Combined Hyperinflation and Expiratory Strength Training in People Living with Motor Neurone Disease (CHEST-MND: COHORT)

People with motor neurone disease (MND) who are receiving physiotherapy services within their usual MND care pathway, AND for whom lung volume recruitment (LVR) and expiratory muscle strength training (EMST) are being recommended, will be eligible to participate in this cohort study. Therapy description: LVR uses a self-inflating bag (similar to a resuscitation bag) with a mouthpiece or mask to deliver consecutive insufflations (i.e., large “puffs” of air), to “stack” a larger volume of air than can be inspired spontaneously. EMST uses a spring-loaded pressure threshold device to provide resistance as one breaths out (e.g. EMST 75 or EMST 150 device). The therapy in this study combines these two devices, so that a person "stacks" a volume of air in using the LVR bag, and then exhales through the resistive training device. The decision to trial LVR+EMST will be made by the treating physiotherapist in collaboration with the PlwMND, as per usual service provision, person-centred care practice and clinical reasoning. Participants will be trained in LVR+EMST by their treating physiotherapist, within a usual clinical visit (estimated clinic duration ~ 30 minutes). Participants will be advised to continue the exercise on their own/with carers at home. Follow-up contact with their treating physiotherapist is as per usual practice - typically this would involve a telehealth or face-to-face appointment where the clinician reviews a person's progress, modifies technique and/or dosage, at a time determined by clinical presentation (i.e., number of weeks/months post initial assessment for review varies according to local service). Rationale for recommending LVR+EMST and dosage (e.g. number of repetitions, sets and frequency) will be as directed by the treating physiotherapist. A repetition consists of an individually prescribed number of compressions via the LVR bag to reach the maximal tolerated insufflation capacity, followed by a forceful expiration through the EMST device, typical set at 50% of the participant’s maximal expiratory pressure (MEP). Adherence with the prescribed intervention regimen will be assessed via participant self-report training diary, as per common clinical practice. Some participants may have adherence objectively measured via a time-stamped data logger fitted to the LVR+EMST kit. Follow-up of participants is as per usual clinical care (usually three-monthly but may be more frequent in the period following commencement of physiotherapy interventions such as LVR+EMST). Participants in this cohort study will be followed for at least one visit post cohort entry. Cohort end date will coincide with any of the events below. As such, the total duration of the treating period will be variable, and largely at the participant's own discretion - Clinical visit where decision is communicated to cease performing LVR+EMST - Participant’s wish to withdrawal from the cohort - End of study data collection period (December 2026) At the end of their study involvement, participants will be invited to participate in a semi-structured interview. The participant will be able to freely opt-out of the interview at this time without it affecting their participation in this study or future studies. For those who agree to the interview, a member of the central research team will arrange a time to conduct the interview. Interviews will be conducted by an experienced qualitative researcher, independent from the treating physiotherapist known to the participant. Interviews will be conducted on a sub-group of participants until data saturation has been achieved, which we anticipate will occur after 10 to 15 interviews.