Expiratory Muscle Strength Training (EMST) for Parkinson’s Disease

People with Parkinson’s disease and other Movement Disorders often develop swallowing disorders, also referred to as dysphagia. A swallowing disorder can affect your ability to move food in your mouth or it can affect the ability of your muscles to successfully and safely transport food and liquid from the back of your throat to your esophagus. Dysphagia can often result in ‘coughing or choking’ with meals. This coughing with meals is often a sign of penetration and/oraspiration of food and liquids, this means food or liquid is entering your airway (instead of your esophagus). If too much material enters the airway you can develop something called aspiration pneumonia a type of chest infection that can potentially be life threatening.

Here at the University of Florida (UF) we have been researching new swallowing therapy techniques. One technique which we have studied here at UF is Expiratory Muscle Strength Training or EMST with the EMST 150. This device was developed here at the University of Florida by Dr. Christine Sapienza, Dr. Paul Davenport and Dr. Daniel Martin. The EMST device (see below) houses a calibrated, one-way, spring-loaded valve to exercise the expiratory and submental muscles – these are muscles important for breathing out forcefully, coughing, and swallowing. The valve blocks the flow of air until enough pressure is produced. Once the valve opens, air flows through the device. The treatment lasts four to five weeks, with participants completing 25 breaths a day (5 sets of 5 repetitions) five days per week. We call this the ‘power of 5’. During the five weeks the device is reset as the participant gets stronger.

The EMST device

We recently completed a study testing the effects of EMST on swallowing function in people with Parkinson’s disease. We found that patients with PD who used the EMST device for four 4 weeks had improvement in their swallowing safety (less penetration or aspiration) as compared to patients who had a placebo device. We have also learned that EMST can improve cough function. This is important because when food or liquid enters the airway, you need a strong cough to get it out. In our clinic we often use EMST, in addition to other swallowing therapies, to improve cough and swallowing function in our patients.

Click here for a news interview with Dr. Michelle Troche about EMST.

More information about the EMST device can also be found at: http://emst150.com/.

We recommend you only complete this training under the supervision of a Speech-Language Pathologist. If you are interested in a speech and/or swallowing evaluation or would like more information about EMST, please contact the Speech and Swallowing team at the Center for Movement Disorders and Neurorestoration.

Other references:
Sapienza C, Troche M, Pitts T, & Davenport P. Respiratory strength training: concept and intervention outcomes. Seminars in Speech Lang. 2011 Feb;32(1):21-30.

Troche MS, Okun MS, Rosenbek JC, Musson N, Fernandez HH, Rodriguez R, Romrell J, Pitts T, Wheeler-Hegland KM, & Sapienza CM. Aspiration and swallowing in Parkinson disease and rehabilitation with EMST: a randomized trial. Neurology. 2010 Nov 23;75(21):1912-9.

Pitts T, Bolser D, Rosenbek JC, Troche M, Okun MS, & Sapienza C. Impact of expiratory muscle strength training on voluntary cough and swallow function in Parkinson disease. Chest 2009;135:1301–1308.

About the Author


Michelle Troche

Dr. Troche is currently an Assistant Professor in the Department of Speech, Language and Hearing Sciences in the College of Public Health and Health Professions…

Read all articles by Michelle Troche