Alright, deep breaths...

Speech, language, voice, cognition, swallowing, and ... respiration?

If you work with adults, you probably work on respiratory support. Something I wasn't entirely prepared for when I switched settings from acute care (where we had our own respiratory therapist) to a SNF. So for any therapists new to respiratory muscle strength training (RMST) I hope this post helps you navigate the murky waters of choosing the correct modality for therapy.

First and foremost, when dealing with respiratory strength training it's important to keep in mind that the desired outcome and patient-specific deficits will be the driving force behind choosing the most appropriate device. Some available devices will target both inspiratory and expiratory muscles, some just inspiratory or expiratory, and some will not provide strengthening at all but may offer an alternative benefit. First up .... The Breather.

The Breather

The Breather is an inexpensive, resistive technology that offers strength training for inspiratory and expiratory muscles. Benefits of The Breather include increasing dyspnea (shortness of breath), airway protection, and movement of the hyolaryngeal mechansim. As an added benefit, PN Medical offers a variety of free training videos for both clinicians and patients. I have used The Breather with multiple patients. It is easy to use and mimics the natural sequence of breathing so even patients with cognitive impairments can use it effectively. It also starts at a very low resistance level so most patient's should be able to complete the exercises without much difficulty. Another pro is that it comes with two different mouthpieces, one of which is more effective for patient's with labial weakness. A commonly cited downside of this modality is that it only offers 5 resistance levels. I have also noticed the rubber valves become stuck occasionally but this is easily corrected by lightly tapping each side of the device on a semi-soft surface (I usually use the arm rest of my patient's recliner).

EMST150

The EMST150 differs from The Breather in that it is a pressure threshold device utilizing a spring-loaded system. The EMST150 is backed by research to improve swallow function (e.g. productive cough, hyolaryngeal excursion, and velar closure). It also has been shown to improve voice and speech quality. One thing I LOVE about this device is the spring-loaded system allows for a lot resistance during expiration which allows for a lot of improvement in swallow function. It should be noted that the EMST150 is for improvement in expiratory function. This device is contraindicated for patient's with GERD and COPD (so like, half your dysphagia caseload).

Philips Threshold PEP

Not quite as popular as the EMST150, the Threshold PEP is another device that utilizes expiratory resistance to strengthen and is also useful in opening airways to expel mucus. One main benefit of this modality is that it can be attached to an inhaler or nebulizer during treatments to enhance intake of medications. If a patient is struggling to complete exercises with the EMST150, this device might be a better place to start due to lower resistance requirements.

Acapella

The Acapella, better known as "the pickle", is a vibratory positive expiratory pressure (PEP) device with the primary intent of mobilizing mucus. One benefit of the Acapella is that it can be connected to a bronchodilator device to ensure successful delivery of medication into the airway. The Acapella is really nice for patient's with mucus buildup who have difficulty following cues to utilize a huff cough. In my opinion, it's also more effective in expelling mucus than utilizing the huff cough independently. Just keep in mind that this device is used to clear mucus from airways, not increase strength of respiratory muscles.

Aerobika

Like the Acapella, the Aerobika is another secretion mobilization device used to open the airways and clear mucus from the upper airways. Similarly, the Aerobika is not used to strengthen the respiratory muscles. It's also worth mentioning that the Aerobika does tend to run a little higher in price compared to the Acapella but it is very effective if used consistently.