Expiratory muscle strength training for radiation-associated aspiration after head and neck cancer: A case series.
Expiratory muscle strength training for radiation-associated aspiration after head and neck cancer: A case series.
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DOI：
10.1002/lary.26845
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发表时间：
2018-05
期刊：
影响因子：
--
通讯作者：
Lewin JS
中科院分区：
文献类型：
--
作者：
Hutcheson KA;Barrow MP;Plowman EK;Lai SY;Fuller CD;Barringer DA;Eapen G;Wang Y;Hubbard R;Jimenez SK;Little LG;Lewin JS
呼气肌力训练（埃姆斯特）是一种简单、廉价的设备驱动运动疗法。埃姆斯特的治疗潜力在患有慢性放射相关误吸的头颈部癌症幸存者中进行了检查。回顾性病例系列。检查了n=64个放射相关吸引器的最大呼气压（MEP）（根据渗透-抽吸量表，PAS，改良钡剂吞咽评分≥6分，MBS）。在入组8周埃姆斯特（25次重复，5天/周，75%负荷）的嵌套患者亚组（n=26）中检查了埃姆斯特前后结局。非参数分析检查了埃姆斯特对主要终点最大呼气压（MEP）的影响。次要指标包括吞咽安全性（吞咽毒性的动态成像分级，DIGEST）、自觉吞咽困难（M.D.安德森吞咽困难量表，MDADI）和饮食（头颈癌患者的行为状态量表，PSSHN）。与性别匹配的已发表规范性数据相比，91%（58/64）的HNC吸引器的MEP降低（平均值±SD：89±37）。26例患者入组埃姆斯特; 3例退出。在23名完成埃姆斯特的患者中，MEP平均改善57%（87±29至137±44 cm H2O，p<0.001）。吞咽安全性（根据DIGEST）显著改善（p=0.03）。EMST后复合MDADI评分改善（术前：59.9±17.1，术后：62.7±13.9，p=0.13）。PSSHN饮食评分没有显著变化。与正常数据相比，慢性辐射相关吸引器的MEP降低，表明呼气增强可能是改善该人群气道保护的新治疗靶点。与神经源性人群的结果相似，这些数据也表明埃姆斯特后呼气压产生能力改善，并转化为慢性辐射相关吸引器吞咽安全性的功能改善。
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. Retrospective case series. Maximum expiratory pressures (MEPs) were examined among n=64 radiation-associated aspirators (per Penetration-Aspiration Scale, PAS, score ≥6 on modified barium swallow, MBS). 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). Non-parametric analyses examined effects of EMST on the primary endpoint maximum expiratory pressures (MEPs). Secondary measures included swallowing safety (Dynamic Imaging Grade of Swall0wing Toxicity, DIGEST), perceived dysphagia (M.D. Anderson Dysphagia Inventory, MDADI), and diet (Performance Status Scale for Head and Neck Cancer Patients, PSSHN). Compared to sex matched published normative data, MEPs were reduced in 91% (58/64) of HNC aspirators (mean±SD: 89±37). Twenty-six patients enrolled in EMST; three 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: 59.9±17.1, post: 62.7±13.9, p=0.13). PSSHN diet scores did not significantly change. 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.
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影响因子：
2.6
作者：
Martin-Harris, Bonnie;Brodsky, Martin B.;Michel, Yvonne;Castell, Donald O.;Schleicher, Melanie;Sandidge, John;Maxwell, Rebekah;Blair, Julie
通讯作者：
Blair, Julie
DOI：
10.1002/lary.26397
发表时间：
2017-04
期刊：
The Laryngoscope
影响因子：
--
作者：
Hutcheson KA;Hammer MJ;Rosen SP;Jones CA;McCulloch TM
通讯作者：
McCulloch TM
DOI：
10.1002/hed.23275
发表时间：
2014-01-01
影响因子：
2.9
作者：
Hunter, Klaudia U.;Lee, Oliver E.;Eisbruch, Avraham
通讯作者：
Eisbruch, Avraham
DOI：
10.1002/hed.24197
发表时间：
2016-04-01
影响因子：
2.9
作者：
Langmore, Susan E.;McCulloch, Timothy M.;Doros, Gheorghe
通讯作者：
Doros, Gheorghe
DOI：
10.1044/1092-4388(2008/07-0016
发表时间：
2008-10-01
影响因子：
2.6
作者：
Wheeler-Hegland, Karen M.;Rosenbek, John C.;Sapienza, Christine M.
通讯作者：
Sapienza, Christine M.