Research supports the use of respiratory muscle training (RMT) to improve ventilator weaning outcomes, swallow safety, and cough strength (Pitts et al., 2009; Elkins & Dentice, 2015). The use of a no- leak speaking valve, such as the Passy Muir ®Valve (PMV®), allows patients with tracheostomies, even those who are ventilator-dependent, to participate in expiratory muscle strength training (EMST).