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The effect of postural maneuvers on safety and efficiency of swallowing in people with head and neck cancer: a cross-sectional study
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Introdução: A maioria das pessoas com cancro de cabeça e pescoço (pCCP) apresenta perturbações da deglutição (PD). As manobras posturais são medidas de intervenção frequentemente utilizadas durante a deglutição e consideradas potencialmente benéficas. Contudo, poucos estudos apresentam avaliação às cegas e a maioria apresenta amostras de dimensão reduzida. Assim, o presente estudo pretende colmatar essas lacunas e tem como objetivo avaliar os efeitos das manobras posturais na segurança e eficácia da deglutição em pCCP com PD. Métodos: Foi conduzido um estudo observacional analítico em 48 pCCP com PD. Foi realizada uma videoendoscopia da deglutição com líquidos finos (IDDSI 0) e extremamente espessos (IDDSI 4), segundo a International Dysphagia Diet Standardisation Initiative (IDDSI). Para cada consistência, os participantes deglutiram três ofertas de 5 mL e realizaram as seguintes manobras: posição neutra (controlo), flexão, extensão e rotação da cabeça. Dois avaliadores externos analisaram às cegas a segurança e eficácia da deglutição através da Penetration-Aspiration (PAS) e Yale Pharyngeal Residue Severity Rating (YPRSRS). Para análise estatística utilizou-se uma ANOVA de medidas repetidas. Resultados: A flexão de cabeça melhorou a segurança da deglutição reduzindo os valores PAS (p = .046), enquanto a extensão piorou (p = .002), obtendo-se valores PAS significativamente mais elevados para IDDSI 0. Não se observaram diferenças significativas para o IDDSI 4. A extensão aumentou os resíduos nas valéculas com IDDSI 0 (p = .008) e IDDSI 4 (p < .001), bem como os resíduos nos seios piriformes para IDDSI 4 (p = .002). A rotação de cabeça aumentou o resíduo valecular (p = .041; p = .031). Conclusão: A flexão de cabeça diminuiu o nível de penetração-aspiração para IDDSI 0, enquanto a extensão e rotação de cabeça pioraram a segurança e eficácia da deglutição, salientando que as manobras compensatórias devem ser avaliadas individualmente em pCCP.
Purpose: Most people with head and neck cancer (pwHNC) experience swallowing disorders. Postural maneuvers are widely used intervention strategies during swallowing and are considered potentially beneficial. However, few studies employ blinded assessments, and most involve small sample sizes. Therefore, the present study aims to address these gaps and to evaluate the effects of postural maneuvers on swallowing safety and efficiency in pwHNC. Methods: An analytical observational study was conducted in 48 pwHNC with swallowing disorders. The assessment was performed using fiberoptic endoscopic evaluation of swallowing with thin (level 0) and extremely thick (level 4) liquids, following the International Dysphagia Diet Standardisation Initiative (IDDSI). For each consistency, participants completed three 5 mL boluses in five postural maneuvers: neutral (control), chin tuck, head extension, and head rotation to the right and left. Two blinded raters independently scored performance using the Penetration-Aspiration Scale (PAS) and the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS). For statistical analysis, repeated measures ANOVA was used. Results: The chin tuck improved swallowing safety (p = .046), showing reduced PAS scores, whereas head extension worsened it (p = .002), with higher PAS scores for IDDSI level 0. No significant safety differences were observed for IDDSI level 4. Regarding efficiency, head extension increased vallecular residue for IDDSI level 0 (p = .008) and IDDSI level 4 (p < .001), and also raised pyriform sinus residue for IDDSI level 4 (p = .002). Head rotation increased vallecular residue (p = .041; p = .031) Conclusion: Findings reinforce the chin tuck’s role in enhancing airway protection, especially with thin liquids. Conversely, head extension and rotation may compromise swallowing safety and efficiency, suggesting the need for individualized compensatory strategies in pwHNC.
Purpose: Most people with head and neck cancer (pwHNC) experience swallowing disorders. Postural maneuvers are widely used intervention strategies during swallowing and are considered potentially beneficial. However, few studies employ blinded assessments, and most involve small sample sizes. Therefore, the present study aims to address these gaps and to evaluate the effects of postural maneuvers on swallowing safety and efficiency in pwHNC. Methods: An analytical observational study was conducted in 48 pwHNC with swallowing disorders. The assessment was performed using fiberoptic endoscopic evaluation of swallowing with thin (level 0) and extremely thick (level 4) liquids, following the International Dysphagia Diet Standardisation Initiative (IDDSI). For each consistency, participants completed three 5 mL boluses in five postural maneuvers: neutral (control), chin tuck, head extension, and head rotation to the right and left. Two blinded raters independently scored performance using the Penetration-Aspiration Scale (PAS) and the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS). For statistical analysis, repeated measures ANOVA was used. Results: The chin tuck improved swallowing safety (p = .046), showing reduced PAS scores, whereas head extension worsened it (p = .002), with higher PAS scores for IDDSI level 0. No significant safety differences were observed for IDDSI level 4. Regarding efficiency, head extension increased vallecular residue for IDDSI level 0 (p = .008) and IDDSI level 4 (p < .001), and also raised pyriform sinus residue for IDDSI level 4 (p = .002). Head rotation increased vallecular residue (p = .041; p = .031) Conclusion: Findings reinforce the chin tuck’s role in enhancing airway protection, especially with thin liquids. Conversely, head extension and rotation may compromise swallowing safety and efficiency, suggesting the need for individualized compensatory strategies in pwHNC.
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Manobras posturais Perturbações da deglutição Deglutição Cancro de Cabeça e Pescoço Videoendoscopia da deglutição Postural maneuvers Swallowing disorders Swallowing Head and Neck Cancer Fiberoptic Endoscopic Evaluation of Swallowing