Page 15 - Functional impairment and cues for rehabilitation of head and neck cancer patients -

structures, cranial neuropathies, and non-use atrophy (5, 42, 43). Knowledge on the course of the functional status on the long-term (that is: longer than six years post-treatment) after state- of-the-art HNC treatment (IMRT with preventive rehabilitation) will help to provide patients with adequate information on long-term effects of treatment. It will also inform clinicians about which functional problems might be expected several years after treatment, so they can timely act accordingly by, for example, initiating rehabilitation. To date, data on such long-term functional outcomes after CRT with preventive swallowing rehabilitation are still scarce.
Figure 2 TheraBite® is used by placing the mouthpieces between the teeth and squeezing the lever open halfway, swallow afterward with the tongue up and forward as far as possible, then close mouth again.
Rehabilitation program
In 2010, a dedicated rehabilitation program for HNC patients was developed in the NKI-AVL, which includes specific swallowing, voice, and speech rehabilitation modules. Unfortunately, the TheraBite® could not be included in the dysphagia protocol used in this program, since it is not imbursed by the health insurance authorities for this indication, despite the apparent cost-effectiveness (44). The multidisciplinary program not only focuses on the aforementioned functional issues but also addresses health problems with regard to overall physical, psychosocial and occupational functioning, in a personalized rehabilitation plan for each individual patient, with the ultimate aim to regain an acceptable quality of life and participation in society (45). Knowledge of the degree and course of functional limitations after HNC treatment will facilitate optimization of the program to target remaining functional problems. Also, identification of (pre-treatment) risk factors (e.g., functional status before treatment and specific tumor characteristics such as HPV status) associated with specific functional outcomes can be identified to enable individualized (preventive) rehabilitation.
Swallow Exercise Aid
Besides evaluating preventive rehabilitation, Kraaijenga et al. also developed a new swallowing rehabilitation tool, the Swallow Exercise Aid (SEA) (figure 3). Some of the prementioned swallowing exercises have been proven to be effective for improving swallowing function; especially the Shaker exercise (32, 46). However, the major disadvantage of this exercise is
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Introduction
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