Preliminary study on the combined effects of simple expiratory muscle strength device training with conventional exercise on submental muscles force and maximal expiratory pressure related to swallowing in patients with head and neck cancer

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Erin Songdechagraiwud
Piyawat Trevittaya
Jirakrit Leelarungrayub
Nuntigar Sonsuwan


Background: After chemo-radiotherapy, most patients with head and neck cancer (HNC) commonly show defect in swallowing and coughing function related to various weaknesses of oropharyngeal muscles. It is possible that strengthening those muscles via an expiratory force device could regain muscle strength.

Objectives: The aim of this preliminary study was to discover whether a combination of expiratory muscle strength training (EMST) together with a simple expiratory muscle strength device in conventional exercise could be performed for improving submental muscle force and expiratory muscle strength in patients with HNC during chemo-radiotherapy.

Material and methods: The effects of combined EMST with a conventional exercise program on submental muscle force and maximal expiratory pressure (MEP) were evaluated when compare to a conventional exercise. Conventional exercise composed of neck, tongue, oral muscle, and supraglottic swallow exercise. Meanwhile, EMST was performed with a resistor at 50% and 70% of MEP. MEP and surface electromyography (sEMG) were tested at before and after a 6-week period of intervention. Satisfaction of using device was evaluated. Moreover, interviews on swallowing and pain sensation were also carried out.

Results: The results showed that sEMG amplitude decreased significantly in the conventional exercise group (n=5, aged 55.80±2.51 years). It was increased significantly in the combined EMST with conventional exercise group (n=5, aged 49.20±3.78 years). However, sEMG duration from submental contraction increased significantly in the conventional exercise group, but decreased significantly in the combined EMST with conventional exercise group. In addition, the MEP value decreased non-significantly in both groups after the 6-week period when compared to the baseline period. Finally, satisfaction of the training device from all of the five patients involved focused on comfort and easy-practical use without dyspnea. Moreover, the swallowing or food swallowing function was improved and less painful when compared to before the device was used.

Conclusion: This preliminary study showed that the combination of EMST with a simple expiratory muscle strength device, which was simple and easily developed, and a conventional exercise program, could improve the submental force among patients with HNC in the clinic, without adverse effects.


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Songdechagraiwud, E., Trevittaya, P., Leelarungrayub, J., & Sonsuwan, N. (2020). Preliminary study on the combined effects of simple expiratory muscle strength device training with conventional exercise on submental muscles force and maximal expiratory pressure related to swallowing in patients with head and neck cancer. Journal of Associated Medical Sciences, 53(2), 7-13. Retrieved from
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