title: Respiratory-swallow training in patients with head and neck cancer.
abstract: OBJECTIVE
  To test a novel intervention to train swallowing to occur in the midexpiratory to low expiratory phase of quiet breathing to improve swallowing safety and efficiency.
  
  
  METHODS
  Safety and efficacy nonrandomized controlled trial with 1-month follow-up.
  
  
  METHODS
  Ambulatory clinics.
  
  
  METHODS
  Patients (N=30) with head and neck cancer (HNC) and chronic dysphagia completed the intervention. Fifteen of these patients participated in a 1-month follow-up visit.
  
  
  METHODS
  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.
  
  
  METHODS
  Respiratory-swallow phase pattern, Modified Barium Swallow Impairment Profile (MBSImP) scores, Penetration-Aspiration Scale (PAS) scores, and MD Anderson Dysphagia Inventory scores.
  
  
  RESULTS
  Using visual feedback, patients were trained to initiate swallows during the midexpiratory phase of quiet breathing and continue to expire after swallowing. This optimal phase patterning increased significantly after treatment (P<.0001). Changes in respiratory-swallowing coordination were associated with improvements in 3 MBSImP component scores: laryngeal vestibular closure (P=.0004), tongue base retraction (P<.0001), and pharyngeal residue (P=.01). Significant improvements were also seen in PAS scores (P<.0001). Relative to pretreatment values, patients participating in 1-month follow-up had increased optimal phase patterning (P<.0001), improved laryngeal vestibular closure (P=.01), tongue base retraction (P=.003), and pharyngeal residue (P=.006) MBSImP scores and improved PAS scores (P<.0001).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC; Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston, SC; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC. Electronic address: harrisbm@musc.edu.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Martin-Harris
authors.affiliation: Faculty of Medicine, University of Montréal, Montréal, QC, Canada; Faculty of Medicine, McGill University, Montréal, QC, Canada.
authors.forename: David
authors.initials: D
authors.lastname: McFarland
authors.affiliation: Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC.
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Hill
authors.affiliation: Division of Pulmonary and Critical Medicine, College of Medicine, Medical University of South Carolina, Charleston, SC.
authors.forename: Charlton B
authors.initials: CB
authors.lastname: Strange
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC; Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston, SC; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC.
authors.forename: Kendrea L
authors.initials: KL
authors.lastname: Focht
authors.affiliation: Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC.
authors.forename: Zhuang
authors.initials: Z
authors.lastname: Wan
authors.affiliation: Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston, SC; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC.
authors.forename: Julie
authors.initials: J
authors.lastname: Blair
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC; Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston, SC.
authors.forename: Katlyn
authors.initials: K
authors.lastname: McGrattan
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000209:etiology* / Q000534:rehabilitation*; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012119:Respiration; D013066:Speech-Language Pathology / Q000379:methods*
keywords: Deglutition disorders; Feedback, sensory; Head and neck neoplasms; Rehabilitation; Respiratory aspiration