Inclusion Criteria:  Individual with tracheostomy who can tolerate daily 30 minute Physical Therapy sessions with use of PMV and be able to maintain oxygen saturations above 88% with exertion. Ability to understand and respond to simple verbal instructions and one step commands in English well enough to consent without any interpretation. Ability to ambulate a minimum of 10 feet with/without assistive device and with/without physical assistance.  Exclusion Criteria:  Active seizures Active Pregnancy Uncontrolled hypertension Cognitive deficits that would disrupt ability to provide informed consent Enteric infection control precautions Ongoing orthostasis Actively on decannulation protocol Medical instability that would cause a doctor to put therapy program on hold