Respiratory-Swallow Training in Veterans with Oropharyngeal Cancer

描述(由申请人提供)： 项目摘要/摘要吞咽障碍(吞咽困难)是口咽癌退伍军人患者中功能性发病率最高的，这些患者要么接受手术治疗，然后接受放射治疗，要么接受较新的器官保存方案治疗。这种损害的性质往往对治疗具有抵抗力，并导致终生健康后果和退伍军人保健系统的高成本负担。最近的初步数据表明，在这组患者中，高度稳定的呼吸-吞咽时相关系的改变与吞咽损害和穿透/吸入有关。这项临床试验的直接目标是测试一种新的呼吸-吞咽干预措施对口咽癌治疗后慢性吞咽障碍退伍军人的吞咽损伤和穿透/吸入的影响。在液体吞咽过程中出现“非最佳”呼吸-吞咽时相模式和可测量的吞咽损害的患者将学习到一种“最佳”生理模式，该模式在吞咽过程中同时具有呼吸道保护和机械优势。这项研究的总体目标是开发理想的呼吸吞咽阶段训练方法和方案，单独或与传统吞咽治疗相结合，改善康复急性期的吞咽功能，并改善患者的长期预后。我们的目的是利用这些初步数据来推动一项更大规模的临床试验，将呼吸吞咽相训练的效果与其他基于证据的吞咽治疗方法进行比较，并将该方法扩展到其他有呼吸吞咽相障碍(如肺部疾病和中风)导致吞咽功能受损的迹象的患者组。

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.