Respiratory Muscle Strength and Pulmonary Hygiene

It is understood and accepted by nurses and speech-language pathologist, that aggressive oral care for patients in hospitals and nursing homes can reduce the incidence of hospital acquired pneumonia. For patients with dysphagia (swallowing impairment), oral care, which includes brushing teeth, can reduce the bacterial overload of oral secretions which may be aspirated into the lower airways and serve as a source of infection. Collectively, the various oral care strategies are referred to as oral hygiene.

Pulmonary hygiene can also be a key factor in preventing or reducing hospital-acquired or aspiration pneumonia, and this includes measures which may strengthen the defense mechanism of individuals. Pulmonary hygiene strategies may include: early mobility, encouraging cough, and deep breathing.

But individuals who have reduced mobility due to advanced age or a neurodegenerative disease, and weak respiratory muscles, may be at greater risk for pulmonary complications which may include recurrent aspiration or silent aspiration associated with dysphagia and reduced cough effort and poor mobilization of pulmonary secretions.

Respiratory Muscle Weakness and Parkinson’s

One of the most important physiological changes in respiratory function that accompanies aging is the decline in respiratory muscle strength, associated with the overall loss of muscle mass or what is referred to as sarcopenia. Measurements of maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) in persons with Parkinson’s disease have been studied by several investigators with results indicating that MIP and MEP values were signifi­cantly lower in patients with PD when compared to healthy age and gender matched controls. Respiratory muscle weakness in patients with PD restricts the ability to overcome rigidity and potentially contributes to reduced lung volume and re­spiratory pressure, which will impact on swallow, cough and speech functions. The impact of dopamanergic medications on respiratory muscle function is not entirely clear, but it is likely that patients with on/off symptoms that include dyskinesia superimposed on respiratory muscle function may have an even more difficult time co-ordinating breathing with swallowing and speech production.

Respiratory Muscle Training

Respiratory muscle training (RMT) devices, are hand-held devices that have been available for over 30 years, and protocols for their use and benefits reported in the literature have focused on various diagnosis, including COPD, neuromuscular diseases, and more recently, Parkinson’s disease. RMT devices are designed to focus on inspiratory, expiratory, or a mix of inspiratory/expiratory muscles. The addition of RMT to a home exercise program may yield benefits for anyone concerned about age-related changes to respiratory muscles, and provide needed strength training and pulmonary hygiene for persons with a diagnosis of a neurodegenerative disease or other medical diagnosis with risk factors for dysphagia and aspiration and/or” silent aspiration.”

If you are interested in learning more about respiratory muscle training, follow the link below to register for a free upcoming webinar.

Breather + RMT kit

When using a flow resistance device, it can sometimes be difficult for therapists to know if patients are training to their full effort, so, the addition of a simple manometer may help provide you or your patients with feedback that provides more targeted training.

The Voice Aerobics® RMT kit  is an affordable accessory that includes: one single patient use medical grade manometer; a connector, tubing, and an additional mouth piece. All pieces are latex free .  

Quantify effort * provide concurrent feedback * set training parameters * monitor progress

In the brief video clip below, Bill demonstrates use of the manometer with The Breather. The RMT kit provides a manometer and all of the adapters required to use with The Breather, EMST device or other device with a 22mm connection.




My MissionTo enlist individuals in their treatment, and help them express their personality & spirit through voice. To educate  and empower. Mary Spremulli, MA, CCC-SLP FiTOUR® Group Exercise Instructor * Voice Aerobics® A Whole Body Approach to Voice Practice

Voice Aerobics the heART and Science of Voice Practice