DESCRIPTION (provided by applicant): 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. Therapy procedures to improve
range of motion including swallowing maneuvers have been shown in pilot data to
be efficacious in patients with reduced range of motion. In this project, we
propose to compare two rehabilitation programs introduced for one month
beginning at 1 month post-treatment in a randomized longitudinal design
involving 198 patients who have been treated for head and neck cancer with
chemoradiation, supraglottic laryngectomy, anterior resection with primary or
skin graft closure, anterior resection with distal or free flap closure,
posterior resection with primary or skin graft closure, or posterior resection
with distal or free flap closure: 1) aggressive range of motion with postural
sensory therapy and 2) postural sensory therapy. After the one-month of
therapy, patients in both therapy arms will receive a one-month rest period
followed by a one-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
as measured by the duration and width of cricopharyngeal opening during
swallows of various volumes than patients receiving postural sensory therapy.
We also hypothesize that patients in the range of motion program will maintain
tongue base, hyoid, laryngeal and cricopharyngeal range of motion at 4, 6 and
12 months after completion of their tumor treatment and that it will be
significantly better than that of patients who were on the postural sensory
programs. Cost-effectiveness is a critical factor in today's health care
system. 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
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