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Expiratory Muscle Strength Training to Improve Voice and Respiratory Outcomes after Laryngectomy: A Feasibility Study

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Title: Expiratory Muscle Strength Training to Improve Voice and Respiratory Outcomes after Laryngectomy: A Feasibility Study
Language: English
Authors: Freya Sparks (ORCID 0000-0002-2406-4944), Margaret Coffey, Lucy Dipper, Jessica Crowther, Simon Hamilton (ORCID 0009-0002-9590-2471), Louise Occomore-Kent (ORCID 0000-0002-6212-5461), Katerina Hilari
Source: International Journal of Language & Communication Disorders. 2025 60(5).
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 15
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Descriptors: Human Body, Physical Health, Rehabilitation, Outcomes of Treatment, Voice Disorders, Feasibility Studies, Motor Reactions, Muscular Strength, Physiology, Assistive Technology
DOI: 10.1111/1460-6984.70107
ISSN: 1368-2822
1460-6984
Abstract: Background: People with laryngectomy who use a tracheoesophageal voice prosthesis for communication experience changes to respiratory function resulting in reduced breath support and increased secretions. This impacts tracheoesophageal voice quality and volume. Expiratory muscle strength training (EMST) is an effective treatment for cough management, voice and respiratory function in other clinical populations, such as neurodegenerative conditions and benign voice disorders. There is limited evidence for the use of EMST in people with laryngectomy. This study explores EMST feasibility and preliminary efficacy with tracheoesophageal speakers. It is hypothesised that, like in other disorders, EMST can improve respiratory parameters and thus tracheoesophageal voice quality. Aims: (1) To investigate the feasibility and acceptability of EMST after laryngectomy. (2) To determine the impact of EMST on respiratory function; participant-reported outcome measures (PROMS) of cough and secretion burden, voice-related quality of life and experiences of communication; objective and perceptual measures of tracheoesophageal voice quality. Methods and Procedures: This was a before-after study with time (double baseline) providing experimental control. Participants completed a 5-week EMST protocol and 6-week maintenance period. Assessments were taken at two baselines, post-EMST and at 6-week follow-up: respiratory: maximum expiratory pressure (MEP), peak flow, forced expiratory volume (FEV1); PROMS: CASA-Q, SECEL, V-RQOL; voice: voice recording for perceptual (clinician-rated) analysis, maximum phonation time, decibels. One-way repeated measures ANOVA or Friedman tests were used as appropriate to explore the pattern of change. Effect sizes were reported. Outcomes and Results: Ten participants (eight male and two female) completed EMST. Participants found EMST acceptable and beneficial, reporting subjective changes in breathing and exercise tolerance. There were no significant differences in any measures between the two baselines. Significant increase from baseline was found in peak flow, FEV1 and decibels post-EMST training and post 6-week maintenance period, respectively. MEP increased significantly from baseline to post-EMST training only. PROMS showed a reduction in cough impact, sputum symptoms and reduced self-evaluation of communication impairment post-EMST. There was a non-significant reduction in maximum phonation time and no significant differences in clinician-rated voice quality post-EMST training and maintenance periods. Participants required device modifications to enable safe usage of the device and to achieve an airtight connection at the neck stoma. Conclusions and Implications: EMST is an acceptable treatment for tracheoesophageal speakers; however, device modifications are required to support usage and minimise airway safety risks. Preliminary efficacy data demonstrate that EMST may improve parameters of respiratory function, volume and self-perception of communication in PWL. A larger-scale randomised trial is required to increase the robustness of findings. It is recommended that device manufacturers develop adapters to facilitate airtight connection to neck stomas and to increase device safety in the laryngectomy population.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1484085
Database: ERIC
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  Data: Expiratory Muscle Strength Training to Improve Voice and Respiratory Outcomes after Laryngectomy: A Feasibility Study
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  Data: <searchLink fieldCode="AR" term="%22Freya+Sparks%22">Freya Sparks</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-2406-4944">0000-0002-2406-4944</externalLink>)<br /><searchLink fieldCode="AR" term="%22Margaret+Coffey%22">Margaret Coffey</searchLink><br /><searchLink fieldCode="AR" term="%22Lucy+Dipper%22">Lucy Dipper</searchLink><br /><searchLink fieldCode="AR" term="%22Jessica+Crowther%22">Jessica Crowther</searchLink><br /><searchLink fieldCode="AR" term="%22Simon+Hamilton%22">Simon Hamilton</searchLink> (ORCID <externalLink term="https://orcid.org/0009-0002-9590-2471">0009-0002-9590-2471</externalLink>)<br /><searchLink fieldCode="AR" term="%22Louise+Occomore-Kent%22">Louise Occomore-Kent</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-6212-5461">0000-0002-6212-5461</externalLink>)<br /><searchLink fieldCode="AR" term="%22Katerina+Hilari%22">Katerina Hilari</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22International+Journal+of+Language+%26+Communication+Disorders%22"><i>International Journal of Language & Communication Disorders</i></searchLink>. 2025 60(5).
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  Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
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  Data: Journal Articles<br />Reports - Research
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  Data: 10.1111/1460-6984.70107
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  Data: 1368-2822<br />1460-6984
– Name: Abstract
  Label: Abstract
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  Data: Background: People with laryngectomy who use a tracheoesophageal voice prosthesis for communication experience changes to respiratory function resulting in reduced breath support and increased secretions. This impacts tracheoesophageal voice quality and volume. Expiratory muscle strength training (EMST) is an effective treatment for cough management, voice and respiratory function in other clinical populations, such as neurodegenerative conditions and benign voice disorders. There is limited evidence for the use of EMST in people with laryngectomy. This study explores EMST feasibility and preliminary efficacy with tracheoesophageal speakers. It is hypothesised that, like in other disorders, EMST can improve respiratory parameters and thus tracheoesophageal voice quality. Aims: (1) To investigate the feasibility and acceptability of EMST after laryngectomy. (2) To determine the impact of EMST on respiratory function; participant-reported outcome measures (PROMS) of cough and secretion burden, voice-related quality of life and experiences of communication; objective and perceptual measures of tracheoesophageal voice quality. Methods and Procedures: This was a before-after study with time (double baseline) providing experimental control. Participants completed a 5-week EMST protocol and 6-week maintenance period. Assessments were taken at two baselines, post-EMST and at 6-week follow-up: respiratory: maximum expiratory pressure (MEP), peak flow, forced expiratory volume (FEV1); PROMS: CASA-Q, SECEL, V-RQOL; voice: voice recording for perceptual (clinician-rated) analysis, maximum phonation time, decibels. One-way repeated measures ANOVA or Friedman tests were used as appropriate to explore the pattern of change. Effect sizes were reported. Outcomes and Results: Ten participants (eight male and two female) completed EMST. Participants found EMST acceptable and beneficial, reporting subjective changes in breathing and exercise tolerance. There were no significant differences in any measures between the two baselines. Significant increase from baseline was found in peak flow, FEV1 and decibels post-EMST training and post 6-week maintenance period, respectively. MEP increased significantly from baseline to post-EMST training only. PROMS showed a reduction in cough impact, sputum symptoms and reduced self-evaluation of communication impairment post-EMST. There was a non-significant reduction in maximum phonation time and no significant differences in clinician-rated voice quality post-EMST training and maintenance periods. Participants required device modifications to enable safe usage of the device and to achieve an airtight connection at the neck stoma. Conclusions and Implications: EMST is an acceptable treatment for tracheoesophageal speakers; however, device modifications are required to support usage and minimise airway safety risks. Preliminary efficacy data demonstrate that EMST may improve parameters of respiratory function, volume and self-perception of communication in PWL. A larger-scale randomised trial is required to increase the robustness of findings. It is recommended that device manufacturers develop adapters to facilitate airtight connection to neck stomas and to increase device safety in the laryngectomy population.
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      – Text: English
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