Advancing expiratory muscle strength training (EMST) with machine learning

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Expiratory muscle strength training (EMST) is a nonpharmacological intervention that uses a calibrated threshold breath training device to strengthen the expiratory muscles. This device features a one-way valve that can be adjusted to provide specific resistance levels, allowing for targeted muscle training and progressive load increases to optimize therapeutic gains. 

A growing body of research supports the use of the EMST 150 as an effective tool for managing swallowing dysfunction, enhancing cough efficacy, improving communication capacity, and even mitigating drooling, making it a widely recommended and easily implementable adjunctive treatment. However, monitoring patient compliance and measuring clinical benefits remains a challenge for clinicians. 

A Machine-Learning Approach to EMST Compliance & Effectiveness 

To address this challenge, clinicians at the General University Hospital in Prague have developed a novel machine-learning system for measuring EMST use and effectiveness. Martin Srp, PT, PhD, and his team have recently published an article, “mHealth-assisted expiratory muscle strength training in Parkinson's disease patients: A proof-of-concept study,” detailing their innovative approach, which integrates an internal microphone within the EMST 150 respiratory training device, connected to a smartphone app “SpiroGym.” This system allows for real-time tracking of patient compliance and key usage metrics, providing clinicians with objective data to guide treatment decisions. 

Using the Self-Efficacy for Home Exercise Program scale (SEHEPS), researchers noted high adherence throughout the course of a 24-week home exercise program, including throughout the non-supervised maintenance phase. The usability of the app was also highly rated for users in both the short-term arm (one week) and long-term arm (24 weeks) of the study. 

Recently, one of the co-authors on this publication, Ota Gal, PT PhD, presented findings related to this publication at the inaugural “Global Perspectives in Allied Health for Movement Disorders: An Interactive Virtual Journey” session by Allied Health Professionals Special Interest Group (AHP SIG). Recordings of the session are available for members of the interest group, which MDS members can join at any time.

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Considering EMST in Your Clinical Practice? 

If you haven't yet incorporated EMST into your treatment approach, it is a safe, cost-effective tool with minimal side effects that can offer significant benefits. Many of the conditions it addresses—particularly swallowing and communication disorders—fall within the scope of practice of speech-language pathologists (SLPs). Consider referring patients to an SLP for evaluation and device calibration to ensure proper implementation and a structured treatment plan. 

If your team does not include an SLP or occupational therapist for this type of assessment, visit the MDS Member Directory to find a professional with the relevant expertise near you. 

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