Respiratory Research Summary:

Martin-Harris, B., Garand, K.L., McFarland, D. (2017). Optimizing Respiratory-Swallowing Coordination in Patients with Oropharyngeal Head and Neck Cancer. Perspectives of the ASHA Special Interest Groups SIG 13, Vol. 2 (Part 3) https://pubs.asha.org/doi/epdf/10.1044/persp2.SIG13.103 

Research focus:
Patients who have oropharyngeal (OP) head and neck cancer (HNC) with dysphagia have shown altered respiratory-swallow patterning. The authors developed a visual biofeedback system, focused on respiratory-swallow treatment (RST) to determine if the optimal respiratory-swallow pattern could be trained and if this trained pattern would show positive impact on physiologic swallowing components, airway protection, and quality of life. They included 30 patients with dysphagia, who were 6 months or greater post-treatment for OP HNC.

Intervention:
During training with a speech-language pathologist (SLP), including using computer technology from plethysmography (measuring lung volumes), the patients learned to identify and implement optimal pattern of swallows. Liquid consistencies were initiated in the expiratory phase of respiration in the mid-to-low lung volume range, followed by expiration.

Results:
Following 8 sessions of RST, all patients learned to integrate this optimal pattern of swallowing that yielded significant improvements in laryngeal vestibule closure, tongue base retraction, pharyngeal residue, and Penetration-Aspiration Scale (PAS) scores, as evidenced from pre- to post-treatment video fluoroscopic swallow studies (VFSS).

Clinical Impact:
These findings suggest that patients with OP HNC and dysphagia could successfully execute an optimal respiratory-swallow pattern with positive effects on mechanisms of bolus clearance and airway protection during liquid swallowing.

ACP Value:
ACP’s Dysphagia program, includes OmniFlow® Breathing Therapy Biofeedback System and Synchrony OmnisEMG™, incorporating virtual reality biofeedback activities with breathing and swallowing exercise to help retrain the respiratory swallow pattern.