Department of Special Education and Communication Disorders



Dietsch 0000-0003-4554-5365

Krishnamurthy 0000-0003-1736-1737

Barlow 0000-0002-6628-6748

Document Type


Date of this Version



Journal of Speech, Language, and Hearing Research (March 2024) 32(4): 729–739

doi: 10.1044/2023_JSLHR-23_00381


Copyright 2024, American Speech-Language-Hearing Association. Used by permission



Expiratory muscle strength training (EMST) is increasingly being used to treat voice, cough, and swallowing deficits in a wide range of conditions. However, a multitude of aero-resistive EMST models are commercially available, and the absence of side-by-side comparative data interferes with clinicians’ ability to assess which model is best suited to a particular client’s needs. The primary aim of this research was to test and compare the pressure and flow parameters of six currently available EMST models to help inform clinical decision making.


We identified and tested five devices of each of six different EMST models to generate benchmark data for minimum trigger pressures across settings. The reliability was tested within each device and between five devices of the same model across settings using coefficient of variation.


All six models required higher pressures to initiate flow at the highest setting compared to the lowest setting, as expected. Detailed descriptive statistics for each model/setting combination include average flow-triggering pressure for each model/setting and the variability across trials within a device and across devices of the same model. From these, ranked order of the least to most stable EMST model was derived.


Systematic testing of several commercially available expiratory re-sistance training devices yielded clinical benchmarks and reliability data to aid clinicians in selecting an appropriate therapy device and regimen for a client based on their available airflow and air pressure as well as reliability of the device. These findings allow clinicians to directly compare key parameters across EMST devices.