Expiratory muscle strength training for radiation-associated aspiration after head and neck cancer: A case series

Katherine A. Hutcheson; Martha P. Barrow; Emily K. Plowman; Stephen Y. Lai; Clifton David Fuller; Denise A. Barringer; George Eapen; Yiqun Wang; Rachel Hubbard; Sarah K. Jimenez; Leila G. Little; Jan S. Lewin

doi:10.1002/lary.26845

Expiratory muscle strength training for radiation-associated aspiration after head and neck cancer: A case series

Katherine A. Hutcheson, Martha P. Barrow, Emily K. Plowman, Stephen Y. Lai, Clifton David Fuller, Denise A. Barringer, George Eapen, Yiqun Wang, Rachel Hubbard, Sarah K. Jimenez, Leila G. Little, Jan S. Lewin

Research output: Contribution to journal › Article › peer-review

48 Scopus citations

Abstract

Objective/Hypothesis: Expiratory muscle strength training (EMST) is a simple, inexpensive, device-driven exercise therapy. Therapeutic potential of EMST was examined among head and neck cancer survivors with chronic radiation-associated aspiration. Study Design: Retrospective case series. Methods: Maximum expiratory pressures (MEPs) were examined among n = 64 radiation-associated aspirators (per penetration–aspiration scale score ≥ 6 on modified barium swallow). Pre–post EMST outcomes were examined in a nested subgroup of patients (n = 26) who enrolled in 8 weeks of EMST (25 repetitions, 5 days/week, 75% load). Nonparametric analyses examined effects of EMST on the primary endpoint MEPs. Secondary measures included swallowing safety (Dynamic Imaging Grade of Swallowing Toxicity [DIGEST]), perceived dysphagia (M.D. Anderson Dysphagia Inventory [MDADI]), and diet (performance status scale for head and neck cancer patients [PSSHN]). Results: Compared to sex-matched published normative data, MEPs were reduced in 91% (58 of 64) of aspirators (mean ± standard deviation: 89 ± 37). Twenty-six patients enrolled in EMST and three patients withdrew. MEPs improved on average 57% (87 ± 29 to 137 ± 44 cm H₂O, P < 0.001) among 23 who completed EMST. Swallowing safety (per DIGEST) improved significantly (P = 0.03). Composite MDADI scores improved post-EMST (pre-EMST: 59.9 ± 17.1, post-EMST: 62.7 ± 13.9, P = 0.13). PSSHN diet scores did not significantly change. Conclusion: MEPs were reduced in chronic radiation-associated aspirators relative to normative data, suggesting that expiratory strengthening could be a novel therapeutic target to improve airway protection in this population. Similar to findings in neurogenic populations, these data also suggest improved expiratory pressure-generating capabilities after EMST and translation to functional improvements in swallowing safety in chronic radiation-associated aspirators. Level of Evidence: 4. Laryngoscope, 128:1044–1051, 2018.

Original language	English (US)
Pages (from-to)	1044-1051
Number of pages	8
Journal	Laryngoscope
Volume	128
Issue number	5
DOIs	https://doi.org/10.1002/lary.26845
State	Published - May 2018

Keywords

Aspiration
expiratory muscle strength training
head and neck cancer
radiation

ASJC Scopus subject areas

Otorhinolaryngology

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10.1002/lary.26845

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@article{f40277426d064a1382bda5f5388787cc,

title = "Expiratory muscle strength training for radiation-associated aspiration after head and neck cancer: A case series",

abstract = "Objective/Hypothesis: Expiratory muscle strength training (EMST) is a simple, inexpensive, device-driven exercise therapy. Therapeutic potential of EMST was examined among head and neck cancer survivors with chronic radiation-associated aspiration. Study Design: Retrospective case series. Methods: Maximum expiratory pressures (MEPs) were examined among n = 64 radiation-associated aspirators (per penetration–aspiration scale score ≥ 6 on modified barium swallow). Pre–post EMST outcomes were examined in a nested subgroup of patients (n = 26) who enrolled in 8 weeks of EMST (25 repetitions, 5 days/week, 75% load). Nonparametric analyses examined effects of EMST on the primary endpoint MEPs. Secondary measures included swallowing safety (Dynamic Imaging Grade of Swallowing Toxicity [DIGEST]), perceived dysphagia (M.D. Anderson Dysphagia Inventory [MDADI]), and diet (performance status scale for head and neck cancer patients [PSSHN]). Results: Compared to sex-matched published normative data, MEPs were reduced in 91% (58 of 64) of aspirators (mean ± standard deviation: 89 ± 37). Twenty-six patients enrolled in EMST and three patients withdrew. MEPs improved on average 57% (87 ± 29 to 137 ± 44 cm H2O, P < 0.001) among 23 who completed EMST. Swallowing safety (per DIGEST) improved significantly (P = 0.03). Composite MDADI scores improved post-EMST (pre-EMST: 59.9 ± 17.1, post-EMST: 62.7 ± 13.9, P = 0.13). PSSHN diet scores did not significantly change. Conclusion: MEPs were reduced in chronic radiation-associated aspirators relative to normative data, suggesting that expiratory strengthening could be a novel therapeutic target to improve airway protection in this population. Similar to findings in neurogenic populations, these data also suggest improved expiratory pressure-generating capabilities after EMST and translation to functional improvements in swallowing safety in chronic radiation-associated aspirators. Level of Evidence: 4. Laryngoscope, 128:1044–1051, 2018.",

keywords = "Aspiration, expiratory muscle strength training, head and neck cancer, radiation",

author = "Hutcheson, {Katherine A.} and Barrow, {Martha P.} and Plowman, {Emily K.} and Lai, {Stephen Y.} and Fuller, {Clifton David} and Barringer, {Denise A.} and George Eapen and Yiqun Wang and Rachel Hubbard and Jimenez, {Sarah K.} and Little, {Leila G.} and Lewin, {Jan S.}",

note = "Publisher Copyright: {\textcopyright} 2017 The American Laryngological, Rhinological and Otological Society, Inc.",

year = "2018",

month = may,

doi = "10.1002/lary.26845",

language = "English (US)",

volume = "128",

pages = "1044--1051",

journal = "Laryngoscope",

issn = "0023-852X",

publisher = "John Wiley and Sons Inc.",

number = "5",

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TY - JOUR

T1 - Expiratory muscle strength training for radiation-associated aspiration after head and neck cancer

T2 - A case series

AU - Hutcheson, Katherine A.

AU - Barrow, Martha P.

AU - Plowman, Emily K.

AU - Lai, Stephen Y.

AU - Fuller, Clifton David

AU - Barringer, Denise A.

AU - Eapen, George

AU - Wang, Yiqun

AU - Hubbard, Rachel

AU - Jimenez, Sarah K.

AU - Little, Leila G.

AU - Lewin, Jan S.

PY - 2018/5

Y1 - 2018/5

N2 - Objective/Hypothesis: Expiratory muscle strength training (EMST) is a simple, inexpensive, device-driven exercise therapy. Therapeutic potential of EMST was examined among head and neck cancer survivors with chronic radiation-associated aspiration. Study Design: Retrospective case series. Methods: Maximum expiratory pressures (MEPs) were examined among n = 64 radiation-associated aspirators (per penetration–aspiration scale score ≥ 6 on modified barium swallow). Pre–post EMST outcomes were examined in a nested subgroup of patients (n = 26) who enrolled in 8 weeks of EMST (25 repetitions, 5 days/week, 75% load). Nonparametric analyses examined effects of EMST on the primary endpoint MEPs. Secondary measures included swallowing safety (Dynamic Imaging Grade of Swallowing Toxicity [DIGEST]), perceived dysphagia (M.D. Anderson Dysphagia Inventory [MDADI]), and diet (performance status scale for head and neck cancer patients [PSSHN]). Results: Compared to sex-matched published normative data, MEPs were reduced in 91% (58 of 64) of aspirators (mean ± standard deviation: 89 ± 37). Twenty-six patients enrolled in EMST and three patients withdrew. MEPs improved on average 57% (87 ± 29 to 137 ± 44 cm H2O, P < 0.001) among 23 who completed EMST. Swallowing safety (per DIGEST) improved significantly (P = 0.03). Composite MDADI scores improved post-EMST (pre-EMST: 59.9 ± 17.1, post-EMST: 62.7 ± 13.9, P = 0.13). PSSHN diet scores did not significantly change. Conclusion: MEPs were reduced in chronic radiation-associated aspirators relative to normative data, suggesting that expiratory strengthening could be a novel therapeutic target to improve airway protection in this population. Similar to findings in neurogenic populations, these data also suggest improved expiratory pressure-generating capabilities after EMST and translation to functional improvements in swallowing safety in chronic radiation-associated aspirators. Level of Evidence: 4. Laryngoscope, 128:1044–1051, 2018.

AB - Objective/Hypothesis: Expiratory muscle strength training (EMST) is a simple, inexpensive, device-driven exercise therapy. Therapeutic potential of EMST was examined among head and neck cancer survivors with chronic radiation-associated aspiration. Study Design: Retrospective case series. Methods: Maximum expiratory pressures (MEPs) were examined among n = 64 radiation-associated aspirators (per penetration–aspiration scale score ≥ 6 on modified barium swallow). Pre–post EMST outcomes were examined in a nested subgroup of patients (n = 26) who enrolled in 8 weeks of EMST (25 repetitions, 5 days/week, 75% load). Nonparametric analyses examined effects of EMST on the primary endpoint MEPs. Secondary measures included swallowing safety (Dynamic Imaging Grade of Swallowing Toxicity [DIGEST]), perceived dysphagia (M.D. Anderson Dysphagia Inventory [MDADI]), and diet (performance status scale for head and neck cancer patients [PSSHN]). Results: Compared to sex-matched published normative data, MEPs were reduced in 91% (58 of 64) of aspirators (mean ± standard deviation: 89 ± 37). Twenty-six patients enrolled in EMST and three patients withdrew. MEPs improved on average 57% (87 ± 29 to 137 ± 44 cm H2O, P < 0.001) among 23 who completed EMST. Swallowing safety (per DIGEST) improved significantly (P = 0.03). Composite MDADI scores improved post-EMST (pre-EMST: 59.9 ± 17.1, post-EMST: 62.7 ± 13.9, P = 0.13). PSSHN diet scores did not significantly change. Conclusion: MEPs were reduced in chronic radiation-associated aspirators relative to normative data, suggesting that expiratory strengthening could be a novel therapeutic target to improve airway protection in this population. Similar to findings in neurogenic populations, these data also suggest improved expiratory pressure-generating capabilities after EMST and translation to functional improvements in swallowing safety in chronic radiation-associated aspirators. Level of Evidence: 4. Laryngoscope, 128:1044–1051, 2018.

KW - Aspiration

KW - expiratory muscle strength training

KW - head and neck cancer

KW - radiation

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Expiratory muscle strength training for radiation-associated aspiration after head and neck cancer: A case series

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