Respiratory Tract (Lung and Bronchial) Diseases

Symptoms and General Pathology

All Conditions

Digestive System Diseases

Ear, Nose, and Throat Diseases

Neoplasms

Mouth and Tooth Diseases

Respiratory Aspiration

Deglutition Disorders

Oropharyngeal Neoplasms

Esophageal Diseases

Gastrointestinal Diseases

Pharyngeal Diseases

Otorhinolaryngologic Diseases

Pharyngeal Neoplasms

Otorhinolaryngologic Neoplasms

Head and Neck Neoplasms

Stomatognathic Diseases

Chronically dysphagic, medically stable patients at least 6 months post treatment for head and neck cancer with non-optimal respiratory-swallowing patterns participated in up to 8 sessions of respiratory phase training to learn an optimal respiratory - swallow phase pattern

Patients were presented with visually guided respiratory feedback to train optimal respiratory-swallow coordination patterns.

Respiratory-Swallow Phase training

Bonnie J Martin-Harris

Cancers of the head and neck require surgical, radiation, and chemotherapy treatments that are intended to cure the disease. These treatments have toxic effects on muscles and structures that are necessary to swallow safely and efficiently. The resulting swallowing problems (dysphagia) often remain chronic for Veterans and interfere with their ability to eat and drink. The cost burden to the VA health system is high. There is an urgent need to develop rehabilitative treatments that lessen these burdens. The proposed research is designed to test a novel swallowing therapy that includes the coordination of breathing with swallowing. Our study will train medically and surgically treated, chronically dysphagic Veterans with histories of oropharyngeal cancer in a novel therapy that involves both swallowing and respiratory systems. If the therapy is found to be effective, the long term goal of the project is to extend the study to a multi-site, clinical trial and test the longstanding effect of this treatment compared to other swallowing therapies on swallowing function, QOL and cost.

Swallowing impairments (dysphagia) represent the highest functional morbidity in veteran patients treated for oropharyngeal cancers with either surgical approaches followed by radiation or with more recent organ-preservation protocols. The nature of the impairments is often resistive to treatment and results in life-long health consequences and high cost burden on the VA health system. Recent preliminary data have linked alterations in the otherwise highly stable respiratory-swallowing phase pattern relationships to the swallowing impairment and penetration/aspiration and in this patient group. The immediate goal of this clinical trial is to test the effect of a novel respiratory-swallow intervention on swallowing impairment and penetration/aspiration in a cohort of chronically dysphagic veterans following treatment for oropharyngeal cancer. Patients presenting with a "non-optimal" respiratory-swallow phase pattern during liquid swallows and measurable swallowing impairment will learn an "optimal" physiologic pattern that facilitates both airway protective and mechanical advantages during swallowing. The broad goal of this research is to develop ideal respiratory-swallowing phase training methods and regimens that alone or combined with traditional swallowing treatments improve swallowing function in the acute phases of recovery and improve long term patient outcome. Our intention is to use these preliminary data to motivate a larger clinical trial to compare the effect of respiratory-swallow phase training with other evidenced based methods of swallowing treatment and expand the approach to other patient groups that have indications of respiratory-swallow phase impairments (e.g. pulmonary disease and stroke) contributing to impaired swallowing function

Respiratory-Swallow Training in Veterans With Oropharyngeal Cancer

Respiratory swallow patterns were collected using nasal airflow and respiratory inductance plethysmography (RIP) of each swallow during the modified barium swallow study. The movements of the ribcage and abdomen were recorded using RIP; data synchronized and recorded using the KayPentax Digital Swallow Workstation Signals Lab. Subjects were categorized as optimal (expiratory-expiratory) versus non-optimal (non-expiratory-expiratory).

Analysis of the percentage of impaired swallow components using a dichotomized MBSImP scoring system

The penetration aspiration scale is a validated 8 point interval scale used to describe penetration and aspiration events. Scores are determined primarily by the depth to which material passes in the airway and by whether or not material entering the airway is expelled. Scores \< 3 are considered to be normal. For the purpose of our study scores were dichotimized to normal and impaired.

US Department of Veterans Affairs

Patient completed daily EXACT-PRO questionnaires regarding respiratory symptoms. Reported changes were reviewed by pulmonologist

Chronically dysphagic, medically stable patients at least 6 months post treatment for head and neck cancer with non-optimal respiratory-swallowing patterns

Respiratory-Swallow Phase training: Will present patients with visually guided, respiratory feedback and train optimal respiratory-swallow coordination patterns, thereby providing the airway protection and mechanical benefits that have been observed in healthy individuals.

Arm 1

Respiratory-Swallow Phase Training

Age, Categorical

Age, Continuous

Sex: Female, Male

Ethnicity (NIH/OMB)

Race (NIH/OMB)

United States

Region of Enrollment

Dr. Bonnie Martin Harris

Lip closure

Tongue control

Bolus transport

Oral residue

Initiation of pharyngeal swallow

Soft palate elevation

laryngeal elevation

Anterior hyiod excursion

Epiglottic inversion

Laryngeal vestibular closure

Pharyngeal stripping wave

Pharyngoesophageal segment opening

Tongue base retraction

Pharyngeal residue

Pre-intervention

Subjects that completed treatment were assessed within one week of meeting respiratory-swallow phase training goals

One Week Post Intervention

VAMC participants were assessed at one month following completion of the treatment protocol

One Month Post Intervention

Percentage of Impairment According to the Modified Barium Swallow Impairment Profile (MBSImP)

Percentage of Impairment According to the Penetration-Aspiration Scale

One Week Post-intervention

VAMC participants were reassessed at one month post treatment

Optimal Respiratory - Swallow Phase

Chronically dysphagic, medically stable patients at least 6 months post treatment for head and neck cancer with non-optimal respiratory-swallowing patterns

Respiratory - Swallow Phase Training

Overall Study

Spots Global Cancer Trial Database for breathing and swallowing