Optimizing Respiratory-Swallowing Coordination in Patients With Oropharyngeal Head and Neck Cancer.
Bonnie Martin-Harris, Kendrea L Focht Garand, David McFarland
PMID 28884146WHAT IT FOUND
30 patients with head and neck cancer dysphagia trained to time swallows during mid-to-low lung volume breathing.
After training, all showed the breathing-swallow pattern, and airway protection scores improved. Quality of life scores rose, but not by the 10-point clinically meaningful change.
Key findings
01All patients learned to initiate swallows during the mid-to-low lung volume expiratory phase after training.
02After training, swallowing mechanics scores improved for laryngeal vestibular closure, tongue base retraction, and pharyngeal residue, and penetration-aspiration scores improved.
03Dysphagia-specific quality of life scores increased after training, but not by the 10-point change considered clinically relevant.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study had no control group, and the paper states that a randomized trial with a control group is needed to inform targeted effects of the training. It was a preliminary trial, and patients were not instructed to practice at home because there was not a reasonable method to ensure compliance. Only liquid consistencies were used during training and testing, and solids were not given because of airway protection concerns. The participants were at least six months after treatment and had dysphagia refractory to prior swallowing treatment, so the paper does not describe what would happen in less chronic or less refractory cases. Only 15 of the 30 patients had one-month follow-up, so durability is not shown for all participants. Dysphagia-specific quality of life scores increased, but not by the 10-point change considered clinically relevant.
Declared interests
The supplied funding and conflicts section reports that the named authors have no relevant nonfinancial interests to disclose.
The easy way to misread this
Do not read these pre-post changes as proof that respiratory-swallow training causes better swallowing. The study had no control group, did not test home practice, and the quality-of-life increase did not reach the 10-point clinically meaningful change.