Respir at or y M u scle St r en gt h
Tr ain in g & In t elligibilit y
Insufficient respiration and breath support can
greatly affect a person's speech intelligibility. For
instance, according to Darling-White & Huber
(2017), poor expir at ion may lim it one's
in t elligibilit y by hindering the ability to produce
proper speech volume and utterance length.
Respir at or y M u scle St r en gt h Tr ain in g is a
beneficial treatment approach used for increasing
intelligibility since it focuses on strengthening the
in spir at or y and expir at or y muscles. This in turn
builds up subglottal pressure and assists with
adequate respiratory control during speech. Th e
goal is f or t h e speaker t o bu ild u p en ou gh f or ce
t o pr odu ce lon g u t t er an ces w it h lim it ed pau sin g
w h ile u sin g su f f icien t volu m e.
Although respiratory support is foundational to
speech, there are various other perceptual and
objective factors that influence intelligibility. As
Darling-White & Huber (2017) note, an
improvement in respiratory support may not lead
to improved speech if additional instruction is not
provided.
In contrast, when respiratory support is provided
while addressing other obstacles to intelligible
speech, desired outcomes are more likely to occur
(for a case study example, see Workinger & Nutsell,
1992). As such, respiratory muscle strength training
is most effective on improving intelligibility when
paired with other speech-language treatments.
Ref er en ces
RESPI RA TO RY M U SCLE
Darling-White, M., & Huber, J. E. (2017). The Impact of
Expiratory Muscle Strength Training on Speech
ST REN GT H T RA I N I N G
Breathing in Individuals With Parkinsons Disease: A
Preliminary Study. American Journal of Speech-Language
Pathology, 26(4), 1159. doi:10.1044/2017_ajslp-16-0132
Kim, J., & Sapienza, C. M. (2005). Implications of
expiratory muscle strength training for rehabilitation of
the elderly: Tutorial. Journal Of Rehabilitation Research &
Development, 42(2), 183-195.
Sapienza, C., Troche, M., Pitts, T., & Davenport, P. (2011).
Respiratory Strength Training: Concept and Intervention
Outcomes. Seminars In Speech & Language, 32(1), 21-30.
doi:10.1055A-0031-1271972
Tsai, Y., Huang, S., Che, W., Huang, Y., Liou, T., & Kuo, Y.
(2016). The Effects of Expiratory Muscle Strength
Training on Voice and Associated Factors in Medical
Professionals With Voice Disorders. Journal Of Voice,
30759.e21-759.e27. doi:10.1016/j.jvoice.2015.09.012
Workinger, M.S., & Netsell, R., (1992) Restoration of
intelligible speech 13 years post-head injury, Brain
Injury, 6:2, 183-187, DOI: 10.3109/02699059209029657
Addit ion al Recom m en ded
Resou r ces
Laciuga, H., Rosenbek, J. C., Davenport, P. W., &
Sapienza, C. M. (2014). Functional outcomes associated
with expiratory muscle strength training: Narrative
review. Journal Of Rehabilitation Research & Development,
51(4), 535-545. doi:10.1682/JRRD.2013.03.0076
McConnell, A. (2013). Respiratory Muscle Training: Theory
and practice. Edinburgh: Churchill Livingstone/Elsevier.
MacLarnon, A. M. and Hewitt, G. P. (1999), The evolution
of human speech: The role of enhanced breathing
control. Am. J. Phys. Anthropol., 109: 341-363.
Richard Glass
Sapienza C.M. & Trocher M.S. (2012) Respiratory muscle
strength training: Theory and Practice. San Diego, CA: Bridget Coneys
Plural Publishing, Inc.
Dayanna Vance-Rodriguez
 Back gr ou n d of Respir at or y
M u scle St r en gt h Tr ain in g
Grounded in the physiological framework of the
respiratory system, Respiratory Muscle Strength
Training involves st r en gt h en in g the musculature
for in spir at ion and expir at ion .
It as a treatment began with a study in the 1970s,
looking at the effects of respiratory muscle
training on healthy individuals as well as the
clinical populations of COPD and spinal cord injury
patients (McConnell, 2013).
Since this start, respiratory muscle training has
been applied to various areas of clinical practice,
including speech and language pathology.
Within the SLP literature, numerous studies have
given evidence regarding the treatment's efficacy
in improving the cough/swallow strength in
patients, and there have been preliminary studies
on its use in speech improvement.
Texts relevant to this subject include Respiratory
Muscle Training: Theory and Practice, by Alison
McConnell (2013), and Respiratory muscle strength
training: Theory and practice, by Sapienza & Troche
(2012).
M ot ivat ion Beh in d Respir at or y Im plem en t at ion of Respir at or y
M u scle St r en gt h Tr ain in g M u scle St r en gt h Tr ain in g
Respiratory Muscle Strength Training is a treatment The two different kinds of Respiratory Muscle
method used for individuals with respiration Strength Training, EMST and IMST, can be used
difficulties. According to Sapienza, Troche, Pitts, with different clients depending on their diagnosis
and Davenport (2011), this therapy approach (Kim & Sapienza, 2005; Laciuga et al., 2014).
targets the f or ce-gen er at in g capacit y of the
In spir at or y M u scle Expir at or y M u scle
muscles involved in both in spir at ion and
St r en gt h Tr ain in g St r en gt h Tr ain in g
expir at ion .
ALS Multiple Sclerosis
Myasthenia Gravis Parkinson?s Disease
Duchesne Muscular Myotonic Dystrophy
In spir at or y M u scle St r en gt h Tr ain in g (IM ST) is
Dystrophy
often used for patients presenting with weakness Stroke
and/or dysfunction of the inspiratory muscles. It Spinal Cord Injury
targets muscle strength and the build-up of
Sapienza, C.M. & Troche, M.S. (2012)
adequate lung volume during inhalation (Sapienza,
Pr in ciples t h at Gu ide St r en gt h Tr ain in g
Troche, Pitts, & Davenport, 2011).
1. Stimulus Intensity: MUST be sufficient to elicit a
Expir at or y M u scle St r en gt h Tr ain in g (EM ST),
change in muscle function.
however, focuses on improving expiratory muscle
function in order to produce sufficient subglottal 2. The target muscle group MUST be "overloaded"
pressure for proper exhalation. This approach is for strength training.
often used for individuals experiencing trouble
3. Change frequency & duration dependent on
producing strong, forceful exhalations (Sapienza et
client's progress.
al., 20111; Tsai et al., 2016).
How t o do it ?.......Different types of devices and
methods can be used to measure inspiratory and
expiratory pressure.
IM ST EM ST
Spirometer EMST 150
Manometer
Sapienza et al. (2011) and Kim and Sapienza (2005)
both discuss RMST's success for improving
functions associated with respiration, swallowing,
and coughing due to enhanced muscle functioning.
For speech-language pathologists focusing on
intelligible speech, the motivation behind RMST is
encouraging proper inhalations and exhalations to
allow for loud, clear vocal productions with limited
unwarranted pausing.