Biographical Sketch: Christine Sapienza, Ph.D.

is a Professor and Chair of the Department of Speech, Language, and Hearing Sciences, University of Florida and a Research Career Scientist at the North Florida/South Georgia Malcom Randall VA hospital. Her area of research interests includes the study of adult and pediatric normal and disordered voice and adult neuromotor disorders. Her publications can be found in The Journal of Speech Language and Hearing Research, The Journal of the Acoustical Society of America, Journal of Applied Physiology, Journal of Voice, American Journal of Speech Language Pathology, Chest, Neurology and others. Dr. Sapienzas most recent work focuses on the use of strength training paradigms in several different populations including Parkinsons disease, voice disorders, spinal cord injury and multiple sclerosis. She is past Editor of the Special Interest Division 3 newsletter, Voice and Voice Disorders and past Associate Editor for the Journal of Speech Language and Hearing Research. She maintains an active research laboratory with 3 current Ph.D. students. Her clinical work takes place at the University of Florida and Shands outpatient voice clinic and VA hospital and in the Center for Movement Disorders and Neurorestoration. She recently published on a new device for addressing airway protection in Parkinsons disease. She is author of the graduate textbook Voice Disorders, Plural Publishing.

What is respiratory muscle strength training? Respiratory muscle strength training programs are exercise-based programs that work to strengthen the muscles used in breathing. Leith and Bradley (1976) first demonstrated in healthy individuals that the respiratory muscles, like their skeletal muscle counterparts, could be specifically trained to improve strength or endurance. Over the years we, as well as other researchers, have found that these programs help other functions, like speech, cough and swallowing. The programs can be either inspiratory or expiratory and are typically accomplished using handheld devices. Training durations typically are 4-8 weeks. Training trials usually take 20-30 min per day.

What is the EMST 150 device: The EMST 150 is a device that was developed to help strengthen the expiratory muscles used for breathing. EMST stands for Expiratory Muscle Strength Training. It has a pressure range that goes to 150 cmH20, which is why we call it the 150.

Why use the EMST 150? The EMST 150 is a simple way to strengthen the expiratory/exhalatory muscles in a short period of time. There is no machine at the gym or health club that can accomplish this for you. If you are in need of improving the power and endurance of your breathing, the EMST 150 can do that for you simply and efficiently.

Is there research supporting the use of the EMST 150? We have been studying respiratory muscle strength training outcomes since the late 1990s. We started investigating how it could be used with patients that have limited glottal airway space. From there we moved our work to others with muscle weakness including multiple sclerosis, spinal cord injury etc. Our latest work has focused on patients with Parkinsons disease. The largest randomized clinical trial on EMST is now published in Neurology (2010). In this work we found positive outcomes for variables related to airway protection. I notice in some pictures people are wearing noseclips. Do I need to wear the nose clips when I train with the device? Yes. The nose clips must be worn when training to prevent air from leaking out of your nose as you are blowing forcefully into the EMST 150. If air leaks out of the nose, the training effect will be lessened. How do I know where to start the training? A step-by-step instructional DVD is included with the EMST150. The trainer is typically set to 75% of the users maximum ability to generate an expiratory pressure (MEP). So, if the EMST Gauge reads 100 then you would set your device to 75, start training there for one week and after one week, re-measure your MEP and reset your trainer if the MEP increased. How do I know how long to train at each level? We suggest training at each level for one week, 5 days per week, completing 25 breaths through the device per day (5 sets of 5 breaths). The training should be done all at once and will take between 15 and 20 minutes per day. Should the device be shared with someone else? Absolutely not. Sharing your device may transfer germs between users. Think of the EMST 150 like your toothbrush. How is the EMST 150 cleaned? Simply clean the EMST 150 with dishwashing soap and rinse thoroughly with warm water. Should I rest in between sets? Yes. We recommend resting 1 to 2 minutes between sets. If / stop the training program what happens? There is a concept in the neuroplasticity literature called Use it or lose it. This is also referred to as detraining in the exercise literature. It is basically a reversal of the adaptations gained with exercise. So we recommend that patients continue to train with the respiratory strength training devices, between 2 to 3 days per week. Whats next with regard to your research? I am working with colleagues developing a multisite randomized clinical trial to test effectiveness of the device use. That is can others (clinicians) adequately use the device and achieve the same outcomes or even better than those we have achieved. This will show us if our effects can be duplicated in large groups of people. We can only hope that the outcomes of a multi-entered trial will be positive meaning that respiratory strength training has a large beneficial effect and is superior to standard treatment.