The Safety and Efficacy of Expiratory Muscle Strength Training for Rehabilitation After Supracricoid Partial Laryngectomy: A Pilot Investigation

Abstract

Objectives: Expiratory muscle strength training (EMST) is a safe, effective intervention that can be performed at home and may be beneficial for individuals with voice and swallowing disorders. To date there have been few studies of EMST in the head and neck cancer population, and there are no previous reports of its use after supracricoid partial laryngectomy (SCPL). The current prospective clinical pilot study was undertaken to determine the safety and efficacy of a 4-week treatment program. Methods: Six participants were recruited who had previously undergone SCPL, were medically stable, and had no contraindications for use of the device. At baseline, objective respiratory measurements were collected, dietary status was recorded, and participants were asked to complete a series of validated self-report instruments relating to voice, swallowing, breathing, and cough. Following the completion of treatment, baseline measures were repeated, and participant feedback was solicited. Results: The majority of individuals found the device easy to use (83%) and beneficial (83%). The side effects of treatment were relatively minor and included dizziness, muscle inflammation, and vocal fatigue. There were improvements in 2 measures from before to after treatment, namely, an average 21% increase in peak cough flow (from 371.67 to 451.33 L/min) and a 38% decrease on the Dyspnea Index (from 6.17 to 3.83). Other measures showed inconsistent changes. Conclusions: EMST appeared to improve cough strength and reduce dyspnea symptoms after SCPL. Further study of the relative efficacy of EMST compared to other rehabilitation protocols after SCPL is needed.

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

“…In the group of partial laryngectomy patients performing EMST a significant increase in peak cough flow (L/min) was found, from below normal prior to the intervention to within normal range after training. 24 Peak expiratory flow rate also increased significantly with training in a group of elderly. 26 It is worth questioning why PEF values did not improve in the studied group of TL participants.…”

“…Their group showed reduced average MEPs at baseline. 20 Palmer et al 24 reported a good MEP at baseline in their group after partial laryngectomy and reasoned their candidates must have good pulmonary support to tolerate some amount of aspiration during recovery. We observed no changes over time for PEF outcomes.…”

“…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.…”

“…14,16,18,20,22,23,27 Most of the clinical studies cited above aimed at improving cough strength to improve clearing of aspiration of oral intake or saliva. [16][17][18]20,22,24 EMST has not been tested in the TL population.…”

Efectos del entrenamiento respiratorio aislado en las variables respiratorias y vocales

“…Entre estas se incluyó a niños hipotónicos [40], pacientes con esclerosis múltiple [41,42] y otros con enfermedad de Parkinson [36,37]. Además, se contó con problemas de voz auto-reportados [43], cáncer laríngeo con estado de post laringectomía parcial [44], quejas de profesores [45], trabajadores de la medicina con fatiga vocal [46] y lo que se denominó profesionales de la voz con disfonía [47,48]. En el grupo de habilitación o entrenamiento vocal solo 2 artículos pudieron ser considerados.…”