By: Adrienne Wilde, MS, CCC-SLP and Nikki Gaylord, MA, CCC-SLP
Capital Region Medical Center
As speech therapists in Capital Region Medical Center’s outpatient rehabilitation facility, we often see patients with speech and swallowing disorders due to stroke, brain injury or progressive diseases. Sometimes, traditional therapy techniques have been exhausted with these patients and it is necessary to pull a special trick out of our therapy bag. In the last year, we have been using a device in therapy that is yielding excellent results with patients suffering from speech and swallowing disorders. It is called the Expiratory Muscle Strength Trainer-150 (EMST-150). It was developed at the University of Florida by speech therapists and researchers who are studying whether muscle strengthening can improve functions like breathing, coughing, voice/speech and swallowing. Your expiratory muscles are those muscles you use to breathe air out. If these muscles are weak, an individual may find themselves having difficulty swallowing or having enough air to talk clearly or loudly.
The EMST-150 therapy technique (patent-pending) uses an experimental pressure threshold device to accomplish the strength training. The device requires patients to develop a progressively increasing expiratory pressure while blowing forcefully into the device. The device can be calibrated to vary the pressure load or resistance as the strength of the muscle improves. This is similar to increasing the weight you are lifting during exercise such as bicep curls or leg extensions except the impact of this strength training would be on the muscles used for speech and swallowing (Troche and Sapienza, 2007). Researchers have shown in recent studies that this device not only improves the overall inhalation and exhalation phases of breathing, but it has shown to create a safer swallow as well as improving elevation of the hyoid bone of the larynx, which is essential during swallowing to close off the respiratory airway. Patient reports regarding use of this device have been positive with many saying that the training is easy to complete and is not time-consuming.
A typical initial visit when training a patient how to use the EMST-150 consists of determining their “starting point” and developing a home exercise program the patient can complete. To determine where they need to start, the therapist sets the dial on the EMST-150 at 80 (which is simply the level of resistance the device will provide as the patient blows air out and through the device) and instructs the patient to blow for two seconds. If the patient is able to blow air through the device the therapist turns the knob on the device to increase the level of resistance. If they are unable to blow air through the device then the therapist simply decreases the level of resistance. The starting point of the program is the highest level of pressure in which the patient is able to blow air. This is referred to as the maximum expiratory pressure. The home program consists of the patient completing 5 sets of exercises per day of 5 blows per set for 5 weeks.
Previous Capital Region patients that have used the EMST-150 device have shown tremendous progress toward therapy goals including being able to eat a certain diet again or being able to project their voice in a crowd. We have used the EMST-150 with a range of patients with a variety of diagnoses, for example, the person with Parkinson’s disease that cannot project their voice anymore; the person who is unable to eat or drink following a stroke; as well as the person that is unable to speak loud enough to communicate after surgery or a brain injury.
If you or a family member is interested in the benefits of the EMST-150 device through a home exercise program, please contact your physician for a referral to Capital Region’s Sam B. Cook Healthplex Speech Therapy at 573-632-5440.