Respiratory-Swallow Training in Veterans with Oropharyngeal Cancer

描述（由申请人提供）： 项目总结/摘要吞咽障碍（吞咽困难）是接受手术后放疗或最近的器官保存方案治疗的口咽癌退伍军人患者中最高的功能性发病率。损伤的性质通常对治疗有抵抗力，并导致终生健康后果和退伍军人管理局卫生系统的高昂成本负担。最近的初步数据表明，在该患者组中，其他高度稳定的吞咽-吞咽相位模式关系的改变与吞咽障碍和渗透/误吸有关。本临床试验的直接目标是在口咽癌治疗后的慢性吞咽困难退伍军人队列中测试新型吞咽干预对吞咽障碍和渗透/误吸的影响。在液体吞咽期间呈现“非最佳”吞咽-吞咽阶段模式和可测量的吞咽损伤的患者将学习“最佳”生理模式，其在吞咽期间促进气道保护和机械优势。本研究的广泛目标是开发理想的呼吸-吞咽阶段训练方法和方案，其单独或与传统吞咽治疗相结合，改善恢复急性期的吞咽功能，并改善患者的长期结局。我们的目的是使用这些初步数据来推动更大规模的临床试验，以比较吞咽阶段训练与其他基于证据的吞咽治疗方法的效果，并将方法扩展到具有呼吸吞咽阶段损伤（例如肺部疾病和中风）的其他患者组，这些症状导致吞咽功能受损。

DESCRIPTION (provided by applicant): PROJECT SUMMARY/ABSTRACT Swallowing impairments (dysphagia) represent the highest functional morbidity in veteran patients treated for oropharyngeal cancers with either surgical approaches followed by radiation or with more recent organ-preservation protocols. The nature of the impairments is often resistive to treatment and results in life-long health consequences and high cost burden on the VA health system. Recent preliminary data have linked alterations in the otherwise highly stable respiratory-swallowing phase pattern relationships to the swallowing impairment and penetration/aspiration and in this patient group. The immediate goal of this clinical trial is to test the effect of a novel respiratory-swallow intervention on swallowing impairment and penetration/aspiration in a cohort of chronically dysphagic veterans following treatment for oropharyngeal cancer. Patients presenting with a "non-optimal" respiratory-swallow phase pattern during liquid swallows and measurable swallowing impairment will learn an "optimal" physiologic pattern that facilitates both airway protective and mechanical advantages during swallowing. The broad goal of this research is to develop ideal respiratory- swallowing phase training methods and regimens that alone or combined with traditional swallowing treatments improve swallowing function in the acute phases of recovery and improve long term patient outcome. Our intention is to use these preliminary data to motivate a larger clinical trial to compare the effect of respiratory-swallow phase training with other evidenced based methods of swallowing treatment and expand the approach to other patient groups that have indications of respiratory- swallow phase impairments (e.g. pulmonary disease and stroke) contributing to impaired swallowing function.