Effects of expiratory muscle strength training on maximal respiratory pressure and swallow-related quality of life in individuals with multiple sclerosis

Abstract

BackgroundWeakening and dyscoordination of expiratory muscles in multiple sclerosis (MS) can impair respiratory and swallow function.ObjectiveThe objective of this paper is to test a novel expiratory muscle strength training (EMST) device on expiratory pressure, swallow function, and swallow-related quality-of-life (SWAL-QOL) in individuals with MS.MethodsParticipants with MS were randomized to a five-week breathing practice of either positive pressure load (EMST) or near-zero pressure (sham). We compared baseline to post-treatment data according to maximum expiratory pressure (MEP), abnormal airway penetration and aspiration (PAS), and SWAL-QOL.ResultsBoth groups improved in MEP (p < 0.001). Forty percent of the EMST group improved on PAS, and 15% worsened; conversely, 21.4% of the sham group worsened and 14.3% improved. There was no group difference in overall SWAL-QOL; but the EMST group had significantly greater gain versus sham on the Burden (p = 0.014) and Pharyngeal Swallow (p = 0.022) domains. Both groups improved in SWAL-QOL domains of Fear, Burden Mental Health, but only the EMST group improved in the SWAL-QOL and domains of Pharyngeal Swallow function, and Saliva management.ConclusionResults suggest that strengthening of expiratory muscles can occur with repetition of focused breathing practice in the absence of high resistance. Conversely, results from the PAS and SWAL-QOL domains suggest that the high resistance of the EMST was required in order to improve the functional safety (reduced penetration/aspiration) and coordination of swallowing, specifically pharyngeal function and saliva management.

Clinical trial readiness study of distal myopathy and dysphagia in nephropathic cystinosis

“…Extending from more recent studies in patients with amyotrophic lateral sclerosis (ALS) and other neurodegenerative processes, we investigated the role of targeted exercise in ameliorating symptoms in the cystinosis population. The impact of EMST in this cohort is similar to that reported in patients with ALS, Parkinsons disease, and multiple sclerosis 32,41‐44 . In the interventional phase of this study, patients with more severe dysphagia showed modest improvements in the PAS score.…”

“…The impact of EMST in this cohort is similar to that reported in patients with ALS, Parkinsons disease, and multiple sclerosis. 32,[41][42][43][44] In the interventional phase of this study, patients with more severe dysphagia showed modest improvements in the PAS score. This may suggest a benefit in more severely affected patients or indicate that the conventional scoring lacks the sensitivity to capture dysphagia in more mildly affected patients.…”

Update on Recent Developments in Communication and Swallowing in Multiple Sclerosis

“…More recently, Tarameshlu et al 11 conducted a randomized controlled trial of traditional therapy (rehabilitation techniques) versus standard care (adaptation and compensation) on swallowing function. Moreover, a randomized controlled trial by Silverman et al 12 studied the effect of expiratory muscle strength training versus a sham condition on swallowing QOL. However, the methods of the found studies are patients with moderate-to-severe MS.…”

“…The number of studies reporting on respiratory muscle strength training in persons with MS has been increasing in the past decade. A randomized controlled trial 12 with a focus on dysphagia concluded that expiratory muscle strength training with resistance leads to improved swallowing safety and improved swallowing coordination. Again, the group of participants was small, and long-term effects are unknown.…”

Expiratory Muscle Strength Training in patients After Total Laryngectomy; A Feasibility Pilot Study

“…A well-known rehabilitation technique to improve cough function is expiratory muscle strength training (EMST). Recently, the use of EMST has been evaluated in several studies, 15 including different patient groups such as Parkinson's disease, 14,16,17 multiple sclerosis, 18 sleep apnea, 19 head and neck cancer patients with dysphagia, 20 stroke, 21,22 amyotrophic lateral sclerosis, 23 supracricoid partial laryngectomy, 24 and healthy participants. [25][26][27] In several populations, to date, EMST has been shown to increase expiratory pressure generation by 30% to 150%, with an average increase of approximately 50% in a 4-week period of time.…”