Page 157 - Functional impairment and cues for rehabilitation of head and neck cancer patients -

RESULTS
There was a minimal interval of three days between the exercises. Time between pre and post exercise MRI are shown in Table 1. Estimated exercise duration ranged from approximately 4 to 6 minutes for SEA exercises and from approximately 5 to 9 minutes for conventional exercises. The inter-rater reliability was moderate to excellent (ICC per muscle group ranged from 0.65 to 0.93, see Table 2) (42). Median T2-values in the control muscle (splenius capitis muscles) before and after cES were 36 ms (range 34–38 ms) and 36 ms (35–37 ms) respectively (effect size 0.03) (Figure 4).
Table 1 Time between pre and post exercise MRI as indication of exercise duration. Of this time, calculation time of the T2-map (maximally 2 minutes) has to be subtracted to estimate exercise duration.
Abbreviations: + = exercise performed with swallow exercise aid, cES = conventional effortful swallow, CTAR = chin tuck against resistance, ES = effortful swallow, JOAR = jaw opening against resistance
Table 2 Average measures Intra-Class Coefficient (ICC) from a two-way mixed model using an absolute agreement definition per measured muscle (group).
6
Muscle activation during swallowing exercises
Subject nr.
CTAR+
JOAR+
ES+
cES
Masako
Shaker
1 8 min 21 s
2 6 min 9 s
3 8 min 46 s
4 --
5 --
6 min 51 s 6 min 58 s 6 min 35 s
6 min 9 s 7 min 56 s 6 min 42 s -
-
7 min 32 s -
-
7 min 2 s 10 min 55 s
7 min 28 s -
-
7 min 42 s 8 min 20 s
7 min 17 s -
-
10 min 12 s 9 min 28 s
ICC (95% CI)
Masseter muscle
Lateral pterygoid muscle
Medial pterygoid muscle
Intrinsic tongue muscle
Extrinsic tongue muscle
Suprahyoid muscles
Infrahyoid muscles Sternocleidomastoid muscle
Superior pharyngeal constrictor muscles
Abbreviations: CI = confidence interval
0.87 (0.80-0.92) 0.92 (0.87-0.95) 0.65 (0.44-0.78) 0.90 (0.84-0.94) 0.87 (0.79-0.92) 0.91 (0.85-0.94) 0.89 (0.83-0.93) 0.93 (0.89-0.96) 0.68 (0.49-0.80)
Median T2-values before and after SEA exercises are presented in Table 3 and Figures 5-7. After CTAR+, JOAR+ as well as the ES+, T2-values of the suprahyoid muscles were significantly increased (all effect sizes of 0.64) (Figures 5a, 6a and 7a). The JOAR+ additionally caused a significant increased T2-value of the lateral pterygoid muscles (effect size 0.64) (Figure 6b). The ES+ additionally caused significant increased T2-values of infrahyoid muscles (effect size 0.64) and the lateral pterygoid muscle (effect size 0.64) (Figured 7b and 7c). After CTAR+, T2-values of the infrahyoid muscles (effect size 0.58) and the sternocleidomastoid muscles (effect size
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