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Introduction: Dysphagia secondary to head and neck cancer and its associated treatment is on the
rise. Exercise-based interventions are an important element of the global rehabilitation process. Lingual function is known to decline through the course of head and neck cancer treatment, effective interventions are needed. A few studies have investigated the impact of device-assisted therapies; however, implementation of these findings in a clinical setting is largely lost with high variability of practice when it comes to the approach of exercise-based therapies. Therefore, in this study, we sought to test the patient outcomes and adherence with implementing a loaner program using individualized targets for lingual function rehabilitation (specifically strength and endurance) in head and neck cancer. We sought to achieve this via the following aims: 1) to investigate the change in lingual strength with use of individualized treatment program versus usual care treatment, 2) to examine the change in standardized swallowing assessment scores via the Modified Barium Swallow Impairment Profile (MBSImP) for patients undergoing individualized treatment program versus usual care treatment, and 3) to compare patient adherence with individualized treatment program versus usual care treatment.
Methods: A retrospective cohort study was completed to compare outcomes between patients who underwent individualized treatment program (ITP) for lingual function rehabilitation with patients who underwent the usual care program (UCP) at the institution. Patients who demonstrated lingual function deficits following treatment for head and neck cancer and participated in swallowing rehabilitation with dysphagia were included in the cohort. Patients in the ITP group were provided with a Tongueometer device; exercise regimen that included the following components: 1) 30 repetitions of repetitive strength activity at 60-75% of maximum strength per day for 5 days a week, 2) 30 repetitions of isometric endurance activity at 50% of maximum strength per day for 5 days a week, 3) intensity of strength and endurance adjusted every 2 weeks, and 4) total duration of rehabilitation of 12 weeks. Patients in the UCP group were instructed to press against a tongue depressor or other static object for 30 repetitions per day. Total duration of rehabilitation was variable across patients. Patients underwent a pre- and post-treatment Modified Barium Swallow Study (MBSS). Swallow studies were scored using MBSImP ratings for oral total score (OT), pharyngeal total score (PT), and individual component scores were analyzed.
Results: The results demonstrated significantly improved strength in both groups (ITP: (z=3.92, p<0.05); UCP: (z=3.931, p< 0.05)) with a greater magnitude of gains in patients who participated in ITP compared to UCP ((F(1, 37) = 15.280, p<0.05)). Lingual endurance was noted to significantly improve through treatment for patients in the ITP group ((z=3.92, p<0.05)). With respect to MBSImP ratings, significantly greater improvement in oral total (OT) scores for patients in the ITP compared to UCP were noted ((F(1,37) = 6.40, p < 0.05)). No significant improvement was noted in pharyngeal total (PT) scores ((F(1, 37) = 1.72, p > 0.05)) or individual components of the MBSImP.
Conclusion: Device-assisted lingual function rehabilitation demonstrates improved outcomes for
strength, endurance, and oral phase of swallowing. Further studies to assess the unique impact of strength only training vs endurance only training on swallowing outcomes may be beneficial to understand the unique impact of each function on outcomes. As adherence can be measured and monitored through device-assisted modalities, it provides improved insight into efficacy of a regimen. Additionally, this study also supported improved adherence in the device-assisted program, which inherently can be beneficial to elicit improved outcomes for swallowing.