Dysphagia Grand Rounds 9

Can respiratory-swallowing coordination be trained and sustained? Does it have a beneficial impact on swallowing physiology and airway protection? What effects does it have in the head and neck cancer population with chronic dysphagia? Read the open-access paper in the link below to learn more. Then watch the Dysphagia Grand Rounds 9 webinar to learn about the clinical implications of this research.   

Article: Respiratory-Swallow Training in Patients with Head and Neck Cancer
Authors: Bonnie Martin-Harris, David McFarland, Elizabeth G. Hill, Charlton B. Strange, Kendrea L. Focht, Zhuang Wan, Julie Blair, and Katlyn McGrattan
Journal: Archives of physical medicine and rehabilitation. 2015;96(5):885-893

Read DGR 9 article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4410058/

Watch DGR 9 webinar: http://dysphagiagrandrounds.yondo.com/playlist/dgr-9-september-2017/454

Abstract: 
Objective

To test a novel intervention to train swallowing to occur in the mid-to-low expiratory phase of quiet breathing to improve swallowing safety and efficiency.

Design
Safety and efficacy non-randomized clinical trial with one-month follow-up.

Setting
Head and neck cancer (HNC) ambulatory clinics.

Participants
Thirty patients with HNC and chronic dysphagia completed the intervention. Fifteen of these patients participated in a one-month follow-up visit.

Interventions
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.

Main Outcome Measures
Respiratory-swallow phase pattern, Modified Barium Swallow Impairment Profile™© (MBSImP) scores, Penetration Aspiration Scale (PAS) scores, M.D. Anderson Dysphagia Inventory scores

Results
Using visual feedback, patients were trained to initiate swallows during the mid-expiratory phase of quiet breathing and to continue to expire after swallowing. This optimal phase patterning increased significantly after treatment (p <0.0001). Changes in respiratory-swallowing coordination were associated with improvements in three MBSImP component scores: laryngeal vestibular closure (p = 0.0004), tongue base retraction (p <0.0001), and pharyngeal residue (p = 0.01). Significant improvements were also seen in PAS scores (p <0.0001). Relative to pre-treatment values, patients participating in one-month follow-up had increased optimal phase patterning (p <0.0001), improved laryngeal vestibular closure (p = 0.01), tongue base retraction (p = 0.003), and pharyngeal residue (p = 0.006) MBSImP scores, and improved PAS scores (p <0.0001).

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.