{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T08:49:34Z","timestamp":1789202974831,"version":"build-2803163510"},"reference-count":64,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T00:00:00Z","timestamp":1755216000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T00:00:00Z","timestamp":1755216000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Lang &amp;amp; Comm Disor"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>People with laryngectomy who use a tracheoesophageal voice prosthesis for communication experience changes to respiratory function resulting in reduced breath support and increased secretions. This impacts tracheoesophageal voice quality and volume.\u00a0Expiratory muscle strength training (EMST) is an effective treatment for cough management, voice and respiratory function in other clinical populations, such as neurodegenerative conditions and benign voice disorders. There is limited evidence for the use of EMST in people with laryngectomy. This study explores EMST feasibility and preliminary efficacy with tracheoesophageal speakers.\u00a0It is hypothesised that, like in other disorders, EMST can improve respiratory parameters and thus tracheoesophageal voice quality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>(1) To investigate the feasibility and acceptability of EMST after laryngectomy. (2) To determine the impact of EMST on respiratory function; participant\u2010reported outcome measures (PROMS) of cough and secretion burden, voice\u2010related quality of life and experiences of communication; objective and perceptual measures of tracheoesophageal voice quality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Procedures<\/jats:title>\n                    <jats:p>This was a before\u2013after study with time (double baseline) providing experimental control. Participants completed a 5\u2010week EMST protocol and 6\u2010week maintenance period. Assessments were taken at two baselines, post\u2010EMST and at 6\u2010week follow\u2010up: respiratory: maximum expiratory pressure (MEP), peak flow, forced expiratory volume (FEV1); PROMS: CASA\u2010Q, SECEL, V\u2010RQOL; voice: voice recording for perceptual (clinician\u2010rated) analysis, maximum phonation time, decibels. One\u2010way repeated measures ANOVA or Friedman tests were used as appropriate to explore the pattern of change. Effect sizes were reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes and Results<\/jats:title>\n                    <jats:p>Ten participants (eight male and two female) completed EMST. Participants found EMST acceptable and beneficial, reporting subjective changes in breathing and exercise tolerance. There were no significant differences in any measures between the two baselines. Significant increase from baseline was found in peak flow, FEV1 and decibels post\u2010EMST training and post 6\u2010week maintenance period, respectively. MEP increased significantly from baseline to post\u2010EMST training only. PROMS showed a reduction in cough impact, sputum symptoms and reduced self\u2010evaluation of communication impairment post\u2010EMST. There was a non\u2010significant reduction in maximum phonation time and no significant differences in clinician\u2010rated voice quality post\u2010EMST training and maintenance periods. Participants required device modifications to enable safe usage of the device and to achieve an airtight connection at the neck stoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and Implications<\/jats:title>\n                    <jats:p>EMST is an acceptable treatment for tracheoesophageal speakers; however, device modifications are required to support usage and minimise airway safety risks. Preliminary efficacy data demonstrate that EMST may improve parameters of respiratory function, volume and self\u2010perception of communication in PWL. A larger\u2010scale randomised trial is required to increase the robustness of findings. It is recommended that device manufacturers develop adapters to facilitate airtight connection to neck stomas and to increase device safety in the laryngectomy population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>WHAT THIS PAPER ADDS<\/jats:title>\n                    <jats:p>\n                      <jats:italic>What is already known on this subject<\/jats:italic>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>According to existing evidence, EMST is an effective treatment for improving cough strength and respiratory function. However, knowledge on the use of EMST after laryngectomy is limited, with only one existing study in evidence (Van Sluis et\u00a0al. 2020).<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:italic>What this paper adds to existing knowledge<\/jats:italic>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>This innovative feasibility study provides evidence on the feasibility and acceptability of EMST with people with laryngectomy and preliminary data on its impact on perceptual and objective measures of tracheoesophageal voice, cough and secretion clearance.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:italic>What are the potential or actual clinical implications of this work?<\/jats:italic>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Subject to further testing, EMST may be an appropriate treatment to consider improving respiratory function, secretion clearance, vocal loudness and self\u2010perception of communication for tracheoesophageal speakers.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1460-6984.70107","type":"journal-article","created":{"date-parts":[[2025,8,16]],"date-time":"2025-08-16T04:17:20Z","timestamp":1755317840000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Expiratory Muscle Strength Training to Improve Voice and Respiratory Outcomes After Laryngectomy: A Feasibility Study"],"prefix":"10.1111","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2406-4944","authenticated-orcid":false,"given":"Freya","family":"Sparks","sequence":"first","affiliation":[{"name":"Department of Language and Communication Sciences School of Health and Medical Sciences City St George's, University of London  London UK"},{"name":"Barts Health NHS Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Coffey","sequence":"additional","affiliation":[{"name":"Imperial College Academic Health Science Centre  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy","family":"Dipper","sequence":"additional","affiliation":[{"name":"Department of Language and Communication Sciences School of Health and Medical Sciences City St George's, University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Crowther","sequence":"additional","affiliation":[{"name":"Barts Health NHS Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9590-2471","authenticated-orcid":false,"given":"Simon","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Barts Health NHS Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6212-5461","authenticated-orcid":false,"given":"Louise","family":"Occomore\u2010Kent","sequence":"additional","affiliation":[{"name":"Department of Language and Communication Sciences School of Health and Medical Sciences City St George's, University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katerina","family":"Hilari","sequence":"additional","affiliation":[{"name":"Department of Language and Communication Sciences School of Health and Medical Sciences City St George's, University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,15]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2273.1995.tb01599.x"},{"issue":"4","key":"e_1_2_11_3_1","first-page":"169","article-title":"Assessment of Voice Related Quality of Life and Its Correlation With Socioeconomic Status After Total Laryngectomy","volume":"4","author":"Agarwal S. 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