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Pavlidou E, Kyrgidis A, Vachtsevanos K, Constantinidis J, Triaridis S, Printza A. Efficacy of High-Intensity Training in Patients with Moderate to Severe Dysphagia after Glossectomy. J Clin Med 2023; 12:5613. [PMID: 37685680 PMCID: PMC10488737 DOI: 10.3390/jcm12175613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Dysphagia is the main impairment arising from glossectomy for tongue cancer treatment. The study aimed to determine if an eight-week training protocol paired with accuracy tasks and swallowing exercises is effective and can improve tongue strength and swallowing in patients after tongue resection. Maximum isometric pressures, tongue endurance, swallowing pressures, mealtime duration, and oropharyngeal swallow function were studied in patients with moderate to severe dysphagia after glossectomy. Twenty-five (25) patients and thirty-one (31) healthy participants were enrolled in the study. The therapy group (TG) consisted of seventeen (17) patients who followed an 8-week treatment protocol and had multiple measurements. The follow-up control group (FUG) consisted of eight non-treated patients who had a baseline and an 8-week follow-up examination. Healthy participants served as the reference group (RF). Maximum isometric pressures, endurance, and swallowing pressures increased significantly in the TG versus the FUG. Significant improvement was documented in the TG regarding the EAT-10 questionnaire, the Penetration-Aspiration Scale scores at thickened and solid boluses, and post-swallow residues at thickened and solid boluses. The treatment protocol with tongue strength exercises combined with accuracy tasks and swallowing exercises improves the post-operative swallowing function in patients after glossectomy. Patients in the TG had more significant and quicker improvement in pressures and endurance compared to FUG.
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Affiliation(s)
- Elena Pavlidou
- 1st Department of Otorhinolaryngology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (E.P.); (J.C.); (S.T.)
| | - Athanasios Kyrgidis
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (A.K.); (K.V.)
| | - Konstantinos Vachtsevanos
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (A.K.); (K.V.)
| | - Jannis Constantinidis
- 1st Department of Otorhinolaryngology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (E.P.); (J.C.); (S.T.)
| | - Stefanos Triaridis
- 1st Department of Otorhinolaryngology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (E.P.); (J.C.); (S.T.)
| | - Athanasia Printza
- 1st Department of Otorhinolaryngology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (E.P.); (J.C.); (S.T.)
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2
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Kim YC, Woo SH, Jeong WS, Oh TS, Choi JW. Impact of Dynamic Tongue Reconstruction on Sequential Changes of Swallowing Function in Patients Undergoing Total or Near-Total Glossectomy. Ann Plast Surg 2023; 91:257-264. [PMID: 37489967 DOI: 10.1097/sap.0000000000003629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
PURPOSE This study aimed to compare the effects of motor-innervated free flap on sequential changes of swallowing function in patients undergoing total or near-total glossectomy with laryngeal preservation. MATERIALS AND METHODS The medical charts of 21 patients who underwent tongue reconstruction after total or near-total glossectomy between April 2015 and December 2020 were retrospectively reviewed. Patients were divided into groups by reconstruction type: conventional, reconstruction using an anterolateral thigh free flap (n = 11), and dynamic, reconstruction using an anterolateral thigh with innervated vastus lateralis flap (n = 10). Demographics, surgical details, and survival outcomes were investigated. A videofluoroscopic penetration-aspiration scale and functional outcome swallowing scale were analyzed according to postoperative time courses, classified as within 6 months, 6 to 12 months, and after 12 months postoperative. A time-to-event analysis was performed for gastrostomy tube status. RESULTS The dynamic group showed improved swallowing outcomes at 6 to 12 months postoperative (dynamic vs conventional group, penetration-aspiration scale: 3 ± 1.51 vs 6 ± 1.63, P = 0.024; functional outcome swallowing scale: 1.89 ± 1.36 vs 4 ± 1.41, P = 0.009). In the multivariate analysis, the dynamic group showed a decreased probability of decompensated swallowing function at 6 to 12 months postoperative (odds ratio, 0.062; 95% confidence interval, 0.004-1.084; P = 0.057). A time-to-event analysis revealed no significant difference in gastrostomy tube status between the dynamic and the conventional group. CONCLUSIONS Considering higher mortality in patients subjected to total or near-total glossectomy, dynamic reconstruction with motor-innervated free flap is worth to perform in terms of enhancing the swallowing function within 1-year postoperative period, thereby improving the quality of life.
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Affiliation(s)
- Young Chul Kim
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, SeoulAsan Medical Center, Seoul, Korea
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3
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Zhang J, Wu HY, Lu Q, Shan XF, Cai ZG, Zhang L, Wei L, Yang Y. Effects of personalized swallowing rehabilitation in patients with oral cancer after free flap transplantation: A cluster randomized controlled trial. Oral Oncol 2022; 134:106097. [PMID: 36126603 DOI: 10.1016/j.oraloncology.2022.106097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/16/2022] [Accepted: 08/23/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Dysphagia is a common and serious complication in patients with oral cancer after free flap transplantation (OC-FFT), which seriously affects their quality of life. Studies have found swallowing rehabilitation can improve the swallowing ability of these patients, but the studies have design deficiencies. This study's purpose was to test the effectiveness of personalized swallowing rehabilitation for this patient population. MATERIALS AND METHODS This is a cluster randomized, non-blind, controlled clinical trial. Participants were 68 OC-FFT patients randomly assigned to intervention (n = 34) or control (n = 34) groups. The control group received routine nursing and health education, while the intervention group received personalized swallowing rehabilitation twice a day for 10 days, based on the results of the Mann Assessment of Swallowing Ability-Oral Cancer (MASA-OC). On the 6th and 15th days and 1 month after the operation, MASA-OC scores and percentage weight loss were measured, and the removal time to nasogastric tube was also recorded. The quality of life was evaluated 1 month after the operation. RESULTS On day 15 and 1 month after the operation, MASA-OC scores were higher and the percentage weight loss was lower in the intervention group than the control group (P < 0.05). The removal time of the nasogastric tube was shorter (P < 0.05), and the quality of life at 1 month was better in the intervention group (P < 0.05). CONCLUSION Personalized swallowing rehabilitation can improve patients' swallowing after OC-FFT, promote the early removal of the nasogastric tube, and improve nutritional status and quality of life.
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Affiliation(s)
- Jing Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology, Beijing 100081, China.
| | - Hong-Yun Wu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology, Beijing 100081, China.
| | - Qian Lu
- Peking University School of Nursing, Beijing 100191, China.
| | - Xiao-Feng Shan
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology, Beijing 100081, China.
| | - Zhi-Gang Cai
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology, Beijing 100081, China.
| | - Lei Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology, Beijing 100081, China.
| | - Li Wei
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology, Beijing 100081, China.
| | - Yue Yang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology, Beijing 100081, China.
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4
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Matsuda Y, Jayasinghe RD, Zhong H, Arakawa S, Kanno T. Oral Health Management and Rehabilitation for Patients with Oral Cancer: A Narrative Review. Healthcare (Basel) 2022; 10:healthcare10050960. [PMID: 35628095 PMCID: PMC9140416 DOI: 10.3390/healthcare10050960] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 04/29/2022] [Accepted: 05/20/2022] [Indexed: 12/10/2022] Open
Abstract
Surgery is the current first choice for oral cancer treatment. Intensity-modulated radiation therapy, molecular targeted drugs, and immune checkpoint inhibitors are still used as adjuvant therapy for advanced cancer. In addition, postoperative rehabilitation and multidisciplinary treatment have also been developed in recent years. Multidisciplinary team approaches and supportive care in oral cancer treatment reportedly shorten the time to treatment and improve outcomes. Although there is enough evidence confirming the role of oral and maxillofacial surgeons, dentists, and dental hygienists in supportive care in oral cancer treatment, there are very few systematic studies. In particular, oral health management is a concept that encompasses oral function management, oral hygiene management, and oral care during oral cancer treatment. We provide a narrative review focusing on oral health management from a multidisciplinary and supportive care perspective, applicable in oral cancer treatment.
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Affiliation(s)
- Yuhei Matsuda
- Department of Lifetime Oral Health Care Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8501, Japan; (H.Z.); (S.A.)
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Japan;
- Correspondence: ; Tel.: +81-3-5803-4649
| | - Ruwan D. Jayasinghe
- Center for Research in Oral Cancer, Department of Oral Medicine and Periodontology, Faculty of Dental Sciences, University of Peradeniya, Getambe 20400, Sri Lanka;
| | - Hui Zhong
- Department of Lifetime Oral Health Care Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8501, Japan; (H.Z.); (S.A.)
| | - Shinichi Arakawa
- Department of Lifetime Oral Health Care Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8501, Japan; (H.Z.); (S.A.)
| | - Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Japan;
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Takahashi N, Barikroo A, Crary MA, Dungan S, Carnaby GD. Transcutaneous Electrical Stimulation as a Resistance Force in Lingual Exercise: A Preliminary Proof-of-Concept Study. J Oral Rehabil 2022; 49:712-719. [PMID: 35397191 DOI: 10.1111/joor.13332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Limited knowledge exists regarding whether transcutaneous electrical stimulation (TES) based exercise can improve the lingual pressure generation. OBJECTIVES To compare the effect of submental TES with two different pulse durations (PD) coupled with isometric lingual exercises on lingual pressure measures. METHODS Twenty-eight healthy volunteers were divided into two submental TES groups: short PD (300 μs) and long PD (700 μs). The Iowa Oral Performance Instrument (IOPI) was used for lingual pressure measurements and exercise. In total, participants attended six exercise sessions three days per week for two consecutive weeks. Maximum and swallowing lingual pressures were measured one hour following each exercise session and three days after the final session to assess any detraining effect. Data were analyzed using repeated measure ANOVA. RESULTS Mean maximum lingual pressure change was significantly greater in TES with short PD versus the long PD condition following the first week of exercise. Following the two-week exercise, a significant increase was found in mean maximum lingual pressure for short and long PD conditions compared with the baseline. However, no significant difference was found between PD conditions for maximum lingual pressure. Likewise, no significant differences in swallowing lingual pressure were found compared with the baseline or across the two TES conditions. CONCLUSION Although short PD induced greater gain in maximum lingual pressure than the long PD after week 1, the enhanced effect faded after week 2, leading to a comparable increase in maximum lingual pressure for both groups. However, increased gain in maximum lingual pressure was not transferred to lingual pressure during swallowing.
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Affiliation(s)
- Noriaki Takahashi
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University, Tama Oral Rehabilitation Clinic, Tokyo, Japan
| | - Ali Barikroo
- Swallowing Physiology & Rehabilitation Research Laboratory, Speech Pathology and Audiology Program, Kent State University, Kent, OH, USA
| | | | | | - Giselle D Carnaby
- School of Health Sciences, University of Texas Health Science Center, San Antonio, TX, USA
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Gharzai LA, Li P, Schipper MJ, Yao J, Mayo CS, Wilkie JR, Hawkins PG, Lyden T, Blakely A, Ibrahim M, Schonewolf CA, Shah J, Eisbruch A, Casper K, Mierzwa M. Characterization of very late dysphagia after chemoradiation for oropharyngeal squamous cell carcinoma. Oral Oncol 2020; 111:104853. [PMID: 32805634 DOI: 10.1016/j.oraloncology.2020.104853] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/03/2020] [Accepted: 06/07/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Improved prognosis for p16+ oropharyngeal squamous cell carcinoma (OPSCC) has led to efforts to mitigate long-term complications of treatment, which remains poorly defined in late survivors. Here we characterize very late dysphagia in OPSCC. MATERIALS AND METHODS Long-term review of 93 p16+ OPSCC patients treated with chemoradiation was performed. We scored videofluoroscopic swallow studies (VFSS) according to the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale. Very late dysphagia was defined >2.5 years from end of treatment. Fine-Gray regression models were used to assess dysphagia with competing risk of death. RESULTS Median follow up was 10.5 years. 402 total VFSS were assessed (median 4 per patient, range 0-8). 15.1% of patients had a DIGEST score ≥2 very late after treatment. Very late DIGEST score ≥2 correlated with T-stage (HR 1.7, p = 0.049), second cancer (HR 6.5, p = 0.004), superior pharyngeal constrictor dose (HR 1.11, p = 0.050), total tongue dose (HR 1.07, p = 0.045), but not hypoglossal nerve dose (p > 0.2). Seven patients (7.5%) had late progressive dysphagia, defined as DIGEST score that increased by ≥2 beyond one year after treatment, and this correlated with higher ipsilateral hypoglossal nerve D1cc dose (75 vs 72 Gy, p = 0.037). CONCLUSION In p16+ OPSCC patients treated with definitive chemoradiation, at least 7.5% developed late progressive dysphagia, and 15.1% experienced moderate dysphagia >2.5 years from treatment. Our study suggests that dose to tongue musculature may be associated with very late dysphagia, and hypoglossal nerve dose may be associated with late progressive dysphagia. More intensive long-term dysphagia survivorship monitoring is suggested.
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Affiliation(s)
- Laila A Gharzai
- Department of Radiation Oncology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Pin Li
- Department of Biostatistics, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Matthew J Schipper
- Department of Biostatistics, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - John Yao
- Department of Radiation Oncology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Charles S Mayo
- Department of Radiation Oncology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Joel R Wilkie
- Department of Radiation Oncology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Peter G Hawkins
- Department of Radiation Oncology, The Permanente Medical Group, 5900 State Farm Dr, Rohnert Park, CA 94928, USA
| | - Teresa Lyden
- Department of Otolaryngology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Anna Blakely
- Department of Otolaryngology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Mohannad Ibrahim
- Department of Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Caitlin A Schonewolf
- Department of Radiation Oncology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Jennifer Shah
- Department of Radiation Oncology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Keith Casper
- Department of Otolaryngology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Michelle Mierzwa
- Department of Radiation Oncology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA.
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7
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Van den Steen L, Baudelet M, Tomassen P, Bonte K, De Bodt M, Van Nuffelen G. Effect of tongue-strengthening exercises on tongue strength and swallowing-related parameters in chronic radiation-associated dysphagia. Head Neck 2020; 42:2298-2307. [PMID: 32352198 DOI: 10.1002/hed.26179] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 03/04/2020] [Accepted: 04/03/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Radiation-associated dysphagia (RAD) is highly prevalent in head and neck cancer (HNC) patients, with insufficient tongue strength (TS) as a characteristic of this disabling complication. The effects of tongue-strengthening exercises (TSE) on TS, swallowing, and quality of life (QoL) have not been studied in this population. METHODS A prospective phase 2 study using an 8 weeks during TSE protocol was carried out in 15 patients with chronic RAD. Outcome parameters were maximal isometric pressure (MIP), TS during swallowing (Pswal), swallowing function, and QoL. All parameters were evaluated at baseline, after 4 and 8 weeks of training, and 4 weeks after the last training session. RESULTS MIP increased significantly, without detraining effects. Pswal did not increase significantly, but relevant effect sizes were measured. Swallowing function ameliorated, but did not result in increased functional oral intake, self-reported outcome or QoL. CONCLUSION TSE in patients with RAD results in increased strength and swallowing function.
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Affiliation(s)
- Leen Van den Steen
- Department of Otolaryngology-Head and Neck Surgery, Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Department of ENT, Head and Neck Surgery and Communication Disorders, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Margot Baudelet
- Department of ENT, Head and Neck Surgery and Communication Disorders, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Peter Tomassen
- Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium
| | - Katrien Bonte
- Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium
| | - Marc De Bodt
- Department of Otolaryngology-Head and Neck Surgery, Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Department of ENT, Head and Neck Surgery and Communication Disorders, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Gwen Van Nuffelen
- Department of Otolaryngology-Head and Neck Surgery, Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Department of ENT, Head and Neck Surgery and Communication Disorders, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
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8
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Karsten RT, Ter Beek LC, Jasperse B, van Alphen MJA, Peeters JM, van der Molen L, Hilgers FJM, Stuiver MM, Smeele LE. MRI Assessment of Swallow Muscle Activation with the Swallow Exercise Aid and with Conventional Exercises in Healthy Volunteers: An Explorative Biomechanical Study. Dysphagia 2020; 36:41-53. [PMID: 32200444 DOI: 10.1007/s00455-020-10108-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 03/13/2020] [Indexed: 11/29/2022]
Abstract
Swallowing muscle strength exercises are effective in restoring swallowing function. In order to perform the exercises with progressive load, the swallow exercise aid (SEA) was developed. Precise knowledge on which muscles are activated with swallowing exercises, especially with the SEA, is lacking. This knowledge would aid in optimizing the training program to target the relevant swallowing muscles, if necessary. Three healthy volunteers performed the three SEA exercises (chin tuck against resistance, jaw opening against resistance and effortful swallow) and three conventional exercises [conventional effortful swallow (cES), Shaker and Masako] in supine position inside an MRI scanner. Fast muscle functional MRI scans (generating quantitative T2-maps) were made immediately before and after the exercises. Median T2 values at rest and after exercise were compared to identify activated muscles. After the three SEA exercises, the suprahyoid, infrahyoid, sternocleidomastoid, and lateral pterygoid muscles showed significant T2 value increase. After the Shaker, the lateral pterygoid muscles did not show such an increase, but the three other muscle groups did. The cES and Masako caused no significant increase in any of these muscle groups. During conventional (Shaker) exercises, the suprahyoid, infrahyoid, and sternocleidomastoid muscles are activated. During the SEA exercises, the suprahyoid, infrahyoid, sternocleidomastoid, and lateral pterygoid muscles are activated. The findings of this explorative study further support the potential of the SEA to improve swallowing rehabilitation.
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Affiliation(s)
- Rebecca T Karsten
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Leon C Ter Beek
- Department of Medical Physics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Bas Jasperse
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maarten J A van Alphen
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | | | - Lisette van der Molen
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Frans J M Hilgers
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Martijn M Stuiver
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Ludi E Smeele
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
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9
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Baudelet M, Van den Steen L, Duprez F, De Bodt M, Deschuymer S, Goeleven A, Hutsebaut I, Mariën S, Meersschout S, Nevens D, Nuyts S, Peeters M, Specenier P, Van den Brekel M, van der Molen L, Vandenbruaene C, Vanderveken O, Van Dinther J, Van Laer C, Vauterin T, Verstraete H, Van Nuffelen G. Study protocol for a randomized controlled trial: prophylactic swallowing exercises in head-and-neck cancer patients treated with (chemo)radiotherapy (PRESTO trial). Trials 2020; 21:237. [PMID: 32122397 PMCID: PMC7053144 DOI: 10.1186/s13063-020-4171-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/13/2020] [Indexed: 01/10/2023] Open
Abstract
Background Dysphagia is a common and serious complication after (chemo)radiotherapy (CRT) for head-and-neck cancer (HNC) patients. Prophylactic swallowing exercises (PSE) can have a significantly positive effect on post-treatment swallowing function. However, low adherence rates are a key issue in undermining this positive effect. This current randomized trial will investigate the effect of adherence-improving measures on patients’ swallowing function, adherence and quality of life (QOL). Methods This ongoing trial will explore the difference in adherence and swallowing-related outcome variables during and after PSE in HNC patients performing the same therapy schedule, receiving different delivery methods. One hundred and fifty patients treated in various hospitals will be divided into three groups. Group 1 performs PSE at home, group 2 practices at home with continuous counseling through an app and group 3 receives face-to-face therapy by a speech and language pathologist. The exercises consist of tongue-strengthening exercises and chin-tuck against resistance with effortful swallow. The Iowa Oral Performance Instrument and the Swallowing Exercise Aid are used for practicing. Patients are evaluated before, during and after treatment by means of strength measurements, swallowing and QOL questionnaires. Discussion Since low adherence rates undermine the positive impact of PSE on post-treatment swallowing function, there is need to develop an efficient PSE protocol maximizing adherence rates. Trial registration ISRCTN, ID: ISRCTN98243550. Registered retrospectively on 21 December 2018.
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Affiliation(s)
- Margot Baudelet
- Department of Radiation Oncology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium. .,Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, St. Pietersnieuwstraat 33, 9000, Ghent, Belgium. .,Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.
| | - Leen Van den Steen
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
| | - Fréderic Duprez
- Department of Radiation Oncology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, St. Pietersnieuwstraat 33, 9000, Ghent, Belgium
| | - Marc De Bodt
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, St. Pietersnieuwstraat 33, 9000, Ghent, Belgium
| | - Sarah Deschuymer
- Department of Radiation Oncology, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Ann Goeleven
- Department of ENT, University Hospitals Leuven, Swallowing Clinic, Leuven, Belgium.,Department of Head and Neck Surgery, University Hospitals Leuven, Swallowing Clinic, Leuven, Belgium
| | - Isabel Hutsebaut
- Department of Radiation Oncology, AZ Sint-Jan General Hospital, Bruges, Belgium
| | - Steven Mariën
- Department of Otolaryngology and Head and Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
| | - Sabine Meersschout
- Department of Radiation Oncology, AZ Sint-Jan General Hospital, Bruges, Belgium
| | - Daan Nevens
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Radiation Oncology, Iridium Kanker Netwerk, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium
| | - Sandra Nuyts
- Department of Radiation Oncology, KU Leuven, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Marc Peeters
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium.,Department Medical Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Pol Specenier
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium
| | - Michiel Van den Brekel
- Department of Head and Neck Oncology and Surgery, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Faculty of Humanities, University of Amsterdam, Spui 21, 1012 WX, Amsterdam, The Netherlands
| | - Lisette van der Molen
- Department of Head and Neck Oncology and Surgery, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Caroline Vandenbruaene
- Department of Speech-Language Pathology and Audiology, Sint-Jan General Hospital, Bruges, Belgium
| | - Olivier Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium
| | - Joost Van Dinther
- Department of Otorhinolaryngology, Sint-Augustinus Hospital, Antwerp, Belgium
| | - Carl Van Laer
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium
| | - Tom Vauterin
- Department of Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Jan General Hospital, Bruges, Belgium
| | - Hilde Verstraete
- Department of Radiation Oncology, Iridium Kanker Netwerk, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium
| | - Gwen Van Nuffelen
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, St. Pietersnieuwstraat 33, 9000, Ghent, Belgium
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10
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Van den Steen L, De Bodt M, Guns C, Elen R, Vanderwegen J, Van Nuffelen G. Tongue-Strengthening Exercises in Healthy Older Adults: Effect of Exercise Frequency – A Randomized Trial. Folia Phoniatr Logop 2020; 73:109-116. [DOI: 10.1159/000505153] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/01/2019] [Indexed: 11/19/2022] Open
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11
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Hedström J, Tuomi L, Finizia C, Olsson C. Identifying organs at risk for radiation-induced late dysphagia in head and neck cancer patients. Clin Transl Radiat Oncol 2019; 19:87-95. [PMID: 31646203 PMCID: PMC6804434 DOI: 10.1016/j.ctro.2019.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 11/02/2022] Open
Abstract
Background and purpose Dysphagia is a common, severe and dose-limiting toxicity after oncological treatment of head and neck cancer (HNC). This study aims to investigate relationships between radiation doses to structures involved in normal swallowing and patient-reported as well as clinically measured swallowing function in HNC patients after curative (chemo-) radiation therapy (RT) with focus on late effects. Materials and methods Patients (n = 90) with HNC curatively treated with RT ± chemotherapy in 2007-2015 were assessed for dysphagia post-treatment by telephone interview and videofluoroscopy (VFS). A study-specific symptom score was used to determine patient-reported dysphagia. The Penetration-Aspiration Scale (PAS) was applied to determine swallowing function by VFS (PAS ≥ 4/ ≥ 6 = moderate/severe dysphagia). Thirteen anatomical structures involved in normal swallowing were individually delineated on the patients' original planning CT scans and associated dose-volume histograms (DVHs) retrieved. Relationships between structure doses and late toxicity were investigated through univariable and multivariable logistic regression analysis (UVA/MVA) accounting for effects by relevant clinical factors. Results Median assessment time was 7 months post-RT (range: 5-34 months). Mean dose to the contralateral parotid gland and supraglottic larynx as well as maximum dose to the contralateral anterior digastric muscle predicted patient-reported dysphagia (AUC = 0.64-0.67). Mean dose to the pharyngeal constrictor muscle, the larynx, the supraglottic larynx and the epiglottis, as well as maximum dose to the contralateral submandibular gland predicted moderate and severe dysphagia by VFS (AUC = 0.71-0.80). Conclusion The patients in this cohort were consecutively identified pre-treatment, and were structurally approached and assessed for dysphagia after treatment at a specific time point. In addition to established dysphagia organs-at-risk (OARs), our data suggest that epiglottic and submandibular gland doses are important for swallowing function post-RT. Keeping DVH thresholds below V60 = 60% and V60 = 17%, respectively, may increase chances to reduce occurrence of severe late dysphagia. The results need to be externally validated in future studies.
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Key Words
- 3D-CRT, Three Dimensional Conformal Radiation Therapy
- AAA, Anisotropic Analytical Algorithm
- ACE-27, Adult Comorbidity Evaluation 27
- AUC, area under the Receiver Operating Characteristic (ROC) curve
- BMI, body mass index
- CI, confidence interval
- CT, computed tomography
- Cc, cubic centimeter
- DARS, dysphagia-aspiration-related structures
- DESdC, Drinking, Eating, Swallowing difficulties and Coughing when eating/drinking
- DVH, dose-volume histogram
- Deglutition disorders
- Dysphagia-aspiration-related structures
- EBRT, external beam radiation therapy
- EQD2, equivalent dose in 2Gy fractions
- Gy, Gray
- HNC, head and neck cancer
- Head and neck neoplasms
- ICRU, International Commission on Radiation Units and Measurements
- IMRT, intensity-modulated radiation therapy
- MVA, multivariable logistic regression
- N.A, non applicable
- OAR, organ-at-risk
- OR, odds ratio
- PAS, penetration-aspiration scale
- PCM, pharyngeal constrictor muscle
- PRO, patient-reported outcome
- QoL, quality of life
- ROC, Receiver Operating Characteristic curve
- RT, radiation therapy
- Radiation dose
- Radiation therapy
- SD, standard deviation
- SEM, standard error of the mean
- SLP, speech-language pathologist
- TNM, Tumor location, Nodular engagement, Metastasis
- UES, upper esophageal sphincter
- UVA, univariable logistic regression
- VFS, videofluoroscopy
- VMAT, volumetric-modulated radiation therapy
- Vx, the volume (%) of a structure receiving ≥xGy.
- ρ, Spearman’s Correlation Coefficient
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Affiliation(s)
- Johanna Hedström
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, 413 45 Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Department of Anesthesia and Intensive Care, Area 2, 416 85 Gothenburg, Sweden
| | - Lisa Tuomi
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, 413 45 Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Department of Otorhinolaryngology, 413 45 Gothenburg, Sweden
| | - Caterina Finizia
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, 413 45 Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Department of Otorhinolaryngology, 413 45 Gothenburg, Sweden
| | - Caroline Olsson
- Department of Radiation Physics, Institute of Clinical Sciences, the Sahlgrenska Academy Gothenburg University, 413 45 Gothenburg, Sweden.,Regional Cancer Center West, the Western Sweden Healthcare Region, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
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12
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Kristensen MB, Isenring E, Brown B. Nutrition and swallowing therapy strategies for patients with head and neck cancer. Nutrition 2019; 69:110548. [PMID: 31563019 DOI: 10.1016/j.nut.2019.06.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 06/26/2019] [Indexed: 01/05/2023]
Abstract
Patients with head and neck cancer experience many problems with eating which make them at high risk of malnutrition. Pre-habilitation swallowing exercises as overseen by a speech pathologist can improve swallowing function. A multidisciplinary approach to care, including effective nutritional screening, assessment and intervention has demonstrated improved outcomes in terms of meet nutritional requirements, improved nutritional status and quality of life. Nutritional recommendations are 1.2-1.5 g protein per kilogram per day and 125kJ/kg body weight per day but as these are guides close monitoring of intake and weight is important. Multidisciplinary teams and telehealth have shown better outcomes for nutrition and swallowing status for head and neck cancer patients and ongoing support is required for best patient care.
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Affiliation(s)
- Marianne Boll Kristensen
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark; REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Nyborg, Denmark; Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
| | - Elizabeth Isenring
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia.
| | - Bena Brown
- Division of Cancer Services, Princess Alexandra Hospital, Metro South Health, Queensland Health, Australia; Centre for Functioning and Health Research, Metro South Health, Queensland Health, Australia; School of Health and Rehabilitation Sciences, The University of Queensland, Australia
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13
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Van den Steen L, Van Gestel D, Vanderveken O, Vanderwegen J, Lazarus C, Daisne J, Van Laer C, Specenier P, Van Rompaey D, Mariën S, Lawson G, Chantrain G, Desuter G, Van den Weyngaert D, Cvilic S, Beauvois S, Allouche J, Delacroix L, Vermorken JB, Peeters M, Dragan T, Van de Heyning P, De Bodt M, Van Nuffelen G. Evolution of self‐perceived swallowing function, tongue strength and swallow‐related quality of life during radiotherapy in head and neck cancer patients. Head Neck 2019; 41:2197-2207. [DOI: 10.1002/hed.25684] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/14/2018] [Accepted: 01/10/2019] [Indexed: 12/18/2022] Open
Affiliation(s)
- Leen Van den Steen
- Department of Otolaryngology and Head and Neck Surgery – Rehabilitation Center for Communication DisordersAntwerp University Hospital Antwerp Belgium
- Faculty of Medicine and Health SciencesUniversity of Antwerp Antwerp Belgium
| | - Dirk Van Gestel
- Department of RadiotherapyInstitut Jules Bordet, Université Libre de Bruxelles Brussels Belgium
| | - Olivier Vanderveken
- Department of Otolaryngology and Head and Neck Surgery – Rehabilitation Center for Communication DisordersAntwerp University Hospital Antwerp Belgium
- Faculty of Medicine and Health SciencesUniversity of Antwerp Antwerp Belgium
- Department of Medical OncologyAntwerp University Hospital Antwerp Belgium
| | - Jan Vanderwegen
- Department of Speech, Language and AudiologyThomas More University College of Applied Sciences Antwerp Belgium
- Department of Otolaryngology and Head and Neck SurgeryCHU Saint‐Pierre Brussels Belgium
| | - Cathy Lazarus
- Department of Otolaryngology and Head and Neck SurgeryMount Sinai Beth Israel New York New York
- Department of OtorhinolaryngoloyAlbert Einstein College of Medicine New York New York
| | - Jean‐François Daisne
- Department of Radiation OncologyUniversité Catholique de Louvain, CHU‐UCL‐Namur Namur Belgium
| | - Carl Van Laer
- Department of Otolaryngology and Head and Neck Surgery – Rehabilitation Center for Communication DisordersAntwerp University Hospital Antwerp Belgium
- Faculty of Medicine and Health SciencesUniversity of Antwerp Antwerp Belgium
- Department of Medical OncologyAntwerp University Hospital Antwerp Belgium
| | - Pol Specenier
- Faculty of Medicine and Health SciencesUniversity of Antwerp Antwerp Belgium
- Department of Medical OncologyAntwerp University Hospital Antwerp Belgium
| | - Diane Van Rompaey
- Department of Otolaryngology and Head and Neck Surgery – Rehabilitation Center for Communication DisordersAntwerp University Hospital Antwerp Belgium
| | - Steven Mariën
- Department of Otolaryngology and Head and Neck Surgery – Rehabilitation Center for Communication DisordersAntwerp University Hospital Antwerp Belgium
| | - Georges Lawson
- ENT Head and Neck DepartmentUniversité Catholique de Louvain, CHU‐UCL‐Namur Namur Belgium
| | - Gilbert Chantrain
- Department of Otolaryngology and Head and Neck SurgeryCHU Saint‐Pierre Brussels Belgium
| | - Gauthier Desuter
- ENT Head and Neck Surgery DepartmentUniversité Catholique de Louvain Brussels Belgium
| | | | - Sophie Cvilic
- Department of RadiotherapyClinique Saint‐Jean Bruxelles Bruxelles Belgium
| | - Sylvie Beauvois
- Department of RadiotherapyInstitut Jules Bordet, Université Libre de Bruxelles Brussels Belgium
| | - Johan Allouche
- Department of Otolaryngology and Head and Neck SurgeryCHU Saint‐Pierre Brussels Belgium
| | - Laurence Delacroix
- ENT Head and Neck DepartmentUniversité Catholique de Louvain, CHU‐UCL‐Namur Namur Belgium
| | - Jan Baptist Vermorken
- Faculty of Medicine and Health SciencesUniversity of Antwerp Antwerp Belgium
- Department of Medical OncologyAntwerp University Hospital Antwerp Belgium
| | - Marc Peeters
- Faculty of Medicine and Health SciencesUniversity of Antwerp Antwerp Belgium
- Department of Medical OncologyAntwerp University Hospital Antwerp Belgium
| | - Tatiana Dragan
- Department of RadiotherapyInstitut Jules Bordet, Université Libre de Bruxelles Brussels Belgium
| | - Paul Van de Heyning
- Department of Otolaryngology and Head and Neck Surgery – Rehabilitation Center for Communication DisordersAntwerp University Hospital Antwerp Belgium
- Faculty of Medicine and Health SciencesUniversity of Antwerp Antwerp Belgium
| | - Marc De Bodt
- Department of Otolaryngology and Head and Neck Surgery – Rehabilitation Center for Communication DisordersAntwerp University Hospital Antwerp Belgium
- Faculty of Medicine and Health SciencesUniversity of Antwerp Antwerp Belgium
- Faculty of Speech, Pathology and AudiologyGhent University Ghent Belgium
| | - Gwen Van Nuffelen
- Department of Otolaryngology and Head and Neck Surgery – Rehabilitation Center for Communication DisordersAntwerp University Hospital Antwerp Belgium
- Faculty of Medicine and Health SciencesUniversity of Antwerp Antwerp Belgium
- Faculty of Speech, Pathology and AudiologyGhent University Ghent Belgium
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14
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Bordoni B, Morabito B, Mitrano R, Simonelli M, Toccafondi A. The Anatomical Relationships of the Tongue with the Body System. Cureus 2018; 10:e3695. [PMID: 30838167 PMCID: PMC6390887 DOI: 10.7759/cureus.3695] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The tongue plays a fundamental role in several body functions such as swallowing, breathing, speaking, and chewing. Its action is not confined to the oral cavity, but it affects lower limb muscle strength and posture. The tongue is an organ that has an autocrine/paracrine mechanism of action to synthesize different substances to interact with the whole body; according to a line of thought, it is also an extension of the enteric system. The aim of this study was to review the functions of the tongue and its anatomical association with the body system. According to the authors' knowledge, this is the first scientific article focusing on the tongue in a systemic context. In a clinical evaluation, connections with the tongue should be considered to optimize the clinical examination of the tongue and therefore enhance rehabilitation programs and therapeutic results.
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Affiliation(s)
- Bruno Bordoni
- Cardiology, Foundation Don Carlo Gnocchi / Institute of Hospitalization and Care, Milan, ITA
| | - Bruno Morabito
- Osteopathy, School of Osteopathic Centre for Research and Studies, Milan, ITA
| | - Roberto Mitrano
- Cardiology, Foundation Don Carlo Gnocchi/institute of Hospitalization and Care, Milan, ITA
| | | | - Anastasia Toccafondi
- Cardiology, Foundation Don Carlo Gnocchi/institute of Hospitalization and Care, Milan, ITA
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15
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VanRavenhorst‐Bell HA, Coufal KL, Patterson JA, Mefferd AS. A comparative study: tongue muscle performance in weightlifters and runners. Physiol Rep 2018; 6:e13923. [PMID: 30460755 PMCID: PMC6246939 DOI: 10.14814/phy2.13923] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 10/19/2018] [Indexed: 12/05/2022] Open
Abstract
Exercise mode (i.e., resistance training, endurance training) is known to yield mode-specific effects on strength and endurance of muscles that are directly targeted during the exercise. Such mode-specific effects can also be observed in indirectly involved (i.e., nontargeted) muscles. Mode-specific muscle performance changes of nontargeted muscles, however, have only been investigated within the skeletal system. Therefore, as a first step, this study aimed to determine if bulbar muscle performance (tongue strength [TS], tongue endurance [TE]) differs between weightlifters and runners and if group differences are tongue region-specific. The Iowa Oral Performance Instrument (IOPI) was used to measure TS and TE of the anterior and posterior tongue regions in 21 weightlifters and 23 runners. In weightlifters anterior TS was significantly greater than posterior TS (P = 0.008), whereas in runners anterior and posterior TS were comparable. Furthermore, weightlifters produced significantly greater anterior TS than runners (P = 0.001). Finally, TE was overall significantly greater in runners than in weightlifters (P = 0.001). Findings suggest that exercise mode may differentially impact performance patterns of nontargeted bulbar muscles. More research is warranted to better understand the mechanisms underlying tongue muscle performance differences between weightlifters and runners.
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Affiliation(s)
| | - Kathy L. Coufal
- Department of Special Education & Communication Disorders, EducationUniversity of NebraskaOmahaNE
| | | | - Antje S. Mefferd
- Department of Hearing and Speech SciencesVanderbilt UniversityNashvilleTN
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16
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Tongue-Strengthening Exercises in Healthy Older Adults: Does Exercise Load Matter? A Randomized Controlled Trial. Dysphagia 2018; 34:315-324. [DOI: 10.1007/s00455-018-9940-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 09/05/2018] [Indexed: 11/29/2022]
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17
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Van den Steen L, Schellen C, Verstraelen K, Beeckman AS, Vanderwegen J, De Bodt M, Van Nuffelen G. Tongue-Strengthening Exercises in Healthy Older Adults: Specificity of Bulb Position and Detraining Effects. Dysphagia 2017; 33:337-344. [PMID: 29052051 DOI: 10.1007/s00455-017-9858-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022]
Abstract
Clinical tongue-strengthening therapy programs are generally based on the principles of exercise and motor learning, including the specificity paradigm. The aim of this study was to investigate the specific effect of anterior and posterior tongue-strengthening exercises (TSE) on tongue strength (TS) in healthy older adults and to measure possible detraining effects. Sixteen healthy elderly completed 8 weeks of TSE by means of the Iowa Oral Performance Instrument (IOPI). They were distributed in two different treatment arms and performed either exclusively anterior or posterior TSE (ATSE, n = 9 or PTSE, n = 7) depending on the treatment arm. Anterior and posterior maximal isometric pressures (MIPA, MIPP) were measured at baseline, halfway, and after completion of the training sessions. Detraining was measured by repeating MIPA and MIPP measures 4 weeks after the last session of TSE. MIPA and MIPP increased significantly in both treatment arms. MIPA was significantly higher in the ATSE group compared to the PTSE group across all measures in time. No significant differences were observed in MIPP between the ATSE and PTSE groups. Regardless of treatment arm, there was no significant detraining effect measured 4 weeks after the last TSE session. This study suggests that TSE show partial specificity concerning bulb position. We conclude that especially anterior training results in higher anterior TS in comparison with posterior exercises. Furthermore, we found no detraining effects, independent of bulb location.
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Affiliation(s)
- Leen Van den Steen
- Department of Otolaryngology and Head & Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Wilrijkstraat 10 Edegem, 2650, Antwerp, Belgium. .,Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.
| | - Charlotte Schellen
- University College Arteveldehogeschool, Voetweg 66, 9000, Ghent, Belgium
| | - Katja Verstraelen
- University College Arteveldehogeschool, Voetweg 66, 9000, Ghent, Belgium
| | | | - Jan Vanderwegen
- University College Thomas More, Molenstraat 8, 2018, Antwerp, Belgium.,CHU Saint-Pierre, Hoogstraat 322, 1000, Brussels, Belgium
| | - Marc De Bodt
- Department of Otolaryngology and Head & Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Wilrijkstraat 10 Edegem, 2650, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Faculty of Speech, Pathology and Audiology, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Gwen Van Nuffelen
- Department of Otolaryngology and Head & Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Wilrijkstraat 10 Edegem, 2650, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Faculty of Speech, Pathology and Audiology, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
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18
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Hedström J, Tuomi L, Finizia C, Olsson C. Correlations Between Patient-Reported Dysphagia Screening and Penetration-Aspiration Scores in Head and Neck Cancer Patients Post-oncological Treatment. Dysphagia 2017. [PMID: 28887707 DOI: 10.1007/s00455-017-9847-6.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Dysphagia is a common and severe toxicity after oncological treatment of head and neck cancer (HNC). The study aim was to investigate relationships between patient-reported dysphagia and clinically measured swallowing function in HNC after modern curative radiotherapy with or without chemotherapy to identify possible alarm symptoms for clinically manifest dysphagia. Patients with tumors of the tonsil, base of tongue, hypopharynx, and larynx treated in 2007-2015 were assessed for dysphagia post-treatment by telephone interview and videofluoroscopy (VFS). A study-specific categorized symptom score was used to determine patient-reported dysphagia (DESdC = presence of Drinking, Eating, Swallowing difficulties, and Coughing when eating/drinking (any combination); scores between 0 and 4 with 0 = no symptom); the penetration-aspiration scale (PAS) to determine swallowing function by VFS. Swallowing difficulties were defined as DESdC ≥ 1 and PAS ≥ 2. Relationships between clinically relevant cut-offs for DESdC and PAS were determined by Pearson's correlation coefficient (Pr). Swallowing difficulties according to DESdC were reported by 89% of the patients and according to PAS by 60% at a median of 7 months post-treatment. Averaged correlations between DESdC score 1/2/3/4 and PAS were 0.16/0.10/0.27/0.18. Almost one in two patients with DESdC score ≥3 had severe swallowing difficulties according to PAS. Correlations between individual DESdC:s were highest for swallowing and eating (Pr = 0.53) and lowest for swallowing and coughing (Pr = 0.11). Our data suggest that if a patient reports having swallowing difficulties, it is likely that he or she also has eating difficulties but not necessarily coughing problems when eating/drinking. However, if all these three symptoms are reported, it is likely that the patient will present with moderate or severe impaired swallowing function according to PAS and thus should be referred for further evaluation and treatment.
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Affiliation(s)
- Johanna Hedström
- Department of Otorhinolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - Lisa Tuomi
- Department of Otorhinolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Caterina Finizia
- Department of Otorhinolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Caroline Olsson
- Department of Radiation Physics, Institute of Clinical Sciences, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Regional Cancer Center West, The Western Sweden Healthcare Region, Gothenburg, Sweden
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19
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Hedström J, Tuomi L, Finizia C, Olsson C. Correlations Between Patient-Reported Dysphagia Screening and Penetration-Aspiration Scores in Head and Neck Cancer Patients Post-oncological Treatment. Dysphagia 2017; 33:206-215. [PMID: 28887707 PMCID: PMC5866278 DOI: 10.1007/s00455-017-9847-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 08/30/2017] [Indexed: 11/19/2022]
Abstract
Dysphagia is a common and severe toxicity after oncological treatment of head and neck cancer (HNC). The study aim was to investigate relationships between patient-reported dysphagia and clinically measured swallowing function in HNC after modern curative radiotherapy with or without chemotherapy to identify possible alarm symptoms for clinically manifest dysphagia. Patients with tumors of the tonsil, base of tongue, hypopharynx, and larynx treated in 2007–2015 were assessed for dysphagia post-treatment by telephone interview and videofluoroscopy (VFS). A study-specific categorized symptom score was used to determine patient-reported dysphagia (DESdC = presence of Drinking, Eating, Swallowing difficulties, and Coughing when eating/drinking (any combination); scores between 0 and 4 with 0 = no symptom); the penetration–aspiration scale (PAS) to determine swallowing function by VFS. Swallowing difficulties were defined as DESdC ≥ 1 and PAS ≥ 2. Relationships between clinically relevant cut-offs for DESdC and PAS were determined by Pearson’s correlation coefficient (Pr). Swallowing difficulties according to DESdC were reported by 89% of the patients and according to PAS by 60% at a median of 7 months post-treatment. Averaged correlations between DESdC score 1/2/3/4 and PAS were 0.16/0.10/0.27/0.18. Almost one in two patients with DESdC score ≥3 had severe swallowing difficulties according to PAS. Correlations between individual DESdC:s were highest for swallowing and eating (Pr = 0.53) and lowest for swallowing and coughing (Pr = 0.11). Our data suggest that if a patient reports having swallowing difficulties, it is likely that he or she also has eating difficulties but not necessarily coughing problems when eating/drinking. However, if all these three symptoms are reported, it is likely that the patient will present with moderate or severe impaired swallowing function according to PAS and thus should be referred for further evaluation and treatment.
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Affiliation(s)
- Johanna Hedström
- Department of Otorhinolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - Lisa Tuomi
- Department of Otorhinolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Caterina Finizia
- Department of Otorhinolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Caroline Olsson
- Department of Radiation Physics, Institute of Clinical Sciences, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Regional Cancer Center West, The Western Sweden Healthcare Region, Gothenburg, Sweden
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20
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Hedström J, Tuomi L, Andersson M, Dotevall H, Osbeck H, Finizia C. Within-Bolus Variability of the Penetration-Aspiration Scale Across Two Subsequent Swallows in Patients with Head and Neck Cancer. Dysphagia 2017; 32:683-690. [PMID: 28593510 PMCID: PMC5608789 DOI: 10.1007/s00455-017-9814-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 05/31/2017] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Johanna Hedström
- Department of Otorhinolaryngology Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden.
| | - Lisa Tuomi
- Department of Otorhinolaryngology Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
| | - Mats Andersson
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
| | - Hans Dotevall
- Department of Otorhinolaryngology Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
| | - Hanna Osbeck
- Department of Otorhinolaryngology Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
| | - Caterina Finizia
- Department of Otorhinolaryngology Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
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21
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Van den Steen L, Vanderveken O, Vanderwegen J, Van Gestel D, Daisne JF, Allouche J, Delacroix L, Van Rompaey D, Beauvois S, Cvilic S, Mariën S, Desuter G, Vermorken JB, Van den Weyngaert D, Specenier P, Van Laer C, Peeters M, Van de Heyning P, Chantrain G, Lawson G, Lazarus C, De Bodt M, Van Nuffelen G. Feasibility of tongue strength measurements during (chemo)radiotherapy in head and neck cancer patients. Support Care Cancer 2017; 25:3417-3423. [PMID: 28573486 DOI: 10.1007/s00520-017-3761-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 05/22/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this study was to investigate the feasibility of tongue strength measures (TSMs) and the influence of bulb location, sex, and self-perceived pain and mucositis in head and neck cancer (HNC) patients during chemoradiotherapy (CRT). METHODS Twenty-six newly diagnosed HNC patients treated with CRT performed anterior and posterior maximal isometric tongue pressures by means of the Iowa Oral Performance Instrument (IOPI). The Oral Mucositis Weekly Questionnaire (OMWQ) and a Visual Analogue Scale (VAS) for pain during swallowing were completed weekly from baseline to 1 week post CRT. RESULTS Feasibility of TSMs during CRT declines significantly from 96 to 100% at baseline to 46% after 6 weeks of CRT. But post-hoc analyses reveal only significant differences in feasibility between baseline and measurements after 4 weeks of treatment. No effect of gender or bulb location was established, but feasibility is influenced by pain and mucositis. CONCLUSIONS Feasibility of TSMs declines during CRT and is influenced by mucositis and pain. For the majority of subjects, TSMs were feasible within the first 4 weeks, which provides a window of scientific and clinical opportunities in this patient population.
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Affiliation(s)
- Leen Van den Steen
- Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium.
| | - Olivier Vanderveken
- Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium
| | - Jan Vanderwegen
- University College Thomas More, Antwerp, Belgium.,CHU Saint-Pierre, Brussels, Belgium
| | - Dirk Van Gestel
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-François Daisne
- Université Catholique de Louvain, CHU-UCL-Namur, Site Sainte-Elisabeth, Namur, Belgium
| | | | - Laurence Delacroix
- Université Catholique de Louvain, CHU-UCL-Namur, Site Godinne, Yvoir, Belgium
| | - Diane Van Rompaey
- Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium
| | - Sylvie Beauvois
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Steven Mariën
- Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium
| | - Gauthier Desuter
- Cliniques Universitaires St-Luc, Universite Catholique de Louvain, Brussels, Belgium
| | - Jan Baptist Vermorken
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium.,Department Medical Oncology, Antwerp University Hospital, Antwerp, Belgium
| | | | - Pol Specenier
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium.,Department Medical Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Carl Van Laer
- Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium
| | - Marc Peeters
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium.,Department Medical Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Paul Van de Heyning
- Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Georges Lawson
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Cathy Lazarus
- Department of Otolaryngology Head & Neck Surgery, Mount Sinai Beth Israel, New York, NY, USA.,Department of Otorhinolaryngology of the Albert Einstein College of Medicine, Department of Otorhinolaryngology, New York, NY, USA
| | - Marc De Bodt
- Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Faculty of Speech, Pathology and Audiology, Ghent University, Ghent, Belgium
| | - Gwen Van Nuffelen
- Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Faculty of Speech, Pathology and Audiology, Ghent University, Ghent, Belgium
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22
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Behaviour change technique taxonomy: a method of describing head and neck cancer dysphagia intervention delivery. Curr Opin Otolaryngol Head Neck Surg 2017; 25:182-187. [PMID: 28306585 DOI: 10.1097/moo.0000000000000360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of the review is to examine the current state of the art of dysphagia intervention delivery description and to propose use of a new tool to facilitate this: the behaviour change technique taxonomy version 1 (BCTTv1). RECENT FINDINGS Describing intervention delivery is difficult, and published research in the field of speech and language therapy (SLT) does not include detail on this key aspect of research protocols. Interventions themselves are often poorly delineated, and a way is needed of classifying how these interventions are delivered in practice. SUMMARY Use of the BCTTv1 would facilitate clarity and transparency in intervention delivery description and have positive implications for research, clinical practice and undergraduate teaching if employed by the SLT profession.
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23
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Calvo I, Sunday KL, Macrae P, Humbert IA. Effects of chin-up posture on the sequence of swallowing events. Head Neck 2017; 39:947-959. [PMID: 28181331 DOI: 10.1002/hed.24713] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 08/31/2016] [Accepted: 12/12/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Chin-up posture is frequently used to manage oral dysphagia after head and neck cancer. This prospective study investigates the effects of chin-ups on the sequence of pharyngeal swallowing events. METHODS Twelve healthy young adults performed 45 consecutive swallows of 5 mL water across 3 phases on videofluoroscopy: 5 swallows in the neutral head position; 30 swallows during chin-up posture; and 10 swallows in the neutral head position. Swallowing kinematic and bolus flow measures for 9 swallowing events were recorded. Linear trends were analyzed across 30 chin-up swallows; pairwise comparison was used to compare the 3 phases. RESULTS Time to hyoid peak and laryngeal vestibule closure changed abruptly during chin-up swallowing compared to the initial neutral position. No measure changed across 30 chin-up swallows. Time of hyoid burst decreased upon returning to the neutral position. CONCLUSION Our findings indicate that chin-up posture challenges the pharyngeal sequence of events for both swallowing kinematics and bolus flow. © 2017 Wiley Periodicals, Inc. Head Neck 39: 947-959, 2017.
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Affiliation(s)
- Irene Calvo
- Department of Neurorehabilitation Sciences, Casa Cura Policlinico, Milano, Italy.,Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida.,Swallowing Systems Core, University of Florida, Gainesville, Florida
| | - Kirstyn L Sunday
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida.,Swallowing Systems Core, University of Florida, Gainesville, Florida
| | - Phoebe Macrae
- Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand
| | - Ianessa A Humbert
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida.,Swallowing Systems Core, University of Florida, Gainesville, Florida
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