I recently went to an interesting course on respiratory muscle strength training, and by recently I mean 2 months ago!
I found the course very interesting. It was taught by Christine Sapienza. Respiratory muscle strength training has strong implications for dysphagia, is easy to implement and really fairly affordable.
Inspiratory strength training works on the muscles of inspiration the diaphragm, the intercostals. Inspiration involves contractions of the diaphragm and external intercostals, which increase intrathoracic volume and decreased volume in pressure.
Respiration is a recoil from inspiration. Exhalation involves relaxation of the inhalation muscles, recruitment of abdominal and internal intercostals to force air out of the lungs.
An incentive spirometer is not the same device used as in respiratory muscle strength training (rmst). The spirometer is commonly used after surgery, to remove anesthesia from the body, encourage sustained inhalation and to help to open the airway.
Resistive trainers such as “The Breather” are also typically not used because they only offer resistance on 5 levels.
Pressure Threshold Devices are recommended for RMST. There are devices for inspiratory muscle strength training and for expiratory muscle strength training (IMST, EMST).
In dysphagia, EMST was found not only to increase greater force with the cough, enabling the patient to produce a more productive cough forcing material from the airway, but also was found to increase hyolaryngeal excursion and velar closure.
EMST is not recommended for those on supplemental oxygen, those with COPD or people with untreated GERD.
The Aspire 150 device is the one that was recommended during the course, as it is the device that was used during the study. The Aspire 150 is is found on the Aspire website and is relatively inexpensive at $39.95 each. The patient used the device 5 times, 5 times a day for 5 weeks.
You can find “A Primer on Inspiratory Muscle Strength Training“, giving further information on IMST. The Power Lung Sport Trainer, the Threshold Inspiratory Muscle Strength Trainer are examples of IMST devices.
When focusing on EMST and IMST in your therapy, you want to find a pressure threshold device to achieve maximum results similar those found in the research as referenced below. Resistive devices usually offer 5 levels of resistance, or 5 holes/notches which to increase the device. The Pressure Threshold Devices offer more. Resistive devices are: Expand-a-Lung, The Breather, PFlex and BreathBuilder.
RMST is also indicated for voice disorders, bilateral vocal fold paralysis, professional voice users, sedentary elderly, Parkinson’s Disease (PD), Multiple Sclerosis (MS), Progressive Supranuclear Palsy (PSP), stroke, healthy elderly. RMST can also be used for ventilator weaning.
For more information on RMST please read the following:
Sapienza, C.M., Davenport, P.W., & Martin, A.D. (2002). Expiratory muscle training increases pressure support high school band students. Journal of Voice, 16, 495-501.
Burkhead, L.M., Sapienza, C.M. & Rosenbek, J.C. (2007). Strength-Training Exercise in Dysphagia Rehabilitation: Principles, Procedures and Directions for Future Research. Dysphagia 22, 251-265.
Sapienza, C.M. (2008). Respiratory Muscle Strength Training Applications. Current Opinion in Otolaryngology & Head and Neck Surgery, 16, 216-220.
Pitts, T. et al. (2009). Impact of Expiratory Muscle Strength Training on Voluntary Cough and Swallow Function in Parkinson’s Disease. Chest, 135(5), 1301-1308.
Wheeler-Hegland K.M., Rosenbek J.C. & Sapienza, C.M. (2008). Submental sEMG and Hyoid Movement During Mendelsohn Maneuver, Effortful Swallow, and Expiratory Muscle Strength Training. JSLHR 51, 1072-1087.