Health & Medical

The EMST150 strengthens the muscles involved in coughing, swallowing and breathing, addressing many serious symptoms of neuromuscular diseases such as Parkinson’s, Multiple Sclerosis, Huntington’s ALS and others.


EMST150 training helps improves swallow and cough strength.

Dysphagia is a disorder of swallowing that impacts an individual's ability to eat and/or swallow liquids properly. In order to swallow, muscle strength and muscle coordination are critical so that the foods can be guided into the esophagus and not be detoured into the airway/trachea.

Dysphagia can be devastating to quality of life and can result in physiological changes leading to life-threatening conditions like aspiration pneumonia, malnutrition, and dehydration. EMST150 training helps improves swallow and cough strength.

Some common causes of dysphagia in adults include head/neck cancer, TBI (traumatic brain injury), progressive diseases like Parkinson’s and ALS, stroke, esophageal dysfunction, and normal aging.

Expiratory muscle strength training with the EMST150 has shown to improve swallow strength. Results on a large randomized clinical trial show that EMST improves swallowing by increasing the muscle strength of some of the swallow muscles.

EMST150 Improves cough strength.

We all cough, but are we aware of the importance of a cough and its protective abilities for our lungs and health. Coughing is responsible for clearing of particulate matter from the airway and to avoid aspiration.

When we cough, the initial phaseis triggered by inhalation or breathing in. The greater the inhalation the greater the amount of pressure is generated for the cough. The second phase, compression, is initiated when the glottis (vocal folds) closes which maintains lung volume as pressure builds and promotes contraction of expiratory muscles., The final phase of the cough, expiratory, happens when the glottis (vocal folds) open. A short blast of air through the opening glottis occurs, forcing the exhalation and clearing material from the airway.

A productive cough can act as a defense mechanism for the lungs as it assists with clearing material from the airway. A productive cough is essential for patients with dysphagia who are at high risk for penetration and aspiration.

In addition, coughing (and cough strength) the body’s process for removing foreign particles from the lungs, diminishes with age and therefore increases the risk for development of pneumonia.

(EMST) Expiratory muscle strength training with the EMST150 focuses on improving maximal expiratory pressure (MEP or PEmax) along with the abdominal muscle and expiratory muscles (Sapienza & Troche, 2012). Our training program can improve cough strength and subglottic pressure, associated with improvement of the coordination and accuracy of the swallow function, reducing the risk for penetration and aspiration.

Parkinson’s Disease

Nearly 1 million Americans have Parkinson’s disease, according to the Parkinson’s Disease Foundation. We understand the importance of finding solutions to their swallowing problems. Studies done with the EMST150 show improved exhalatory breath pressure, improved voluntary cough, and reduced swallowing symptoms resulting in improved quality of life and swallow safety in addition to reduced feelings of breathlessness.

Impact of expiratory muscle strength training on voluntary cough and swallow function in Parkinson disease. Pitts T, Bolser D, Rosenbek JC, Troche M, Okun MS, Sapienza C.Chest 2009;135:1301–1308.
Aspiration and swallowing in Parkinson disease and rehabilitation with EMST: a randomized trial. Troche MS, Okun MS, Rosenbek JC, Musson N, Fernandez HH, Rodriguez R, Romrell J, Pitts T, Wheeler-Hegland KM, Sapienza CM.Neurology. 2010 Nov 23;75(21):1912-9. doi: 10.1212/WNL.0b013e3181fef115.


In adults with a history of ischemic stroke, Training with the EMST150 improves expiratory muscle strength, reflex cough strength, and urge to cough. There is now a study that confirms EMST as an effective treatment for the development of suprahoid muscle activity in stroke patients with dysphagia. Additionally, improvements in aspiration and penetration outcomes were observed.

Effects of expiratory muscle strength training on oropharyngeal dysphagia in subacute stroke patients: a randomized controlled trial J. S. Park,
D. H. Oh,
Close, Gangwon-do,
M. Y. Chang,
K. M. Kim, Kyeong Mi Kim, 197 Inje-ro, Gimhae-si, Gyeongsangnam-do J Oral Rehabil. 2016 May; 43(5): 364-72. Doi: 10.1111/joor.12382. Epub 2016 Jan 24. 621-749, 24


When patients with COPD trained with the EMST150, the strength of the expiratory muscle was increased. Improvements in exhalatory breath pressure for persons with COPD can lead to decreased feelings of breathlessness and beneficial effects on exercise performance and quality of life.

“The main finding of the present study is the significant improvement in dyspnea at rest, health-related quality of life, and timed walking distance in COPD patients following a short expiratory muscle training period. Most of these changes were proportional to the improvement in expiratory muscle strength. It should be noted that improvements in SGRQ scores and walking test distance were not only statistically significant but also should be considered clinically relevant.”

Clinical outcomes of expiratory muscle training in severe COPD patients Susana Motaa, b, Rosa Gu¨ella, Esther Barreiroc, Ingrid Solanesa, Alba Ramı´rez-Sarmientoc, Mauricio Orozco-Levic, Pere Casana, Joaquim Geac, Joaquı´n Sanchisa.

Spinal Cord Injury

Spinal cord injury is a complex medical condition. There are systematic reviews suggesting positive outcomes of respiratory muscle strength training for improving expiratory breath pressure and endurance. Our research team has worked with patients with spinal cord injury with positive clinical results for those with muscle weakness. We have clinical outcomes documenting improvements in exhalatory breath pressure, voluntary cough production and voice quality.

Expiratory muscle training in spinal cord injury: a randomized controlled trial. Roth EJ, Stenson KW, Powley S, Oken J, Primack S, Nussbaum SB, Berkowitz M; Arch Phys Med Rehabil 2010; 91:857-


The EMST150 is in studies for use with persons with ALS and it is reported as feasible and well tolerated in patients with ALS showing improvements in both expiratory force-generating pressures and swallow kinematics.

“While exercise in persons with ALS has historically been discouraged due to fear that muscle overburden may execrate physical decline, recent animal and human data suggest that moderate intensity exercise applied early in the disease may serve a neuroprotective role in ALS. Indeed, exciting preliminary data from our laboratory indicate that a regimen of expiratory muscle strength training (EMST) in persons with mild-moderate ALS has a positive effect on expiratory force generating abilities, airway protection and cough during swallowing, swallow kinematics, self-reported swallow severity and swallow- related quality of life.”

Impact of expiratory strength training in amyotrophic lateral sclerosis. Plowman EK, Watts SA, Tabor L, Robison R, Gaziano J, Domer AS, Richter J, Vu T, Gooch C Muscle Nerve. 2016 Jun;54(1):48-53. doi: 10.1002/mus.24990. Epub 2016 Mar 3.PMID: 26599236

Pompe’s Disease

Persons with pediatric onset and late onset Pompe’s disease have shown improvement with expiratory muscle strength training for increasing breath pressure.

In one trial after another, the EMST150™ training system brought about significant improvements in individuals with Parkinson’s, multiple sclerosis, spinal cord injuries and other forms of neuromuscular disease. Patients saw improved cough strength as a result of increased exhalatory muscle strength, allowing them to remain independent longer. In addition, EMST150 researchers recognized an opportunity for patients with spinal cord injuries or degenerative diseases that weaken respiratory muscles to use the device to strengthen weakened muscles, improving breathing, coughing, swallowing and speech. And, since the EMST150 is the only device of its kind that is calibrated, therapists are able to track and document progress during therapy programs.

We are motivated by the last 10 years of data and the new information being examined. Dr. Sapienza’s review of respiratory muscle strength training and the number of systematic and meta analyses of respiratory muscle strength training outcomes is strongly suggesting the capability of muscle strength training programs. Most importantly, the EMST150 is the only device to be actively used in randomized clinical trials as the most widely used device in the clinical market. The EMST150™, its protocol and performance are unmatched.

Respiratory muscle training (RMT) in late-onset Pompe disease (LOPD): Effects of training and detraining; Jones, Harrison N. et al.Molecular Genetics and Metabolism , Volume 117, Issue 2 , 120 - 128