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"Efficacy of Electrical Stimulation for Dysphagia in Head and Neck Cancer Patients"
Project Summary:Sensory Stimulation, stretch or range of motion, and active exercise are the current primary modes of rehabilitation with cancer patients. These modalities directly target the problems face by post radiated patients. Logemann found range of motion exercise to the tongue improved swallow function in 9 post-surgical head and neck cancer patients, but this evidence must still be considered preliminary. At this time, there have been no published randomized controlled trials (RCT) that have looked at the efficacy of different types of swallowing therapy for patients with HNCa. Specific Aim 1: Determine whether there is an objective benefit to swallowing function from a therapy program of neuromuscular electrical stimulation (NMES) paired with swallowing behavior when compared to sham NMES (unstimulated-the device has been altered so that there is no current flowing out of the device) paired with swallowing behavior in post-radiated HNCa patients with dysphagia. Both groups will get targeted exercise therapy. Recorded flouroscopic swallow studies will act as the measurement tool, allowing us to determine exact scores including 1) Penetration-Aspiration Scale (PAS) [18,19], 2) Oropharyngeal Swallow Efficiency (OPSE) [19,20] 3)extent of hyoid excursion during the swallow, and 4) ability to swallow different food choices via presentation of 5 standardized food consistencies. We will be able to determine the severity of dysphagia and elucidate in detail, changes after treatment. Specific Aim 2: Determine whether patients perceive improved quality of life after receiving NMES therapy combined with exercise therapy as compared to sham NMES combined with exercise therapy. This will be measured by 2 validated scales: the Performance Status Scale for Head and Neck Cancer Patients [20,21] and The Head and Neck Center Inventory (HCNI) [21] which contain domains centered around eating, diet and social interaction. We believe the patient’s perception of the problem and his ability to function in activities associated with eating is as important as an objective change in the swallow and we need to correlate physiological and functional outcomes.
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University of Wisconsin Department of Surgery
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