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Using Ultrasound to Document the Effects of Expiratory Muscle Strength Training (EMST) on the Geniohyoid Muscle

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Abstract

Expiratory muscle strength training (EMST) is an exercise program designed to strengthen the muscles of expiration by increasing expiratory load during breathing exercises using either resistive or pressure threshold devices. Previous research has shown that EMST may increase submental suprahyoid muscle activity as measured with surface electromyography. The impact of EMST on submental muscles is of interest to those who treat dysphagia. The purpose of this study was to determine whether the cross-sectional area of the geniohyoid muscle changes as observed with ultrasound during a 5-week EMST program performed at 75% of maximum expiratory strength using the EMST150 device in healthy adults. Ten healthy adults participated in the 5-week program. Maximum expiratory pressure (MEP) and cross-sectional area of the geniohyoid muscle were measured weekly. Geniohyoid cross-sectional area was measured from ultrasound images recorded in the coronal plane. Repeated Measures ANOVA was used to determine whether there were significant changes among the dependent variables over the study period. Both MEP and geniohyoid area increased significantly in response to a 5-week program of EMST. EMST in healthy adults is effective at strengthening the geniohyoid muscle as reflected by significantly increased cross-sectional area measured with B-mode ultrasound. This is the first study to document weekly change in muscle morphology as a result of EMST. Increasing geniohyoid muscle mass and consequent strength through a program of EMST may be beneficial for persons with pharyngeal stage dysphagia resulting from reduced hyolaryngeal elevation, reduced laryngeal closure, or reduced UES opening.

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References

  1. Sapienza C, Troche M, Pitts T, Davenport P. Respiratory strength training: concept and intervention outcomes. Semin Speech Lang. 2011;32(1):21–30. https://doi.org/10.1055/s-0031-1271972.

    Article  PubMed  Google Scholar 

  2. Laciuga H, Rosenbek JC, Davenport PW, Sapienza CM. Functional outcomes associated with expiratory muscle strength training: narrative review. J Rehabil Res Dev. 2014;51(4):535–46. https://doi.org/10.1682/JRRD.2013.03.0076.

    Article  PubMed  Google Scholar 

  3. Kim J, Sapienza CM. Implications of expiratory muscle strength training for rehabilitation of the elderly: tutorial. J Rehabil Res Dev. 2005;42(2):211–24. https://doi.org/10.1682/jrrd.2004.07.0077.

    Article  PubMed  Google Scholar 

  4. Sapienza CM, Davenport PW, Martin AD. Expiratory muscle training increases pressure support in high school band students. J Voice. 2002;16(4):495–501. https://doi.org/10.1016/s0892-1997(02)00125-x.

    Article  PubMed  Google Scholar 

  5. Baker S, Davenport P, Sapienza C. Examination of strength training and detraining effects in expiratory muscles. J Speech Lang Hear Res. 2005;48(6):1325–33. https://doi.org/10.1044/1092-4388(2005/092).

    Article  PubMed  Google Scholar 

  6. Kim J, Davenport P, Sapienza C. Effect of expiratory muscle strength training on elderly cough function. Arch Gerontol Geriatr. 2009;48(3):361–6. https://doi.org/10.1016/j.archger.2008.03.006.

    Article  PubMed  Google Scholar 

  7. Anand S, El-Bashiti N, Sapienza C. Effect of training frequency on maximum expiratory pressure. Am J Speech Lang Pathol. 2012;21(4):380–6. https://doi.org/10.1044/1058-0360(2012/11-0048).

    Article  PubMed  Google Scholar 

  8. Silva IS, Pedrosa R, Azevedo IG, et al. Respiratory muscle training in children and adults with neuromuscular disease. Cochrane Database Syst Rev. 2019;9(9):CD011711. https://doi.org/10.1002/14651858.CD011711.pub2.

    Article  PubMed  Google Scholar 

  9. Templeman L, Roberts F. Effectiveness of expiratory muscle strength training on expiratory strength, pulmonary function and cough in the adult population: a systematic review. Physiotherapy. 2020;106:43–51. https://doi.org/10.1016/j.physio.2019.06.002.

    Article  PubMed  Google Scholar 

  10. Wang Z, Wang Z, Fang Q, Li H, Zhang L, Liu X. Effect of expiratory muscle strength training on swallowing and cough functions in patients with neurological diseases: a meta-analysis. Am J Phys Med Rehabil. 2019;98(12):1060–6. https://doi.org/10.1097/PHM.0000000000001242.

    Article  PubMed  Google Scholar 

  11. Brooks M, McLaughlin E, Shields N. Expiratory muscle strength training improves swallowing and respiratory outcomes in people with dysphagia: a systematic review. Int J Speech Lang Pathol. 2019;21(1):89–100. https://doi.org/10.1080/17549507.2017.1387285.

    Article  PubMed  Google Scholar 

  12. Allen J, Astin R, Smith C, Banks D, Turner C. Expiratory muscle strength training improves measures of pressure generation and cough strength in a patient with myotonic dystrophy type 1. Neuromuscul Disord. 2020;30(9):750–5. https://doi.org/10.1016/j.nmd.2020.07.003.

    Article  PubMed  Google Scholar 

  13. Pitts T, Bolser D, Rosenbek J, Troche M, Okun MS, Sapienza C. Impact of expiratory muscle strength training on voluntary cough and swallow function in Parkinson disease. Chest. 2009;135(5):1301–8. https://doi.org/10.1378/chest.08-1389.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Troche MS, Okun MS, Rosenbek JC, et al. Aspiration and swallowing in Parkinson disease and rehabilitation with EMST: a randomized trial. Neurology. 2010;75(21):1912–9. https://doi.org/10.1212/WNL.0b013e3181fef115.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Byeon H. Effect of simultaneous application of postural techniques and expiratory muscle strength training on the enhancement of the swallowing function of patients with dysphagia caused by Parkinson’s disease. J Phys Ther Sci. 2016;28(6):1840–3. https://doi.org/10.1589/jpts.28.1840.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Jenks J, Pitts LL. Effects of an intensive exercise-based swallowing program for persons with Parkinson’s disease and complex medical history: a single-case experiment. Am J Speech Lang Pathol. 2019;28(3):1268–74. https://doi.org/10.1044/2019_AJSLP-18-0168.

    Article  PubMed  Google Scholar 

  17. López-Liria R, Parra-Egeda J, Vega-Ramírez FA, et al. Treatment of dysphagia in Parkinson’s disease: a systematic review. Int J Environ Res Public Health. 2020;17(11):4104. https://doi.org/10.3390/ijerph17114104.

    Article  PubMed Central  Google Scholar 

  18. Rodríguez MÁ, Crespo I, Del Valle M, Olmedillas H. Should respiratory muscle training be part of the treatment of Parkinson’s disease? A systematic review of randomized controlled trials. Clin Rehabil. 2020;34(4):429–37. https://doi.org/10.1177/0269215519896054.

    Article  PubMed  Google Scholar 

  19. Reyes A, Cruickshank T, Nosaka K, Ziman M. Respiratory muscle training on pulmonary and swallowing function in patients with Huntington’s disease: a pilot randomised controlled trial. Clin Rehabil. 2015;29(10):961–73. https://doi.org/10.1177/0269215514564087.

    Article  PubMed  Google Scholar 

  20. Plowman EK, Watts SA, Tabor L, et al. Impact of expiratory strength training in amyotrophic lateral sclerosis. Muscle Nerve. 2016;54(1):48–53. https://doi.org/10.1002/mus.24990.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Plowman EK, Tabor-Gray L, Rosado KM, et al. Impact of expiratory strength training in amyotrophic lateral sclerosis: results of a randomized, sham-controlled trial. Muscle Nerve. 2019;59(1):40–6. https://doi.org/10.1002/mus.26292.

    Article  PubMed  Google Scholar 

  22. Guillén-Solà A, Messagi Sartor M, Bofill Soler N, et al. Respiratory muscle strength training and neuromuscular electrical stimulation in subacute dysphagic stroke patients: a randomized controlled trial. Clin Rehabil. 2017;31(6):761–71. https://doi.org/10.1177/0269215516652446.

    Article  PubMed  Google Scholar 

  23. Hegland KW, Davenport PW, Brandimore AE, Singletary FF, Troche MS. Rehabilitation of swallowing and cough functions following stroke: an expiratory muscle strength training trial. Arch Phys Med Rehabil. 2016;97(8):1345–51. https://doi.org/10.1016/j.apmr.2016.03.027.

    Article  PubMed  Google Scholar 

  24. Park JS, Oh DH, Chang MY, Kim KM. Effects of expiratory muscle strength training on oropharyngeal dysphagia in subacute stroke patients: a randomised controlled trial. J Oral Rehabil. 2016;43(5):364–72. https://doi.org/10.1111/joor.12382.

    Article  CAS  PubMed  Google Scholar 

  25. Moon JH, Jung JH, Won YS, Cho HY, Cho K. Effects of expiratory muscle strength training on swallowing function in acute stroke patients with dysphagia. J Phys Ther Sci. 2017;29(4):609–12. https://doi.org/10.1589/jpts.29.609.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Eom MJ, Chang MY, Oh DH, Kim HD, Han NM, Park JS. Effects of resistance expiratory muscle strength training in elderly patients with dysphagic stroke. NeuroRehabilitation. 2017;41(4):747–52. https://doi.org/10.3233/NRE-172192.

    Article  PubMed  Google Scholar 

  27. Liaw MY, Hsu CH, Leong CP, et al (2020) Respiratory muscle training in stroke patients with respiratory muscle weakness, dysphagia, and dysarthria - a prospective randomized trial. Medicine (Baltimore). 99(10):e19337. doi: https://doi.org/10.1097/MD.0000000000019337. Erratum in: Medicine (Baltimore). 2020;99(17):e20194

  28. Arnold RJ, Bausek N. Effect of respiratory muscle training on dysphagia in stroke patients-A retrospective pilot study. Laryngoscope Investig Otolaryngol. 2020;5(6):1050–5. https://doi.org/10.1002/lio2.483.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Silverman EP, Miller S, Zhang Y, Hoffman-Ruddy B, Yeager J, Daly JJ. Effects of expiratory muscle strength training on maximal respiratory pressure and swallow-related quality of life in individuals with multiple sclerosis. Mult Scler J Exp Transl Clin. 2017;3(2):2055217317710829. https://doi.org/10.1177/2055217317710829.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Hutcheson KA, Barrow MP, Plowman EK, et al. Expiratory muscle strength training for radiation-associated aspiration after head and neck cancer: a case series. Laryngoscope. 2018;128(5):1044–51. https://doi.org/10.1002/lary.26845.

    Article  PubMed  Google Scholar 

  31. Palmer AD, Bolognone RK, Thomsen S, Britton D, Schindler J, Graville DJ. The safety and efficacy of expiratory muscle strength training for rehabilitation after supracricoid partial laryngectomy: a pilot investigation. Ann Otol Rhinol Laryngol. 2019;128(3):169–76. https://doi.org/10.1177/0003489418812901.

    Article  PubMed  Google Scholar 

  32. Mancopes R, Smaoui S, Steele CM. Effects of expiratory muscle strength training on videofluoroscopic measures of swallowing: a systematic review. Am J Speech Lang Pathol. 2020;29(1):335–56. https://doi.org/10.1044/2019_AJSLP-19-00107.

    Article  PubMed  Google Scholar 

  33. Wheeler KM, Chiara T, Sapienza CM. Surface electromyographic activity of the submental muscles during swallow and expiratory pressure threshold training tasks. Dysphagia. 2007;22(2):108–16. https://doi.org/10.1007/s00455-006-9061-4.

    Article  PubMed  Google Scholar 

  34. Pearson WG Jr, Langmore SE, Zumwalt AC. Evaluating the structural properties of suprahyoid muscles and their potential for moving the hyoid. Dysphagia. 2011;26(4):345–51. https://doi.org/10.1007/s00455-010-9315-z.

    Article  PubMed  Google Scholar 

  35. Pearson WG Jr, Hindson DF, Langmore SE, Zumwalt AC. Evaluating swallowing muscles essential for hyolaryngeal elevation by using muscle functional magnetic resonance imaging. Int J Radiat Oncol Biol Phys. 2013;85(3):735–40. https://doi.org/10.1016/j.ijrobp.2012.07.2370.

    Article  PubMed  Google Scholar 

  36. Pearson WG, Griffeth JV, Ennis AM. Functional anatomy underlying pharyngeal swallowing mechanics and swallowing performance goals. Perspect ASHA Spec Interest Groups. 2019. https://doi.org/10.1044/2019_PERS-SIG13-2018-0014.

    Article  Google Scholar 

  37. Wheeler-Hegland KM, Rosenbek JC, Sapienza CM (2008) Submental sEMG and hyoid movement during Mendelsohn maneuver, effortful swallow, and expiratory muscle strength training. J Speech Lang Hear Res. 51(5):1072–1087. doi: https://doi.org/10.1044/1092-4388(2008/07-0016). Erratum in: J Speech Lang Hear Res. 2008;51(6):1643. PMID: 18728114

  38. Reyes A, Cruickshank T, Thompson J, Ziman M, Nosaka K. Surface electromyograph activity of submental muscles during swallowing and expiratory muscle training tasks in Huntington’s disease patients. J Electromyogr Kinesiol. 2014;24(1):153–8. https://doi.org/10.1016/j.jelekin.2013.09.009.

    Article  PubMed  Google Scholar 

  39. Hutcheson KA, Hammer MJ, Rosen SP, Jones CA, McCulloch TM. Expiratory muscle strength training evaluated with simultaneous high-resolution manometry and electromyography. Laryngoscope. 2017;127(4):797–804. https://doi.org/10.1002/lary.26397.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Park JS, Oh DH, Chang MY. Effect of expiratory muscle strength training on swallowing-related muscle strength in community-dwelling elderly individuals: a randomized controlled trial. Gerodontology. 2017;34(1):121–8. https://doi.org/10.1111/ger.12234.

    Article  PubMed  Google Scholar 

  41. McKinnis LN. Fundamentals of musculoskeletal imaging. 4th ed. Philadelphia: F.A. Davis Company; 2014.

    Google Scholar 

  42. Park JS, Jung YJ, Kim MJ. Effects of neuromuscular electrical stimulation synchronized with chewing exercises on bite force and masseter muscle thickness in community-dwelling older adults in South Korea: a randomized controlled trial. Int J Environ Res Public Health. 2020;17(13):4902. https://doi.org/10.3390/ijerph17134902.

    Article  PubMed Central  Google Scholar 

  43. Oh JC. Effect of the head extension swallowing exercise on suprahyoid muscle activity in elderly individuals. Exp Gerontol. 2018;110:133–8. https://doi.org/10.1016/j.exger.2018.06.004.

    Article  PubMed  Google Scholar 

  44. Choi JB, Jung YJ, Park JS. Comparison of 2 types of therapeutic exercise: jaw opening exercise and head lift exercise for dysphagic stroke: a pilot study. Medicine. 2020;99(38): e22136. https://doi.org/10.1097/MD.0000000000022136.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Yano J, Yamamoto-Shimizu S, Yokoyama T, Kumakura I, Hanayama K, Tsubahara A. Effects of tongue-strengthening exercise on the geniohyoid muscle in young healthy adults. Dysphagia. 2020;35(1):110–6. https://doi.org/10.1007/s00455-019-10011-2.

    Article  PubMed  Google Scholar 

  46. Ogawa N, Mori T, Fujishima I, et al. Ultrasonography to measure swallowing muscle mass and quality in older patients with sarcopenic dysphagia. J Am Med Dir Assoc. 2018;19(6):516–22. https://doi.org/10.1016/j.jamda.2017.11.007.

    Article  PubMed  Google Scholar 

  47. Shimizu S, Hanayama K, Nakato R, Sugiyama T, Tsubahara A. Ultrasonographic evaluation of geniohyoid muscle mass in perioperative patients. Kawasaki Med J. 2016;42:47–56.

    Google Scholar 

  48. Ogawa N, Wakabayashi H, Mori T, et al. Digastric muscle mass and intensity in older patients with sarcopenic dysphagia by ultrasonography. Geriatr Gerontol Int. 2021;21(1):14–9. https://doi.org/10.1111/ggi.14079.

    Article  PubMed  Google Scholar 

  49. Galén S, Jost-Brinkmann PG. B-mode and M-mode ultrasonography of tongue movements during swallowing. J Orofac Orthop. 2010;71(2):125–35. https://doi.org/10.1007/s00056-010-9928-8.

    Article  PubMed  Google Scholar 

  50. Lori M, Sapienza CM, Rosenbek JC. Strength-training exercise in dysphagia rehabilitation: principles, procedures, and directions for future research. Dysphagia. 2007;22(3):251–65. https://doi.org/10.1007/s00455-006-9074-z.

    Article  Google Scholar 

  51. Shaker R, Easterling C, Kern M, et al. Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening. Gastroenterology. 2002;122(5):1314–21. https://doi.org/10.1053/gast.2002.32999.

    Article  PubMed  Google Scholar 

  52. Logemann JA, Rademaker A, Pauloski BR, et al. A randomized study comparing the Shaker exercise with traditional therapy: a preliminary study. Dysphagia. 2009;24(4):403–11. https://doi.org/10.1007/s00455-009-9217-0.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Yoon WL, Khoo JK, Rickard Liow SJ. Chin tuck against resistance (CTAR): new method for enhancing suprahyoid muscle activity using a Shaker-type exercise. Dysphagia. 2014;29(2):243–8. https://doi.org/10.1007/s00455-013-9502-9.

    Article  PubMed  Google Scholar 

  54. Kahrilas PJ, Logemann JA, Krugler C, Flanagan E. Volitional augmentation of upper esophageal sphincter opening during swallowing. Am J Physiol. 1991;260(3 Pt 1):G450–6. https://doi.org/10.1152/ajpgi.1991.260.3.G450.

    Article  CAS  PubMed  Google Scholar 

  55. Azola AM, Greene LR, Taylor-Kamara I, Macrae P, Anderson C, Humbert IA. The relationship between submental surface electromyography and hyo-laryngeal kinematic measures of mendelsohn maneuver duration. J Speech Lang Hear Res. 2015;58(6):1627–36. https://doi.org/10.1044/2015_JSLHR-S-14-0203.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Miura Y, Nakagami G, Yabunaka K, et al. A randomized controlled trial to investigate the effectiveness of the prevention of aspiration pneumonia using recommendations for swallowing care guided by ultrasound examination. Healthcare (Basel). 2018;6(1):15. https://doi.org/10.3390/healthcare6010015.

    Article  Google Scholar 

  57. Yoshida M, Miura Y, Okada S, et al. Effectiveness of swallowing care on safe oral intake using ultrasound-based observation of residues in the epiglottis valley: a pragmatic, quasi-experimental study. Healthcare (Basel). 2020;8(1):50. https://doi.org/10.3390/healthcare8010050.

    Article  Google Scholar 

  58. Wakabayashi H. Assessment of swallowing function and muscle using ultrasonography in general and family medicine. J Gen Fam Med. 2020;21(2):1–2. https://doi.org/10.1002/jgf2.298.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Waters TM, Logemann JA, Pauloski BR, et al. Beyond efficacy and effectiveness: conducting economic analyses during clinical trials. Dysphagia. 2004;19(2):109–19. https://doi.org/10.1007/s00455-003-0507-7.

    Article  PubMed  Google Scholar 

  60. Lazarus CL, Husaini H, Falciglia D, et al. Effects of exercise on swallowing and tongue strength in patients with oral and oropharyngeal cancer treated with primary radiotherapy with or without chemotherapy. Int J Oral Maxillofac Surg. 2014;43(5):523–30. https://doi.org/10.1016/j.ijom.2013.10.023.

    Article  CAS  PubMed  Google Scholar 

  61. Langmore SE, McCulloch TM, Krisciunas GP, et al. Efficacy of electrical stimulation and exercise for dysphagia in patients with head and neck cancer: a randomized clinical trial. Head Neck. 2016;38(Suppl 1):E1221-31. https://doi.org/10.1002/hed.24197.

    Article  PubMed  Google Scholar 

  62. Machtay M, Moughan J, Trotti A, et al. Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis. J Clin Oncol. 2008;26(21):3582–9. https://doi.org/10.1200/JCO.2007.14.8841.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Schwartz DL, Hutcheson K, Barringer D, et al. Candidate dosimetric predictors of long-term swallowing dysfunction after oropharyngeal intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2010;78(5):1356–65. https://doi.org/10.1016/j.ijrobp.2009.10.002.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Hutcheson KA, Lewin JS, Barringer DA, et al. Late dysphagia after radiotherapy-based treatment of head and neck cancer. Cancer. 2012;118(23):5793–9. https://doi.org/10.1002/cncr.27631.

    Article  PubMed  Google Scholar 

  65. Hutcheson KA, Lewin JS, Holsinger FC, et al. Long-term functional and survival outcomes after induction chemotherapy and risk-based definitive therapy for locally advanced squamous cell carcinoma of the head and neck. Head Neck. 2014;36(4):474–80. https://doi.org/10.1002/hed.23330.

    Article  PubMed  Google Scholar 

  66. Szczesniak MM, Maclean J, Zhang T, Graham PH, Cook IJ. Persistent dysphagia after head and neck radiotherapy: a common and under-reported complication with significant effect on non-cancer-related mortality. Clin Oncol (R Coll Radiol). 2014;26(11):697–703. https://doi.org/10.1016/j.clon.2014.08.009.

    Article  CAS  Google Scholar 

  67. Goepfert RP, Lewin JS, Barrow MP, et al. Predicting two-year longitudinal MD Anderson Dysphagia Inventory outcomes after intensity modulated radiotherapy for locoregionally advanced oropharyngeal carcinoma. Laryngoscope. 2017;127(4):842–8. https://doi.org/10.1002/lary.26153.

    Article  PubMed  Google Scholar 

  68. Eraj SA, Jomaa MK, Rock CD, et al (2017) Long-term patient reported outcomes following radiation therapy for oropharyngeal cancer: cross-sectional assessment of a prospective symptom survey in patients ≥65 years old. Radiat Oncol 12(1):150. doi: https://doi.org/10.1186/s13014-017-0878-9. Erratum in: Radiat Oncol. 2017;12 (1):186

  69. Strojan P, Hutcheson KA, Eisbruch A, et al. Treatment of late sequelae after radiotherapy for head and neck cancer. Cancer Treat Rev. 2017;59:79–92. https://doi.org/10.1016/j.ctrv.2017.07.003.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This research was supported by a Research and Creative Activities Support (RACAS) Award, Office of Research, University of Wisconsin Milwaukee

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  1. Kacey M. Yahnke

    Present address: Sun Prairie Area School District, Sun Prairie, WI, USA

  2. Kacey M. Yahnke

    Present address: Recover Health Care, Madison, WI, USA

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  1. Department of Communication Sciences and Disorders, College of Health Sciences, University of Wisconsin Milwaukee, 2400 E. Hartford Avenue, Suite 840, Milwaukee, WI, 53211, USA

    Barbara R. Pauloski & Kacey M. Yahnke

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Pauloski, B.R., Yahnke, K.M. Using Ultrasound to Document the Effects of Expiratory Muscle Strength Training (EMST) on the Geniohyoid Muscle. Dysphagia 37, 788–799 (2022). https://doi.org/10.1007/s00455-021-10328-x

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