title: Expiratory muscle strength training: speech production outcomes in patients with multiple sclerosis.
abstract: OBJECTIVE
  This study investigated the effect of expiratory muscle strength training (EMST) on voice production, dysarthria, and voice-related quality-of-life issues in persons with multiple sclerosis (PwMS). It was hypothesized that PwMS would have improved voice production and reduced voice-related quality-of-life issues following EMST.
  
  
  METHODS
  Seventeen participants with MS and 14 healthy (H) controls completed 8 weeks of EMST, followed by 4 weeks of no training. Analyzed outcomes as a function of EMST were maximal expiratory pressure (MEP), sustained vowel prolongation (SVP), words per minute (WPM) measured from connected speech, and quality-of-life indices related to the presence of the dysarthria and dysphonia.
  
  
  RESULTS
  PwMS had lower MEPs, shorter SVP, and less WPM than the controls prior to training. Following EMST, both groups had significant improvement in MEPs that stayed above baseline after training halted. EMST did not improve voice production or voice-related quality of life for PwMS.
  
  
  CONCLUSIONS
  Respiratory muscle weakness is present in PwMS having mild- to moderate-level disability. EMST improved expiratory muscle strength but did not statistically change objective and subjective components of voice/speech production in PwMS.
authors.affiliation: Malcom Randall VA Medical Center, Brain Rehabilitation Research Center, Gainesville, FL 32608, USA. toni.chiara@med.va.gov
authors.forename: T
authors.initials: T
authors.lastname: Chiara
authors.forename: D
authors.initials: D
authors.lastname: Martin
authors.forename: C
authors.initials: C
authors.lastname: Sapienza
mesh_terms: D000328:Adult; D004185:Disability Evaluation; D004401:Dysarthria / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D045853:Exhalation / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008448:Maximal Expiratory Flow Rate / Q000502:physiology; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation*; D011788:Quality of Life; D012132:Respiratory Muscles / Q000502:physiology; D012720:Severity of Illness Index; D013060:Speech / Q000502:physiology*; D013061:Speech Acoustics; D013070:Speech Therapy / Q000379:methods*; D014833:Voice Quality / Q000502:physiology