Speech and Language Therapy - EMST Expiratory Muscle Strength Training

You have received this information leaflet because a speech and language therapist (SLT) has assessed your swallowing and identified that you may benefit from EMST to improve the safety, ease and/or efficiency of your swallow.

What is EMST?

Expiratory
Muscle
Strength
Training

Users blow into a device which aims to exercise and increase the maximal pressure of the expiratory muscles. EMST is used as a rehabilitation approach for exercising the muscles important for coughing, swallowing and breathing out forcefully.

EMST and Swallowing

In a safe and efficient swallow, the larynx (voice box) moves upwards and forwards to protect the airway and open the entrance to the food pipe (oesophagus) to reduce the risk of food or drink remaining in your throat (pharynx) after swallowing and ‘going down the wrong way.’

If your airway is not protected when you swallow, it might put you at risk of food or drink entering the airway and moving down onto your lungs – this is known as aspiration.

Strength and pressure of the expiratory muscles are essential for efficient laryngeal movement when swallowing. A high pressure needs to be generated when executing the upward lift of the larynx to ensure food and drink is cleared through your throat and goes down into your oesophagus.

Additionally, strong muscles for coughing are important for protecting your airway. This is because a strong cough will help to expel any food or drink that may enter the airway and prevent it from reaching your lungs.

EMST aims to improve protection of your airway during the swallow function by increasing:

1. Cough strength
2. The strength of your swallowing muscles
3. The upwards lift of the larynx during swallowing

There are some health conditions that have associated risks for EMST use. Before use of an EMST device, always seek guidance from your therapist. If there are any concerns, your therapist may wish to speak to your doctor.

EMST: Instructions for use To set up your EMST device

1. Turn the valve of the EMST all the way to the left (anticlockwise)
2. Remove the cap and insert the mouthpiece. There are 2 mouthpieces provided and your speech therapist will help you decide which one is best for you
3. Put on the nose clip
4. Take a deep breath in and place the EMST device mouthpiece behind your teeth and form a tight seal with your lips (use your hand to secure your lips if needed)
5. Breathe out hard and fast so air is released through the device
6. If air went through, turn the valve one full turn to the right
7. Repeat steps 4 and 5
8. Continue to increase the pressure by one full turn until you can’t blow any more air through
9. Turn the valve back one quarter anticlockwise – this is your maximum expiratory pressure where you will begin training. Your speech and language therapist will do this with you

To use your EMST device

Set aside 20-30 minutes each day to complete the exercise.

We recommend sitting for the duration of your training session, but you can stand if this is more comfortable.

If you feel lightheaded at any time, stop your training session. Report this to your speech and language therapist who may be able to adjust the programme for you.

If you feel pain whilst using EMST, stop immediately and speak to your doctor or therapist.

1. Place the nose clip on your nose
2. Take a deep breath in, hold it, and place the mouthpiece in your mouth creating a seal with your lips
3. Breathe out hard and fast
4. Rest for at least 15 seconds
5. Repeat exercise 5 times
6. Take a one-minute break (this completes one set)
7. Complete five breath sets for a total of 25 training breaths Aim to complete training sessions five days a week.

At the end of each week, turn the valve clockwise by a quarter turn to increase the pressure.

After 5 weeks, your speech and language therapy team may reassess your swallow to see if the device has helped. You will be advised on ongoing use of the device depending on how effective it has been for you.

You may be recommended to switch to a maintenance programme of training three days a week using the final valve setting achieved in week 5.

Please note - your speech therapist may give you a different training programme with a different number of breaths, breaks or repetitions, depending on your individual needs.

Remember to clean your mouthpiece weekly using washing up liquid and warm water. Air-dry before re-using.