Impact of expiratory strength training in amyotrophic lateral sclerosis

Abstract

Introduction: We evaluated the feasibility and impact of expiratory muscle strength training (EMST) on respiratory and bulbar function in persons with amyotrophic lateral sclerosis (ALS).

Methods: Twenty-five ALS patients participated in this delayed intervention open-label clinical trial. Following a lead-in period, patients completed a 5-week EMST protocol. Outcome measures included: maximum expiratory pressure (MEP); physiologic measures of swallow and cough; and penetration-aspiration scale (PAS) scores.

Results: Of participants who entered the active phase of the study (n = 15), EMST was well tolerated and led to significant increases in MEPs and maximum hyoid displacement during swallowing post-EMST (P < 0.05). No significant differences were observed for PAS scores or cough spirometry measures.

Conclusions: EMST was feasible and well tolerated in this small cohort of ALS patients and led to improvements in expiratory force-generating pressures and swallow kinematics. Further investigation is warranted to confirm these preliminary findings. Muscle Nerve 54: 48-53, 2016.

Keywords: amyotrophic lateral sclerosis; expiratory muscle strength training; rehabilitation; respiratory training; swallowing.

Conflict of interest statement

Conflict of Interest: None.

Published 2015. This article is a U.S. Government work and is in the public domain in the USA.

Figures

Figure 1

A. Mean Maximum Expiratory Pressure (MEP) across testing sessions. MEPs were significantly higher following the EMST intervention compared to Baseline 2 (P<0.02). B. Mean maximum hyoid displacement (mm) across testing sessions. Hyoid displacement during swallowing was greater post-EMST intervention compared to both baseline tests (P<0.05). Error bars are 95% C.I. and * denotes a significant difference between evaluation time points.