Combined Respiratory Training in Persons With ALS

Inclusion Criteria: 1. A diagnosis of probable or definite ALS in accordance with the Revisited El-Escorial Criteria. 2. Disease duration from symptom onset of ≤ 2 years, 3. Lung volume recruitment and expiratory muscle strength training naïve, 4. Reduced peak cough flow (% predicted for age and gender). Exclusion Criteria: 1. History of stroke, head and neck cancer or other concomitant disorder that might contribute to dysphagia or respiratory impairment. 2. Use of prescription cough assist or non-invasive volume ventilation devices. 3. Enrollment in another research investigation that might impact cough or respiratory function. 4. Diagnosis of frontotemporal dementia or advanced cognitive impairment. 5. Tracheostomy placement/Use of invasive mechanical ventilation. 6. Contraindications for respiratory training (i.e., history of pneumothorax, severe chronic obstructive pulmonary disease).