DGR 9 - September 2017

DGR 9 - September 2017


Total Duration: 55:25

Video: 1

Dysphagia Grand Rounds 9

Article: Respiratory-Swallow Training in Patients with Head and Neck Cancer
Authors: Bonnie Martin-Harris, David McFarland, Elizabeth G. Hill, Charlton B. Strange, Kendrea L. Focht, Zhuang Wan, Julie Blair, and Katlyn McGrattan
Journal: Archives of physical medicine and rehabilitation. 2015;96(5):885-893

Read DGR 9 article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4410058/

To test a novel intervention to train swallowing to occur in the mid-to-low expiratory phase of quiet breathing to improve swallowing safety and efficiency.

Safety and efficacy non-randomized clinical trial with one-month follow-up.

Head and neck cancer (HNC) ambulatory clinics.

Thirty patients with HNC and chronic dysphagia completed the intervention. Fifteen of these patients participated in a one-month follow-up visit.

Training protocol based on hierarchy of motor skill acquisition to encourage autonomous and optimal respiratory-swallowing coordination. Visual feedback of respiratory phase and volume for swallowing initiation was provided by nasal airflow and rib cage/abdomen signals.

Main Outcome Measures
Respiratory-swallow phase pattern, Modified Barium Swallow Impairment Profile™© (MBSImP) scores, Penetration Aspiration Scale (PAS) scores, M.D. Anderson Dysphagia Inventory scores

Using visual feedback, patients were trained to initiate swallows during the mid-expiratory phase of quiet breathing and to continue to expire after swallowing. This optimal phase patterning increased significantly after treatment (p <0.0001). Changes in respiratory-swallowing coordination were associated with improvements in three MBSImP component scores: laryngeal vestibular closure (p = 0.0004), tongue base retraction (p <0.0001), and pharyngeal residue (p = 0.01). Significant improvements were also seen in PAS scores (p <0.0001). Relative to pre-treatment values, patients participating in one-month follow-up had increased optimal phase patterning (p <0.0001), improved laryngeal vestibular closure (p = 0.01), tongue base retraction (p = 0.003), and pharyngeal residue (p = 0.006) MBSImP scores, and improved PAS scores (p <0.0001).

Improvements in respiratory-swallowing coordination can be trained using a systematic protocol and respiratory phase-lung volume related biofeedback in patients with HNC and chronic dysphagia, with favorable effects on airway protection and bolus clearance.

DGR 9: Respiratory-Swallow Training In Patients With Head And Neck Cancer | September 2017
In this webinar, Dr. Ianessa Humbert reviews a feasibility and efficacy study that tested the ability to train optimal respiratory-swallow phase patterning in patients with chronic dysphagia. SLP Rinki Varindani Desai discusses the clinical implications of this study at the end of the webinar.