Rehabilitation of swallowing and cough functions following stroke: an expiratory muscle strength training trial

Hegland KW, Davenport PW, Brandimore AE, Singletary FF, Troche MS.

Arch Phys Med Rehabil. 2016 Apr 26. pii: S0003-9993(16)30078-8. doi: 10.1016/j.apmr.2016.03.027.




To determine the effect of expiratory muscle strength training on both cough and swallow function in stroke patients.


Prospective pre-post intervention trial with one participant group.


Two outpatient rehabilitation clinics PARTICIPANTS: Fourteen adults with a history of ischemic stroke in the preceding 3 – 24 months participated in this study.


Expiratory muscle strength training (EMST). The training program was completed at home and consisted of 25 repetitions per day, 5 days per week, for 5 weeks.


Baseline and post-training measures were: maximum expiratory pressure, voluntary cough airflows, reflex cough challenge to 200μM capsaicin, sensory perception of urge-to-cough, and fluoroscopic swallow evaluation. Repeated measures and one-way analyses of variance were used to determine significant differences pre/post training.


Maximum expiratory pressure increased in all participants by an average of 30cmH2O post training. At baseline, all participants demonstrated a blunted reflex cough response to 200 μM capsaicin. Following 5 weeks of training, measures of urge to cough and cough effectiveness increased for reflex cough, however voluntary cough effectiveness did not increase. Swallow function was minimally impaired at baseline, and there were no significant changes in the measures of swallow function post training.


Expiratory muscle strength training improves both expiratory muscle strength, reflex cough strength and urge-to-cough. Voluntary cough and swallow measures were not significantly different post training. It may be that stroke patients benefit from the training for up-regulation of reflex cough and thus improved airway protection.


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