Speech and swallow rehabilitation in head and neck cancer: United Kingdom National Multidisciplinary Guidelines


This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. The disease itself and the treatment can have far reaching effects on speech and swallow function, which are consistently prioritised by survivors as an area of concern. This paper provides recommendations on the assessments and interventions for speech and swallow rehabilitation in this patient group.


• All multidisciplinary teams should have rehabilitation patient pathways covering all stages of the patient’s journey including multidisciplinary and pre-treatment clinics. (G)

• Clinicians treating head and neck cancer patients should consult the National Cancer Rehabilitation Pathway for head and neck cancers. (G)

• All head and neck cancer patients should have a pre-treatment assessment of speech and swallowing. (G)

• A programme of prophylactic exercises and the teaching of swallowing manoeuvres can reduce impairments, maintain function and enable a speedier recovery. (R)

• Continued speech and language therapist input is important in maintaining voice and safe and effective swallow function following head and neck cancer treatment. (R)

• Disease recurrence must be ruled out in the management of stricture and/or stenosis. (R)

• Continuous radial expansion balloons offer a safe, effective dilation method with advantages over gum elastic bougies. (R)

• Site, length and completeness of strictures as well as whether they are in the presence of the larynx or not, need to be assessed when establishing the likelihood of surgically improved outcome. (G)

• Primary surgical voice restoration should be offered to all patients undergoing laryngectomy. (R)

• Attention to surgical detail and long-term speech and language therapist input is required to optimise speech and swallowing after laryngectomy. (G)

• Patients should commence wearing heat and moisture exchange devices as soon as possible after laryngectomy. (R)




Effect of Lee Silverman Voice Treatment (LSVT LOUD®) on swallowing and cough in Parkinson’s disease: A pilot study.

Miles A1, Jardine M2, Johnston F2, de Lisle M2, Friary P2, Allen J3.

J Neurol Sci. 2017 Dec 15;383:180-187. doi: 10.1016/j.jns.2017.11.015. Epub 2017 Nov 15.


PURPOSE: Lee Silverman Voice Treatment (LSVT LOUD®) is an effective therapy for phonation in Parkinson’s Disease (PD) but little is known about any additional spread of effects to swallowing and cough function. This pilot study examined the effect of LSVT LOUD on pharyngeal swallowing parameters and reflexive cough strength.

METHODS: Twenty participants (14 men, 6 women; mean 68years, SD3.5) with PD referred for LSVT LOUD with complaints of voice deterioration were recruited. Mean duration of PD was 6yrs., SD 3. Self-reported Eating Assessment Tool-10 scores ranging from 0 to 25 (normal<3). Prior to LSVT LOUD, 1-week post- and 6-months post-treatment, participants undertook a videofluoroscopic study of swallowing and aerodynamic measures of involuntary cough.

RESULTS: All participants completed the LSVT LOUD programme; 3 participants were lost to follow-up at 6-months. All participants made significant gains in average sound pressure level (dB SPL). Aspiration was not observed. Pharyngeal residue (p<0.05) and pharyngeal area at rest reduced (p<0.01) while maximal opening of pharyngoesophageal segment (PES) (p<0.05) and PES opening duration (p<0.05) significantly increased. There was a significant improvement in involuntary cough peak expiratory flow rate and peak expiratory flow rise time. All changes were maintained at 6-months.

CONCLUSION: LSVT LOUD demonstrates additional spread effects on pharyngoesophageal deglutitive function and involuntary cough effectiveness in people with mild PD referred with voice complaints. Consequently, LSVT LOUD has potential to provide additional benefits for swallowing safety and efficiency in this patient group.

Copyright © 2017 Elsevier B.V. All rights reserved.


Effects of jaw opening exercise on aspiration in stroke patients with dysphagia: a pilot study.

Oh DH1, Won JH2, Kim YA2, Kim WJ3.

J Phys Ther Sci. 2017 Oct;29(10):1817-1818. doi: 10.1589/jpts.29.1817. Epub 2017 Oct 21.

Imagem: Cefon


[Purpose] The purpose of this study was to investigate the effect of jaw opening exercise (JOE) on aspiration in patients with dysphagia after stroke. [Subjects and Methods] Three subjects were recruited. Isometric and isotonic JOE were performed using a rubber ball, 5 days a week for 4 weeks. Aspiration was evaluated using the penetration-a spiration scale (PAS) based on a videofluoroscopic swallowing study. [Results] All subjects showed a score reduction of at least 1 point and a maximum reduction of 2 points in the PAS in the liquid type. [Conclusion] This study confirmed that JOE can be used to reduce aspiration in patients with dysphagia after stroke.


Sabor azedo e temperatura fria na fase oral da deglutição no acidente vascular encefálico

Ana Rita GattoI; Paula Cristina ColaII; Roberta Gonçalves da SilvaIII; André Augusto SpadottoIV; Priscila Watson RibeiroV; Arthur Oscar SchelpV; Lidia Raquel de CarvalhoVI; Maria Aparecida Coelho de Arruda Henry

CoDAS vol.25 no.2 São Paulo  2013



OBJETIVO: Verificar o efeito do sabor azedo e da temperatura fria no tempo de trânsito oral da deglutição.

MÉTODOS: Participaram deste estudo 52 indivíduos (28 do gênero masculino e 24 do gênero feminino) após acidente vascular encefálico isquêmico, com lesão à direita ou à esquerda e disfagia orofaríngea de grau leve a moderado, com idades variando de 50 a 80 anos (mediana=66 anos). Foi realizada a videofluoroscopia da deglutição para a análise dos tempos de deglutição. Cada indivíduo foi avaliado durante a deglutição de bolo na consistência pastosa, oferecido em colher com 5 ml, com quatro estímulos diferentes (natural, frio, azedo e azedo-frio). Após o exame foram realizadas as medidas de tempo de trânsito oral utilizando software específico. Foram mensurados o tempo de trânsito oral (a partir do início do movimento do bolo alimentar na boca) e o tempo de trânsito oral total (a partir do momento em que o bolo é colocado na boca).
RESULTADOS: A associação entre o estímulo azedo e a temperatura fria provocou mudanças significavas no tempo de trânsito oral total e no tempo de trânsito oral, com redução nestes tempos.
CONCLUSÃO: O sabor azedo e a temperatura fria associados apresentaram redução do tempo de trânsito oral em pacientes pós acidente vascular encefálico.


Effect of the combination of Mendelsohn maneuver and effortful swallowing on aspiration in patients with dysphagia after stroke.

Kim JH1, Kim YA2, Lee HJ2, Kim KS3, Kim ST4, Kim TS5, Cho YS3.

J Phys Ther Sci. 2017 Nov;29(11):1967-1969. doi: 10.1589/jpts.29.1967. Epub 2017 Nov 24.

Imagem retirada Google



This study investigated the effect of a combined method incorporating the Mendelsohn maneuver and effortful swallowing on aspiration in patients with dysphagia after stroke.

Subjects and Methods:

Three patients with dysphagia were recruited. All patients were treated with a combined method consisting of the Mendelsohn maneuver and effortful swallowing. The intervention period was total 20 sessions. Evaluation was based on videofluoroscopic swallowing study and the degree of aspiration was assessed using penetration-aspiration scale.


Before and after intervention, all participants showed a decrease in aspiration with liquid type and semisolid type food.


This study confirms that the combined method of the Mendelsohn maneuver and effortful swallowing has a positive effect on aspiration in patients with dysphagia after stroke.


Relationship Between Frequency of Spontaneous Swallowing and Salivary Substance P Level in Patients with Acute Stroke.

Niimi M, Hashimoto G, Hara T, Yamada N, Abo M, Fujigasaki H, Ide T

Dysphagia. 2017 Nov 28. doi: 10.1007/s00455-017-9867-2. [Epub ahead of print]

Imagem: eatrightpro.org


The frequency of spontaneous swallowing is useful for screening of dysphagia in acute stroke. Low levels of substance P (SP) in saliva attenuate the swallowing reflex. The aim of this study was to determine the relationship between the frequency of spontaneous swallowing and salivary SP levels. In 40 subjects, saliva was collected within 72 h after stroke onset and salivary SP levels were measured using ELISA kit at a later date. The frequency of spontaneous swallowing was measured over 1 h using a microphone placed on the neck. Pneumonia was diagnosed by the presence of pyrexia and at least two respiratory problems of four categories (sputum, cough or breathing pattern, breath sound, and gas change). The presence of detectable levels of SP in the saliva was confirmed in 17 patients (high SP group), whereas the level was below the detection limit of the ELISA kit in 23 patients (low SP group). The frequency of spontaneous swallowing was significantly lower in low SP group (16.1 ± 11.6 per hour) than in the high SP group (30.4 ± 20.4, p = 0.016). As the result of multiple regression analysis, salivary SP levels were correlated with frequency of spontaneous swallowing independently of age, NIHSS, and GCS. The incidence of pneumonia was significantly higher in the low than high SP group (p < 0.001). In conclusion, the frequency of spontaneous swallowing was decreased in acute stroke patients with low salivary SP levels. Salivary SP levels can be potentially a useful biomarker of risk of stroke-associated pneumonia in the acute stage.


Continuum theory: presbyphagia to dysphagia? Functional assessment of swallowing in the elderly.

Fonte imagem: Pinterest 

de Lima Alvarenga EH1, Dall’Oglio GP2, Murano EZ3, Abrahão M2.

Eur Arch Otorhinolaryngol. 2017 Nov 9. doi: 10.1007/s00405-017-4801-7. [Epub ahead of print]


OBJECTIVES: To investigate whether disclosed symptoms (coughing, choking and throat clearing) can be used as early predictors of swallowing disorders in non-hospitalized elderly population. In addition, to determine the presence of early findings of swallowing disorders through fiber optic endoscopic evaluation of swallowing (FEES).
MATERIALS AND METHODS: One hundred subjects older than 60 years were recruited from local community social meetings for seniors, they fulfilled inclusion criteria, and were given an oral interview and underwent FEES, with findings classified as: (1) saliva stasis; (2) pharyngeal residue; (3) penetration; (4) aspiration; (5) laryngeal sensitivity.
RESULTS: Twenty-one percent of subjects declared previous choking, 10% coughing, and 7% throat clearing, 39% had pharyngeal residue; 6% saliva stasis; 9% penetration; 2% aspiration; and 92% laryngeal sensitivity present. Thirty-three percent showed pharyngeal residue without saliva stasis, while only 6% showed positivity for both (p = 0.003).
CONCLUSIONS: Our data suggest that health care professionals should be aware that among an apparently healthy population, some subjects may have swallowing disorders without clinical complaints and that a nasolaryngoscopy exam may not be enough to predict dysphagia. We suggest that FEES should be performed to look for surrogate of dysphagia such as pharyngeal residue, laryngeal penetration, and aspiration.

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