Evaluating the feasibility of a respiratory-swallow training intervention to improve swallow function for people with head and neck cancer
Swallow training in head and neck cancer
Development of Respiratory-Swallow Training programme (biofeedback) A treatment manual will be developed for ReST using biofeedback using the TIDieR framework detailing: the equipment set-up, feedback provision, monitoring and measuring of goals for both interventions. Respiratory Swallow Training (ReST) using biofeedback group: Clinicians (Speech and language therapists) at the participating sites will be trained to deliver ReST using biofeedback, as per the treatment protocol. Training will include: theoretical underpinning, treatment procedure, practical application and use of instrumentation. Competency will be determined by successful (100%) identification of optimal respiratory-swallow coordination (exhale-swallow-exhale pattern) using visual feedback. ReST training sessions with take place up to 1 hour weekly for up to 6 weeks until mastery is reached. An experienced speech and language therapist, who has received training, will deliver ReST using biofeedback to participants at an NHS clinic or the participant’s home, dependent of individual preference or clinical availability. Participants will continue to see their treating therapist as part of usual care (if applicable) whilst receiving ReST. The treatment protocol will follow a tripartite design incorporating principles of motor learning as outlined by Martin-Harris & colleagues (2015). Goals will be included which are divided into sub-goals within three learning domains: 1) identification, 2) acquisition, and 3) mastery. Participants will only move onto the next phase when they have demonstrated 90% accuracy (over 10 trials) on any given goal. 1. Identification: Participants will be presented with a series of static graphical representations of swallowing and respiration via an online programme. These graphics will show the respiratory cycles and the swallowing. Participants will be asked to identify specific targets to demonstrate their ability to recognise: (1) phases of breathing, (2) the swallow t
1. Have a clinical diagnosis of dysphagia on instrumental assessment using videofluoroscopic swallow study or fibreoptic endoscopic evaluation of swallowing 2. Have dysphagia indicated by outcome measures with penetration aspiration scale score at least 3 and/or DIGEST efficiency grade at least 1 3. Have completed chemotherapy, radiotherapy and or surgical intervention with curative intent for first time diagnosis of squamous cell carcinoma of the head and neck at least 3 months previously 4. Be able to give informed consent 5. Be aged 18 years or above 6. Be able to tolerate fluids orally IDDSI Level 0 to 3 7. Exhibit a suboptimal respiratory swallow pattern exhale to inhale, inhale to inhale, or inhale to exhale in at least 20% of swallow trials 8. Be able to hold a drink orally and resume breathing
1. A nasogastric tube, laryngectomy or tracheostomy where tube presence will alter respiratory swallow coordination 2. Known neurological disease or insult impacting on swallowing 3. Spinal surgery or insult impacting on swallowing 4. Chronic COPD with forced expiratory volume less than 30% on pulmonary function testing 5. Recent history within the last 3 months of aspiration pneumonia