Degree

Doctor of Philosophy (PhD)

Department

Communication Science and Disorders

Document Type

Dissertation

Abstract

Chemoradiotherapy is not without risk of injury to the muscles and nerves associated with swallowing function. Current research supports the use of prophylactic behavioral swallowing exercise in the HNC population, however, wide variations in swallowing treatment methodologies exist and no optimal SLP-patient visit frequency has been established. In addition, poor patient adherence to swallowing exercise appears prevalent. The current study explored the impact of speech language pathologist (SLP)-patient contact time, adherence to prophylactic behavioral swallowing exercises, and explored effects of exercise intensity on immediate post-radiation swallowing outcomes. Groups included a high frequency group (5 weekly SLP-patient visits, n = 15), a low frequency group (3 weekly SLP-patient visits, n = 15), a 1day/week group (1 weekly SLP-patient visit, n = 25), and a current typical treatment group (3-4 SLP-patient visits during the 7 weeks of radiation treatment, n = 25). Results revealed that higher frequency of SLP-patient contact time resulted in decreased aspiration risk, improved oral diet levels, and reduced risk of feeding tube placement. This resulted in a new recommendation to provide 2 weekly SLP-patient visits over the course of radiation therapy, for a total minimum of 14 visits over 7 the course of radiation. Results also highlighted a potential for significant cost savings associated with reduced feeding tube placements. Significant relationships were found between adherence levels and maintenance of body mass index (BMI) level weight level, public eating scores and normalcy of diet. Predictive equations determined that 60% adherence may help maintain weight and stabilize BMI but 100% adherence of this study’s total exercise regimen was needed to maximize subjects’ diet level. Results also highlighted new objective measurement data and established a new range of salivary loss related to diet level or feeding tube use. Findings revealed that a salivary loss of 74.85% - 88.68% was associated with feeding tube dependence. Additionally, a salivary loss of 47.18% was associated with the ability to maintain a normal unaltered diet. This provided an objective level to measure the effectiveness of methodologies designed to protect and/or restore salivary function in future studies.

Date

8-7-2019

Committee Chair

Kunduk, Melda

Available for download on Saturday, August 06, 2022

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