Description of Lab Projects in Progress
Biomechanics and Sensory Input of Swallow After Head & Neck Cancer
Treatment for head and neck cancer can change not only the range and rate of motion of involved structures during the swallow, that is, the biomechanics of the swallow, by altering the direction and strength of muscle pull or by introducing scar tissue, but also may alter the neural input into the region of treatment. Alterations in the biomechanics of the pharyngeal swallow potentially change its efficiency and safety. Altering neural input may cause difficulty in triggering the pharyngeal swallow which results in food reaching the lower areas of the pharynx too early, also potentially altering swallow safety and efficiency. The major objectives of this study are to increase our understanding of the effects of tumor treatment, recovery, and rehabilitation on the biomechanical and sensory characteristics of the oropharyngeal swallow. This project is funded by NIH/NCI P01CA40007.
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Comparison of Two Therapies for UES Dysphagia
Pharyngeal phase dysphagia can be a severe and costly side effect of stroke and chemoradiation therapy for head and neck cancer, causing the patient to regularly aspirate and be unable to eat by mouth. A major subset of pharyngeal phase dysphagia is caused by inability to move the bolus completely through the upper esophageal sphincter (UES) during swallowing. Available therapy for this condition is limited and yields a degree of success, but a new therapy procedure, the Shaker exercise, offers an exciting new opportunity to rehabilitate these patients perhaps more effectively and efficiently than the usual therapy program. This study is a randomized clinical trial of these two therapies in patients with severe pharyngeal phase dysphagia with inability to move the bolus completely through the UES. The patients must be non-oral for at least 3 months because of aspiration of residue from either or both the valleculae and pyriform sinuses. The primary objective of this project is to identify which of two therapy programs, the Shaker exercise versus traditional therapy, results in the largest number of stable, non-oral dysphagic patients who can swallow safely and return to full oral feeding after 6 weeks of intervention. This project is funded by NIH/NIDDK R01-DK062178-01 in collaboration with Reza Shaker, M.D., at the Medical College of Wisconsin.
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Effects of Swallowing Therapy in Head and Neck Cancer
Treatment for head and neck cancer often results in significant swallowing problems because of reduced range of motion of the larynx, tongue base and pharyngeal walls. In this study we compare two rehabilitation programs introduced at 1 month post-cancer treatment in a randomized involving 198 patients who have been treated for head and neck cancer with chemoradiation or various surgical procedures: 1) aggressive range of motion with postural sensory therapy and 2) postural sensory therapy. After 1 month of therapy, patients in both therapy arms will receive a 1-month rest period followed by a 1-month therapy refresher at month 3 post-treatment. We hypothesize that the patients randomized to range of motion with postural sensory therapy will exhibit significantly more oral intake at 2 months post cancer treatment, will maintain their gains better after 1 month rest and will have a more normal diet at 4 months post treatment and significantly better pharyngeal flexibility at 4, 6 and 12 months after tumor treatment completion than patients receiving postural sensory therapy. We believe that patients in the range of motion/postural sensory group will exhibit less cost for medically needed services at 4, 6 and 12 months after completion of tumor treatment (immediately after, 2 and 8 months after completion of swallowing therapy) than patients in the postural sensory therapy group. This is a newly funded project and is supported by NIH/NCI R01CA95576.
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Effects of LSVT on Dysphagia in Parkinson's Disease
Lee Silverman Voice Treatment (LSVT®) has shown promise in improving swallow as well as voice and speech. This project is designed to define the effects of LSVT® on swallow in patients who exhibit VFG-verified aspiration on any food volume or viscosity. Thirty patients with idiopathic Parkinson's Disease (PD) who aspirate (with or without cough response) on any food consistency will serve as subjects in this study. When identified clinically as at risk for aspiration, patients will receive a modified barium swallow on a standard protocol followed by randomization to immediate LSVT® treatment for 1 month (4 sessions per week for 4 weeks) or delayed LSVT® beginning 1 month after the first group's therapy is completed. Thus, the comparison of critical interest is therapy vs. no therapy. The delayed group will serve as the no therapy arm. Patients in both arms will receive instructions on diet and posture modification as necessary based on the results of VFG. After completion of one month of therapy, patients will receive a modified barium swallow assessment to document change. The outcome measure will be elimination of aspiration. This newly funded project is supported by NIH/NIDC R21DC05755.
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