Klaske van Sluis

Expiratory muscle strength training 115 ease [14, 16, 17], multiple sclerosis [18], sleep apnea [19], head and neck cancer patients with dysphagia [20], stroke [21, 22], amyotrophic lateral sclerosis [23], supracricoid partial laryngectomy [24], and healthy participants [25–27]. In sev- eral populations, to date, EMST has been shown to increase expiratory pressure generation by 30 to 150%, with an average increase of approximately 50% in a 4-week period of time [14, 16, 18, 20, 22, 23, 27]. Most of the clinical studies cited above aimed at improving cough strength to improve clearing of aspi- ration of oral intake or saliva. [16–18, 20, 22, 24] EMST has not been tested in the TL population. The main objective of the present study is to evaluate feasibility, safety, and compliance of EMST in individuals who have undergone TL. Subsequently, objective and subjective outcomes of the effects of EMST on pulmonary function, physical exertion, fatigue, and vocal functioning are assessed. 7.2 Materials and Methods This prospective, randomized case-series study examined feasibility of EMST and its effects on pulmonary function and voice, in a group of male TL par- ticipants, who were at least a half year post-surgery and, if applicable, post- operative (chemo) radiation. Participants were screened and recruited from the head and neck department of the Netherlands Cancer Institute, Amsterdam, The Netherlands. Exclusion criteria were: recurrence of head and neck cancer, a history of lung cancer, severe asthma, tuberculosis, uncontrolled or untreated hypertension, a heart attack in the last year, or abdominal hernia. The study was approved by the medical ethical review committee of the Netherlands Can- cer Institute (registration nr. NL60167.031.16.). 7.2.1 Expiratory muscle strength training and adjustment to use after total laryngectomy EMST150 (Aspire Products) is a threshold based device-driven treatment for improving expiratory pressure generating capacity. EMST employs a handheld training device consisting of a plexiglass tube. Inside the device is a variable tension spring controlling a valve that is calibrated in pressure, adjustable from 30 till 150cmH20. When enough pressure is developed, the valve opens, allow- ing air to flow through the trainer. The patient is instructed to exhale forcefully through the device. In this way, EMST targets the rectus abdominis and inter- nal intercostal muscles through a program of progressive overloading which is an exercise stimulus specific for forceful expiration. To adjust the use of the EMST150 device for TL participants, we developed and produced an adaptor to connect the device at the adhesive baseplate in front of the tracheostoma. This adaptor contains an opening on top to allow inhalation which can be occluded manually, a small lumen for use of the voice