The purpose of this study is to investigate the effects of two treatment techniques called Expiratory Muscle Strength Training (EMST) and Lung Volume Recruitment (LVR) on breathing, swallowing, speech, and cough function in persons with mild to moderate ALS. Half of the participants will do EMST alone, and the other half of the participants will do EMST and LVR.
Inclusion Criteria:
- ALS defined as possible, laboratory-supported probable, probable, or definite by El
Escorial criteria
- Reduced Maximal Expiratory Pressure (MEP) compared to norms for age and sex
- Forced Vital Capacity (FVC) > 65% predicted
Exclusion Criteria:
- Inability to provide informed consent
- Relative contraindications to LVR, including known pneumothorax, active internal
bleeding, unstable hypertension, unstable angina, emphysema, recent barotrauma, or
FEV1 (Forced Expiratory Volume, trial 1)/FVC ratio < 0.7.
- Use of EMST or breath stacking > 3 days/week within 12 weeks of screening
- Amyotrophic Lateral Sclerosis-Cognitive Behavioral Scale (ALS-CBS) score predictive of
dementia (≤ 10)
- Participation in another clinical trial of an intervention in ALS within 30 days of
study enrollment or during study enrollment