period. Session factors that may have influenced feasibility were examined. Preliminary treatment effect was defined as changes in pMEP and PEFR. Time taken to obtain pMEP and complete EMST was 17.48 min, and time taken to obtain PEFR and complete CST was 17.69 min. pMEP, single voluntary cough PEFR, and sequential voluntary cough PEFR increased from pre- to posttreatment. Findings suggest that the delivery of EMST and CST is feasible via telehealth and yield improvements to pMEP and PEFR. This has important implications for expanding service delivery of airway protective interventions and reducing health care disparities in people with neurodegenerative movement disorders. https://doi.org/10.23641/asha.21357669.

"Effects of an Expiratory Muscle Strength Training Method on Young Individuals and its Clinical Use"

"Effects of an Expiratory Muscle Strength Training Method on Young Individuals and its Clinical Use"

Expiratory Muscle Strength Training for Drooling in Adults with Parkinson’s Disease

One of the most debilitating symptoms of advanced Parkinson’s disease is drooling. Currently, the main treatment that is offered for drooling is botulinum toxin injections to the saliva glands which have a number of side effects and do not treat the causes of drooling, such as impaired swallowing and lip closure. This study explored the effect of an alternative therapy approach for drooling that aimed at improving the swallow, expiratory muscle strength training (EMST). Sixteen participants received EMST over a 6- to 8-week period. Measurements were taken pre- and post-training for drooling (Sialorrhea Clinical Scale for Parkinson’s Disease; SCS-PD), swallowing, lip strength and peak cough flow. Measures of drooling, swallowing and peak cough flow were stable over pre-training assessments and improved following training (p < 0.01). The most conservative estimate of the within-group change for SCS-PD was − 2.50 (95% confidence interval − 3.22 to − 1.22). No adverse effects were reported and participants gave high satisfaction ratings for the training. A programme of EMST offers promise as a therapy to reduce drooling for people with Parkinson’s disease. Adequately powered randomised controlled trials of EMST are now needed.