The Effects of Expiratory Muscle Strength Training on Communication in Amyotrophic Lateral Sclerosis when Implemented via Telepractice

The purpose of the current study was to determine whether implementing EMST through telepractice is feasible and effective for providing better respiratory support to improve or maintain communication and cough production in ALS. In a nine-week multiple baseline design, twelve participants with mild ALS completed six weeks of Expiratory Muscle Strength Training (EMST) at a moderate intensity level. Descriptive data revealed that it is feasible for speech-language pathologists to implement EMST through telepractice with individuals who have ALS, as minimal time and caregiver involvement was required to implement EMST successfully and adherence and attendance rates were high. EMST implemented through telepractice resulted in a significant increase in maximum expiratory pressure (MEP) at the group level. At the individual level, nine participants had significant increases in MEP, two participants MEP remained stable, and one participant’s MEP decreased Post-Training, most likely due to poor adherence. These overall improvements to MEP did not result in significant improvements to respiratory-dependent speech outcome measures such as pause frequencies and pause durations at the group level. A lack of significant changes to the respiratory-dependent speech outcome measures, but a significant declination in the control variable of articulation rate that is not dependent on the respiratory system suggests that EMST had a maintenance effect for most participants. At the individual level, EMST appears to impact neural control of speech as it alters the pause patterns uniquely for each participant, with some participants demonstrating improvements and others demonstrating maintenance or declination. Maintenance at the group level was also observed for cough strength following EMST. In conclusion, EMST can be implemented via telepractice with people who have mild ALS and may help people with ALS maintain speech and cough production by altering respiratory support.