2008 Volume 12 Issue 1 Pages 69-74
Head-neck cancer patients with dysphagia may have difficulties in performing Shaker's head-raising exercise because of physical consequences of neck muscle weakness and surgical intervention. We report newly developed muscle strengthening exercises and treatment progress for these patients. Two cases were presented. A 62-year-old woman with esophageal cancer and a 56-year-old woman with thyroid cancer underwent surgical interventions and behavioral treatment for dysphagia. Following the radical operations, both patients showed severe pharyngeal dysphagia associated with breathy hoarseness, weakness of neck muscles, and restricted laryngeal movements. A Shaker's head-raising exercise was practically impossible in a supine position. A videofluorograpic examination of swallowing showed aspiration and limited laryngeal excursion. The neck muscle strengthening exercises were composed of isotonic and isometric exercises of head flexion with and without manually applied resistive force in an upright and reclining positions. Pushing exercises were included to improve the laryngeal closure. To facilitate safe and efficient feeding, compensatory techniques including super-supraglottic swallowing and chin-down posture were used. Both cases were fed orally for all the meals within two months following the treatment, and dysphonia and laryngeal elevation was improved. Thus, our manual resistive exercises were considered effective for dysphagic patients who have difficulties with voluntary head-raising movement.
