The effect of the Shaker head‐lift exercise on swallowing function following treatment for head and neck cancer: Results from a randomized, controlled trial with videofluoroscopic evaluation

Abstract

Background Dysphagia is common following treatment for head and neck cancer (HNC) and intervention to improve swallowing function is warranted. This study aimed to evaluate the efficacy of the Shaker head‐lift exercise (HLE) to improve dysphagia in HNC patients. Methods Patients treated for HNC with radiochemotherapy and with subsequent dysphagia were randomly assigned to intervention (HLE, n = 25) and control (standard dysphagia management, n = 27) groups. Videofluoroscopic evaluation of penetration‐aspiration, initiation, residue, movement of selected structures, and self‐perceived swallowing function, before and after 8 weeks of treatment, were compared. Results Although adherence to training was high, no statistically significant differences in objectively measured swallowing function between the groups or within‐group changes were found. Self‐perceived swallowing function improved in the intervention group. Conclusions In this HNC population, neither HLE nor standard dysphagia management improved objectively measured swallowing function as evaluated after 8 weeks. Future research focusing on finding effective interventions for dysphagia is warranted.

Treatment with head-lift exercise in head and neck cancer patients with dysphagia: results from a randomized, controlled trial with flexible endoscopic evaluation of swallowing (FEES)

“…Patients were presented with different amounts and consistencies of barium contrast, similar to the protocol described below. Details of the VFSS have been described elsewhere [ 30 ]. A gastrointestinal radiologist and an SLP scored the video recordings of the VFSS according to PAS [ 31 ] prior to inclusion to assess which patients were eligible for inclusion in the study.…”

“…The PAS includes eight scale steps where “1” denotes no material entering the airway and “8” material enters the airway, passes below the vocal fold, and no effort is made to eject. The PAS was assessed as illustrated in the previously published report on VFSS data [ 30 ]. Residue in the vallecula and pyriform sinuses, respectively, after each bolus according to the Yale Pharyngeal Residue Severity Scale [ 42 , 43 ].…”

“…The PAS includes eight scale steps where “1” denotes no material entering the airway and “8” material enters the airway, passes below the vocal fold, and no effort is made to eject. The PAS was assessed as illustrated in the previously published report on VFSS data [ 30 ].…”

“…Before inclusion in the study, all participants gave their written informed consent. The study population has been described in part, in previous work [ 30 ].…”

“…The Shaker HLE is feasible and possible to perform for most patients [ 29 ]. However, previous analysis of data from the present randomized study of videofluoroscopic examination of swallowing (VFSS) only demonstrated minor changes pertaining penetration and/or aspiration events or structural movement variables during swallowing after HLE treatment in patients with HNC [ 30 ]. Further analysis of the effect of the HLE regarding other aspects of swallowing function in HNC patients is needed.…”