Expiratory muscle strength training for radiation-associated aspiration after head and neck cancer: A case series.

Autor: Hutcheson KA; Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas., Barrow MP; Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas., Plowman EK; Department of Speech, Language, and Hearing Sciences, The University of Florida, Gainesville, Florida, U.S.A., Lai SY; Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.; Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas., Fuller CD; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas., Barringer DA; Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas., Eapen G; Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas., Wang Y; Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas., Hubbard R; Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas., Jimenez SK; Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas., Little LG; Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas., Lewin JS; Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Jazyk: angličtina
Zdroj: The Laryngoscope [Laryngoscope] 2018 May; Vol. 128 (5), pp. 1044-1051. Date of Electronic Publication: 2017 Aug 22.
DOI: 10.1002/lary.26845
Abstrakt: Objective/hypothesis: Expiratory muscle strength training (EMST) is a simple, inexpensive, device-driven exercise therapy. Therapeutic potential of EMST was examined among head and neck cancer survivors with chronic radiation-associated aspiration.
Study Design: Retrospective case series.
Methods: Maximum expiratory pressures (MEPs) were examined among n = 64 radiation-associated aspirators (per penetration-aspiration scale score ≥ 6 on modified barium swallow). Pre-post EMST outcomes were examined in a nested subgroup of patients (n = 26) who enrolled in 8 weeks of EMST (25 repetitions, 5 days/week, 75% load). Nonparametric analyses examined effects of EMST on the primary endpoint MEPs. Secondary measures included swallowing safety (Dynamic Imaging Grade of Swallowing Toxicity [DIGEST]), perceived dysphagia (M.D. Anderson Dysphagia Inventory [MDADI]), and diet (performance status scale for head and neck cancer patients [PSSHN]).
Results: Compared to sex-matched published normative data, MEPs were reduced in 91% (58 of 64) of aspirators (mean ± standard deviation: 89 ± 37). Twenty-six patients enrolled in EMST and three patients withdrew. MEPs improved on average 57% (87 ± 29 to 137 ± 44 cm H 2 O, P < 0.001) among 23 who completed EMST. Swallowing safety (per DIGEST) improved significantly (P = 0.03). Composite MDADI scores improved post-EMST (pre-EMST: 59.9 ± 17.1, post-EMST: 62.7 ± 13.9, P = 0.13). PSSHN diet scores did not significantly change.
Conclusion: MEPs were reduced in chronic radiation-associated aspirators relative to normative data, suggesting that expiratory strengthening could be a novel therapeutic target to improve airway protection in this population. Similar to findings in neurogenic populations, these data also suggest improved expiratory pressure-generating capabilities after EMST and translation to functional improvements in swallowing safety in chronic radiation-associated aspirators.
Level of Evidence: 4. Laryngoscope, 128:1044-1051, 2018.
(© 2017 The American Laryngological, Rhinological and Otological Society, Inc.)
Databáze: MEDLINE
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