Hyoid bone displacement as parameter for swallowing impairment in patients treated for advanced head and neck cancer

Association of Tongue Strength and Maximum Incisal Opening with Oral Intake in Persons with Head and Neck Cancer Treated with Radiotherapy: A Retrospective Study

Persons treated with radiotherapy (RT) for cancer of the head and neck (HNC) may experience limited oral intake at treatment completion. The purpose of this retrospective study was to examine the contributions of tongue strength and maximum incisal opening (MIO) to oral intake in a cohort of veterans treated for HNC. Medical records of veterans diagnosed with HNC treated with RT who were seen by the Speech Pathology Service prior to and throughout treatment per usual care were reviewed for this study; eighty-two records met the inclusion criteria for analysis. Tongue strength in kPa, MIO in mm, feeding tube status at completion of RT, and food and liquid consistencies consumed at completion of RT were among the data abstracted from the records. Most veterans (67%) did not have a feeding tube present at the completion of RT and reported drinking thin liquids (84.2%) at treatment completion. Eighteen percent reported including all food consistencies in their diet at the end of treatment. Both MIO and tongue strength decreased after treatment. Greater tongue strength during RT and larger MIO at the completion of RT were predictive of improved functional outcomes for oral intake at the end of treatment. This study provides evidence of the importance of increasing tongue strength and MIO during treatment with RT, and supports an important focus for intervention by speech-language pathologists.

Functional outcomes of hyoid suspension in anterior oromandibular reconstruction

BACKGROUND

Hyoid suspension can be considered in major oromandibular reconstruction. The impact of hyoid suspension on flap viability, swallowing outcomes, airway, and long term radiographic hyoid position is unknown. The objective of this study is to describe outcomes after hyoid suspension in anterior mandibular reconstruction with fibular free flaps. We hypothesized hyoid suspension would not affect flap viability and would benefit functional outcomes.

METHODS

A retrospective cohort study was conducted in an academic tertiary medical center. The study consisted of 84 adults who underwent anterior mandibular reconstruction from February 2014 to September 2020. The primary outcome studied was the post-suspension flap viability. Secondary outcomes include pre/post-operative hyomental distance on computed-tomography, duration of perioperative tracheostomy, postoperative feeding tube dependence, and post-operative aspiration pneumonia.

RESULTS

A total of 84, predominantly male (66.5 %), patients with an average age of 58.9 ± 11.5 were included in the study. Of those that met inclusion criteria, 25 (29.4 %) underwent intraoperative hyoid suspension. Univariable analysis showed no significant association between resuspension and post-operative total flap loss (p = 0.864) or partial flap loss (p = 0.318). There was no association between hyoid suspension and any of the studied postoperative functional outcomes or radiographic measures.

CONCLUSIONS

Hyoid suspension is an option during oromandibular reconstruction and does not impact flap viability. The impact on functional outcomes and long-term hyoid position in this patient subset remains unclear.

Deep Learning for Automatic Hyoid Tracking in Videofluoroscopic Swallow Studies

The hyoid bone excursion is one of the most important gauges of larynx elevation in swallowing, contributing to airway protection and bolus passage into the esophagus. However, the implications of various parameters of hyoid bone excursion, such as the horizontal or vertical displacement and velocity, remain elusive and raise the need for a tool providing automatic kinematics analysis. Several conventional and deep learning-based models have been applied automatically to track the hyoid bone, but previous methods either require partial manual localization or do not transform the trajectory by anatomic axis. This work describes a convolutional neural network-based algorithm featuring fully automatic hyoid bone localization and tracking and spine axis determination. The algorithm automatically estimates the hyoid bone trajectory and calculates several physical quantities, including the average velocity and displacement in horizontal or vertical anatomic axis. The model was trained in a dataset of 365 videos of videofluoroscopic swallowing from 189 patients in a tertiary medical center and tested using 44 videos from 44 patients with different dysphagia etiologies. The algorithm showed high detection rates for the hyoid bone. The results showed excellent inter-rater reliability for hyoid bone detection, good-to-excellent inter-rater reliability for calculating the maximal displacement and the average velocity of the hyoid bone in horizontal or vertical directions, and moderate-to-good reliability in calculating the average velocity in horizontal direction. The proposed algorithm allows for complete automatic kinematic analysis of hyoid bone excursion, providing a versatile tool with high potential for clinical applications.

Enhancing Self-care Among Oral Cancer Survivors: Protocol for the Empowered Survivor Trial

BACKGROUND

Survivors of oral cavity and oropharyngeal cancer frequently experience difficulties in swallowing; tasting; speaking; chewing; and maintaining comfortable movements of the head, neck, and shoulder. Engagement in regular self-care can reduce further loss of function and mitigate late effects. Despite the substantial self-care requirements, there are no empirically based interventions to enhance the skills and confidence of these survivors in managing their ongoing care.

OBJECTIVE

The aim of this study is to describe the rationale and methodology for a randomized controlled trial evaluating Empowered Survivor (ES) versus Springboard Beyond Cancer, a general web-based program for cancer survivors, on self-efficacy in managing care, preparedness for managing survivorship, and health-related quality of life (QOL).

METHODS

This study will recruit a total of 600 individuals who were diagnosed with oral cavity or oropharyngeal cancer in the past 3 years and are currently cancer free primarily from state cancer registries; these individuals will be randomly assigned to either the ES or Springboard Beyond Cancer condition. The participants complete measures of self-efficacy in managing care, preparedness for survivorship, health-related QOL, and engagement in oral self-examination and head and neck strengthening and flexibility exercises at baseline and 2 and 6 months after baseline. The primary aim of this study is to evaluate the impact of ES versus Springboard Beyond Cancer on self-efficacy, preparedness, and health-related QOL. The secondary aim is to examine the mediators and moderators of ES's impact on self-efficacy in managing care, preparedness, and health-related QOL at 6 months. The exploratory aim is to conduct a process evaluation of ES to identify potential oncology or community settings for future implementation.

RESULTS

Multilevel modeling will be used to examine whether there are significant differences between the ES and Springboard Beyond Cancer interventions over time. Mediational models will evaluate the indirect effects of ES on outcomes. Quantitative analyses will evaluate the predictors of ES use, and qualitative analyses will evaluate the preferred timing and settings for the implementation of ES.

CONCLUSIONS

This randomized controlled trial evaluates a completely web-based intervention, ES, versus a general web-based program for cancer survivors, Springboard Beyond Cancer, on self-efficacy in managing care, preparedness for managing survivorship, and health-related QOL and identifies the putative mediators and moderators of the intervention's effects. If an effect on the primary outcomes is illustrated, the next step could be an implementation trial to evaluate the intervention's uptake in and impact on an oncology care setting or nonprofit organizations.

TRIAL REGISTRATION

ClincalTrials.gov NCT04713449; https://clinicaltrials.gov/ct2/show/NCT04713449.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/39996.

Position of the Hyoid Bone and Dimension of Nasopharynx and Oropharynx after Occlusal Splint Therapy and Physiotherapy in Patients Diagnosed with Temporomandibular Disorders

Background: The aim of the study was to assess the position of the hyoid bone, as well as the width of the nasopharynx and oropharynx after occlusal splint therapy combined with physiotherapy in patients diagnosed with temporomandibular disorders (TMD). Methods: This was a clinical trial study. The study group consisted of 40 patients diagnosed with TMD, who were qualified for the treatment combining physiotherapy and occlusal splint therapy. Hyoid bone position as well as the width of the nasopharynx and oropharynx were assessed in lateral cephalograms taken before and after the end of the treatment. There were 15 generally healthy participants included into the control group, who had taken lateral cephalograms twice within the period of 1 to 2 years and did not receive any occlusal treatment in the meantime. Results: The position of the hyoid bone was significantly lowered and the dimension of the lower part of the oropharynx was significantly decreased after the end of the long-term occlusal splint therapy combined with physiotherapy in patients diagnosed with TMD. Conclusions: Long-term occlusal splint therapy combined with physiotherapy affected the position of the hyoid bone and the dimension of the lower part of the oropharynx.

Latent changes in the pharyngeal stage of swallowing in non-aspirating older adults

PURPOSE

The characteristic changes in the swallowing mechanism with aging are collectively termed presbyphagia. Although several studies have investigated presbyphagia in older adults, few have assessed oldest-old adults. We aimed to characterize the latent changes of swallowing function in oldest-old adults and to consider risk ages for presbyphagia.

METHODS

We analyzed the records of 85 individuals (44 males and 41 females, aged 25-101 years) who underwent videofluoroscopic swallowing studies. The included participants had penetration and aspiration scores of ≤ 2 and no history of aspiration, pneumonia, or diseases that affect swallowing. They were divided into four age groups: 25-64 years (non-older), 65-74 years (young-old), 75-84 years (middle-old), and ≥ 85 years (oldest-old). We analyzed and compared the pharyngeal delay time (PDT), duration of tongue base and posterior pharyngeal wall contact, duration and dimension of upper esophageal sphincter opening (UES-O), and maximal hyoid bone displacement between the age groups.

RESULTS

Among the older groups, the oldest-old showed significantly longer PDT than younger-old adults, and the UES-O tended to be wider in the former. However, no other remarkable differences were found between the oldest-old and other old groups. Statistical comparisons between the < 75 and ≥ 75-year age groups revealed significant age-related changes in the PDT and duration and dimension of UES-O.

CONCLUSION

On videofluoroscopic evaluation, physiological changes with aging affected few parameters of swallowing in our cohort. These findings indicate that in non-aspirating oldest-old adults, any deterioration may be adjusted for by compensatory changes to maintain swallowing function.

Medidas cinemáticas da deglutição obtidas por ultrassonografia: um protocolo de revisão de escopo

RESUMO Objetivo: identificar e sintetizar as evidências científicas sobre medidas cinemáticas da deglutição obtidas por ultrassonografia. Métodos: este protocolo seguiu a metodologia proposta pelo Joanna Briggs Institute (JBI) e as diretrizes para elaboração de revisões de escopo do Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols - extension for scoping reviews (PRISMA-ScR). As bases de dados eletrônicas pesquisadas serão: PubMed/Medline, Scopus, Web of Science, Lilacs, ScienceDirect, Embase e Google Scholar. Uma estratégia de busca foi desenvolvida para PubMed/Medline, que será adaptada para cada base de dados. Inicialmente, os artigos serão rastreados pelo título e resumo por dois revisores independentes. Em seguida, farão a leitura do texto completo dos artigos de acordo com os critérios de elegibilidade. Os dados serão extraídos dos artigos incluídos por meio de formulário padronizado. Os resultados serão apresentados em fluxograma e resumo narrativo. Considerações Finais: a execução deste protocolo apresentará o estado da arte sobre o tema pesquisado e contribuirá para a melhor compreensão das possibilidades de análise quantitativa da deglutição por meio da ultrassonografia.

Kinematic measures of swallowing obtained with ultrasound: a scoping review protocol

ABSTRACT Purpose: to identify and synthesize scientific evidence on kinematic measures of swallowing obtained with ultrasound. Methods: a protocol following the methodology proposed by the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols - extension for scoping reviews (PRISMA-ScR). The search will be made in PubMed/MEDLINE, Scopus, Web of Science, LILACS, ScienceDirect, Embase, and Google Scholar, using a search strategy developed for PubMed/MEDLINE, which will be adapted for each database. Articles will be initially screened by title and abstract by two independent reviewers who will read their full text according to the eligibility criteria. Data in included articles will be extracted by means of a standardized form and the results presented in a flowchart and narrative summary. Final Considerations: once carried out, this protocol will present the state-of-the-art on the research topic and help better understand the possibilities to quantitatively analyze swallowing through ultrasound.

Can Videofluoroscopic Swallowing Kinematic Analysis Predict Recovery of Oral Intake in Postoperative Oral Cancer Patients Requiring Nasogastric Tube Feeding?

This retrospective study determined the significant predictive factors for the number of days required to remove nasogastric tubes (NGTs) after surgery in patients with oral cancer (OC). In this study, patients underwent a videofluoroscopic swallowing study (VFSS) approximately 2 weeks after surgery. Videofluoroscopic images were analyzed, and variables such as swallowing and swallowing kinematics were measured. Patient characteristics, swallowing kinematics, and swallowing results were assessed using a Cox proportional hazards model. This study assessed 129 participants (66 men, 63 women, mean age: 69.0 ± 14.1 years) with nine types of cancer. The Cox proportional hazard ratio revealed that sex, body mass index before surgery, radiotherapy and/or chemotherapy, dysphagia before surgery, normalized pharyngeal constriction ratio, upper esophageal sphincter (UES) opening, and laryngeal vestibule disclosure (LVC) disorder were predictive factors for the removal of NGTs when adjusted for age. The study identified several predictive factors for the removal of NGTs and oral intake recovery in patients with OC. Regarding swallowing kinematics, UES opening is the most significant predictive factor. After surgery for OC, VFSS should be performed to assess safe eating methods and predict the recovery of oral intake and removal of the NGT.

Ultrasound: an emerging modality for the dysphagia assessment toolkit?

PURPOSE OF REVIEW

Videofluoroscopy (VFSS) and fibreoptic endoscopic evaluation of swallowing (FEES) are established instrumental techniques to support differential diagnosis and treatment of oropharyngeal dysphagia. Whilst their value is undisputed, each tool is not without limitations. The COVID-19 pandemic has restricted access to VFSS and FEES leading clinicians to explore alternative or augmentative tools to support swallowing assessment.Ultrasound (US) is an established tool for visualisation of head and neck anatomy, including structures implicated in swallowing. Although US has been utilised in swallowing research for many years, its application has not translated into common clinical practice. This review presents and debates the evidence for and against use of US for clinical swallowing assessment.

RECENT FINDINGS

Evaluation of swallowing muscle morphometry and measurement of isolated swallowing kinematics are two primary uses of US in swallowing assessment that have been identified in the literature. Use of US to detect bolus flow, aspiration and residues is in its early stages and needs further research.

SUMMARY

US shows promise as an adjunctive modality to support assessment of swallowing. With standardisation, these measurements may have potential for transition into clinical care. Reliability and validity testing and development of normative data are imperative to ensure its use as an evidence-based instrumentation.

The Relationships Between Radiation Dosage and Long-term Swallowing Kinematics and Timing in Nasopharyngeal Carcinoma Survivors

This study aimed to investigate the relationship between intensity-modulated radiation therapy (IMRT) dosimetry and swallowing kinematic and timing measures. Thirteen kinematic and timing measures of swallowing from videofluoroscopic analysis were used as outcome measures to reflect swallowing function. IMRT dosimetry was accessed for thirteen swallowing-related structures. A cohort of 44 nasopharyngeal carcinoma (NPC) survivors at least 3 years post-IMRT were recruited. The cohort had a mean age of 53.2 ± 11.9 years, 77.3% of whom were male. There was an average of 68.24 ± 14.15 months since end of IMRT; 41 (93.2%) had undergone concurrent chemotherapy. For displacement measures, female sex and higher doses to the cricopharyngeus, glottic larynx, and base of tongue were associated with reduced hyolaryngeal excursion and pharyngeal constriction, and more residue. For timing measures, higher dose to the genioglossus was associated with reduced processing time at all stages of the swallow. The inferior pharyngeal constrictor emerged with a distinctly different pattern of association with mean radiation dosage compared to other structures. Greater changes to swallowing kinematics and timing were observed for pudding thick consistency than thin liquid. Increasing radiation dosage to swallowing-related structures is associated with reduced swallowing kinematics. However, not all structures are affected the same way, therefore organ sparing during treatment planning for IMRT needs to consider function rather than focusing on select muscles. Dose-response relationships should be investigated with a comprehensive set of swallowing structures to capture the holistic process of swallowing.

Quantitative Ultrasound Assessment of Hyoid Bone Displacement During Swallowing Following Thyroidectomy

The aim of this study was to investigate temporal ultrasound measurements of the hyoid bone displacement during swallowing following thyroidectomy in women and to relate these measures to age, clinical outcomes, and upper digestive airway symptoms. The sample was divided into an experimental group (EG) of 20 women who underwent thyroidectomy (mean age = 49.55 years ± 15.14) and a control group (CG) of 20 healthy women volunteers (mean age = 40.75 years ± 15.92). Both groups were submitted to ultrasound assessment to obtain four temporal measurements of hyoid bone displacement during swallowing: elevation, anteriorization, maximum displacement, and maintenance of maximum displacement. In both groups, swallowing of ten milliliters of liquid and the same volume of thickened liquid (honey) were analyzed. The images were recorded on video (30 frames/second) and analyzed according to a standardized protocol. Temporal measurements of hyoid bone elevation and maximum displacement during swallowing of thickened liquid were significantly shorter in EG (p = 0.034 and p = 0.020, respectively). There were no differences in the swallowing of liquid, and no other variable was related to the ultrasound temporal measurements investigated. This study concludes that women who undergo thyroidectomy have a shorter time of hyoid bone elevation and maximum displacement during swallowing of 10 mL of thickened liquid.

Effects of Expiratory Muscle Strength Training on Videofluoroscopic Measures of Swallowing: A Systematic Review

Purpose Expiratory muscle strength training (EMST) is increasingly utilized in dysphagia rehabilitation; however, little is known about the effects of this approach on swallowing function or physiology. We conducted a systematic review to appraise and synthesize evidence regarding the effects of EMST on videofluoroscopic measures of swallowing in individuals with medical diagnoses, in which dysphagia is a concern. Method A literature search was conducted according to Cochrane guidelines. Of 292 nonduplicate articles, 11 were judged to be relevant for review. These underwent detailed review for study quality, risk of bias evaluation, and synthesis of swallowing outcomes. Results The selected articles described EMST in a variety of patient populations using either the EMST150 or the Phillips Threshold positive expiratory pressure device. The typical protocol involved five sets of five breaths through the device (25 breaths/day), 5 days per week for 4 weeks. Exercise loads were set between 50% and 75% depending on the population, and treatment was typically supervised by a clinician weekly. The Penetration-Aspiration Scale was the most commonly reported videofluoroscopic outcome measure. Conclusions differed as to whether or not swallowing improved following a course of EMST. Differences in videofluoroscopy protocols, methods of summarizing participant performance, and statistical approaches across studies meant that meta-analysis of swallowing outcomes could not be completed. Conclusion This review failed to find clear evidence regarding the effects of EMST on videofluoroscopic measures of swallowing. Heterogeneity in the etiologies and baseline severity of dysphagia across studies and in the methods used to measure swallowing outcomes was a particular barrier to data synthesis.

Impaired Movement Scaling and Reduced Synchrony with Vestibule Closure Characterize Swallowing in Severe Dysphagia

The contribution of hyoid and laryngeal movement deficits to penetration or aspiration in dysphagia is unclear, partly due to large variations in normal hyolaryngeal kinematics for swallowing. In healthy volunteers, laryngeal and hyoid kinematics relate to the requirements for laryngeal vestibule closure suggesting a central schematic control of movement magnitude and patterning for airway protection. Our first aim was to determine if patients with severe dysphagia showed evidence of an impaired swallowing schema, by examining if their kinematic measures were related to their hyolaryngeal space before swallow onset, and if hyolaryngeal movement synchrony for vestibule closure was disrupted. Our second aim was to determine the kinematic measures that predicted bolus penetration and aspiration in dysphagia. The methods included two-dimensional measures of the hyoid and laryngeal anterior and superior displacement and velocity, and the change in laryngeal vestibule area made from videofluoroscopic swallow recordings of 21 healthy volunteers and 21 patients with dysphagia on tube feeding secondary to the stroke or head and neck cancer. The results demonstrated that the patients did not adapt their hyolaryngeal movements during swallowing to their initial hyolaryngeal space. Further, none of the patients' measures of hyoid or laryngeal peak velocity timing were synchronized with vestibule closure, demonstrating a disorganized movement patterning. Laryngeal elevation peak velocity independently predicted penetration and aspiration. In conclusion, the central schema for swallowing patterning was disturbed, impairing the integration of kinematic actions for airway protection in severe dysphagia, while laryngeal peak elevation velocity predicted penetration and aspiration on patient swallows.

Simple laryngeal suspension procedure by suturing the digastric muscle to the periosteum of the mandible in neck dissection for tongue cancer

PURPOSE

In this article, a simple, new laryngeal suspension procedure is described. The effect of hyoid bone suspension by suturing the digastric muscle to the periosteum of the mandible is analyzed.

MATERIALS AND METHODS

To elucidate the effect of hyoid bone suspension, CT scans of 26 patients who underwent ipsilateral neck dissection with primary resection of tongue cancer were retrospectively reviewed, and the distance between the hyoid bone and the mandible was measured on the operated and unoperated sides of the neck. A total of 14 patients who underwent suturing of the digastric muscle to the mandible (digastric muscle-sutured group) and the 12 patients who did not (control group) were compared.

RESULTS

In the digastric muscle-sutured group, the average distance between the hyoid bone and the mandible was significantly smaller on the operated side (17.8 ± 0.57 mm) than on the unoperated side (19.8 ± 0.93 mm; p < 0.05). In the control group, there was no significant difference between the operated side (21.0 ± 1.42 mm) and the unoperated side (19.7 ± 1.39 mm). The difference in the distance between the operated and unoperated sides was significantly larger in the digastric muscle-sutured group (1.97 ± 0.79 mm) than in the control group (-1.32 ± 0.61; p < 0.05).

CONCLUSIONS

It was shown for the first time that suturing of the digastric muscle to the periosteum of the mandible in neck dissection with primary resection of tongue cancer resulted in hyoid bone suspension. This simple procedure can be useful for laryngeal suspension.

Semi-automatic tracking, smoothing and segmentation of hyoid bone motion from videofluoroscopic swallowing study

Motion analysis of the hyoid bone via videofluoroscopic study has been used in clinical research, but the classical manual tracking method is generally labor intensive and time consuming. Although some automatic tracking methods have been developed, masked points could not be tracked and smoothing and segmentation, which are necessary for functional motion analysis prior to registration, were not provided by the previous software. We developed software to track the hyoid bone motion semi-automatically. It works even in the situation where the hyoid bone is masked by the mandible and has been validated in dysphagia patients with stroke. In addition, we added the function of semi-automatic smoothing and segmentation. A total of 30 patients’ data were used to develop the software, and data collected from 17 patients were used for validation, of which the trajectories of 8 patients were partly masked. Pearson correlation coefficients between the manual and automatic tracking are high and statistically significant (0.942 to 0.991, P-value<0.0001). Relative errors between automatic tracking and manual tracking in terms of the x-axis, y-axis and 2D range of hyoid bone excursion range from 3.3% to 9.2%. We also developed an automatic method to segment each hyoid bone trajectory into four phases (elevation phase, anterior movement phase, descending phase and returning phase). The semi-automatic hyoid bone tracking from VFSS data by our software is valid compared to the conventional manual tracking method. In addition, the ability of automatic indication to switch the automatic mode to manual mode in extreme cases and calibration without attaching the radiopaque object is convenient and useful for users. Semi-automatic smoothing and segmentation provide further information for functional motion analysis which is beneficial to further statistical analysis such as functional classification and prognostication for dysphagia. Therefore, this software could provide the researchers in the field of dysphagia with a convenient, useful, and all-in-one platform for analyzing the hyoid bone motion. Further development of our method to track the other swallowing related structures or objects such as epiglottis and bolus and to carry out the 2D curve registration may be needed for a more comprehensive functional data analysis for dysphagia with big data.

STAMPS: development and verification of swallowing kinematic analysis software

Background

Swallowing impairment is a common complication in various geriatric and neurodegenerative diseases. Swallowing kinematic analysis is essential to quantitatively evaluate the swallowing motion of the oropharyngeal structures. This study aims to develop a novel swallowing kinematic analysis software, called spatio-temporal analyzer for motion and physiologic study (STAMPS), and verify its validity and reliability.

Methods

STAMPS was developed in MATLAB, which is one of the most popular platforms for biomedical analysis. This software was constructed to acquire, process, and analyze the data of swallowing motion. The target of swallowing structures includes bony structures (hyoid bone, mandible, maxilla, and cervical vertebral bodies), cartilages (epiglottis and arytenoid), soft tissues (larynx and upper esophageal sphincter), and food bolus. Numerous functions are available for the spatiotemporal parameters of the swallowing structures. Testing for validity and reliability was performed in 10 dysphagia patients with diverse etiologies and using the instrumental swallowing model which was designed to mimic the motion of the hyoid bone and the epiglottis.

Results

The intra- and inter-rater reliability tests showed excellent agreement for displacement and moderate to excellent agreement for velocity. The Pearson correlation coefficients between the measured and instrumental reference values were nearly 1.00 (P < 0.001) for displacement and velocity. The Bland–Altman plots showed good agreement between the measurements and the reference values.

Conclusions

STAMPS provides precise and reliable kinematic measurements and multiple practical functionalities for spatiotemporal analysis. The software is expected to be useful for researchers who are interested in the swallowing motion analysis.

Electronic supplementary material

The online version of this article (doi:10.1186/s12938-017-0412-1) contains supplementary material, which is available to authorized users.

Efficacy of a novel swallowing exercise program for chronic dysphagia in long-term head and neck cancer survivors

BACKGROUND

The efficacy of rehabilitative exercises for chronic dysphagia treatment in head and neck cancer survivors has not been studied extensively and is ambiguous.

METHODS

A prospective clinical phase II study using an intensive strength training program was carried out in 17 head and neck cancer survivors with chronic dysphagia. Both swallow and nonswallow exercises were performed for 6-8 weeks with a newly developed tool allowing for progressive muscle overload, including chin tuck, jaw opening, and effortful swallow exercises. Outcome parameters were feasibility, compliance, and parameters for effect.

RESULTS

Feasibility in terms of the program completion rate was 88%. Compliance with the exercises was 97%. After the training period, chin tuck, jaw opening, and anterior tongue strength had substantially improved. All but 1 patient reported to benefit from the exercises.

CONCLUSION

Feasibility and compliance were high. Some objective and subjective effects of progressive load on muscle strength and swallowing function could be demonstrated.

Within-Bolus Variability of the Penetration-Aspiration Scale Across Two Subsequent Swallows in Patients with Head and Neck Cancer

To compare two consecutive swallowing attempts to study if there is a difference in Rosenbek’s penetration-aspiration scale (PAS) scores between the first and second swallowing attempt of the same bolus type in videofluoroscopic examination of swallowing (VFS). Additional aims include reflecting on which bolus sizes and consistencies are the most relevant to include in further studies for head and neck cancer (HNC) patients. The VFS for 38 patients curatively treated for HNC was studied. All included patients showed swallowing difficulties (PAS ≥ 2). The examination protocol included two swallows each of six different boluses: 3, 5, 10, 20 ml thin, 5 ml mildly thick, and 3 ml of extremely thick liquid. All boluses were compared between the first and second swallowing attempt with regard to PAS scores. No statistically significant differences in PAS were found between the first and second swallow for any of the boluses in this study on group level. For 20 ml thin and 3 ml extremely thick liquid, there were low Intra-Class Correlations, indicating a low within-bolus agreement. The greatest within-bolus differences were found for 20 ml thin, 5 ml mildly thick and 3 ml extremely thick liquid, which demonstrated high intra-individual coefficient of variation (0.458–0.759). The data of this study show a high within-bolus variability of the PAS score between two subsequent swallows for all different consistencies. In order to assess swallowing safety, the highest PAS score for each bolus type is suggested for use in studies of HNC patients.