Expiratory Muscle Strength Training via Telehealth: Lessons Learned and Implications for Broader Implementation and Access

A growing body of literature demonstrates that telehealth can expand access to specialized care for individuals with neurodegenerative disease by reducing travel burden, appointment time, and associated costs, while maintaining high levels of patient, care partner, and provider satisfaction. Within the field of dysphagia management, there is developing evidence to support assessment and treatment via telehealth. Expiratory Muscle Strength Training (EMST) involves breathing forcefully through a calibrated, spring-loaded valve set to a specific pressure threshold, typically determined as a percentage of the individual’s maximum expiratory pressure (MEP). Typically, EMST is performed in five sets of five repetitions over a 4 to 5-week period. Studies have demonstrated increases in MEP and improved voluntary and reflexive cough effectiveness following EMST in individuals with neurodegenerative disease. The feasibility and preliminary effect of EMST via telehealth has been identified in patients with movement disorders. Additionally, preliminary data from a large-scale clinical trial comparing in-person and telehealth EMST in PD are promising and will be discussed. During this webinar, practical strategies to implement EMST via telehealth will be presented and clinical resources shared, including treatment dosage, remote device calibration, and troubleshooting, illustrated through a clinical case example.

Michelle S. Troche, PhD, CCC-SLP is currently an Associate Professor and Program Director in the Communication Sciences and Disorders Program, Department of Biobehavioral Sciences at Teachers College, Columbia University. She holds adjunct positions in the Departments of Neurology and Otolaryngology. She directs the Laboratory for the Study of Upper Airway Dysfunction. Her research is focused on improving health outcomes and quality of life associated with disorders of airway protection (i.e., swallowing and cough) through a programmatic research agenda aimed at understanding the multiple behaviors contributing to airway protection, their disorders, and rehabilitation. She is a certified Speech-Language Pathologist and her clinical work has mainly been in the area of movement disorders. It is those experiences that have shaped her research interests and guided her work. Her research has been funded by the National Institutes of Health, Michael J. Fox Foundation, CurePSP Foundation, and National Ataxia Foundation.