Page 158 - Functional impairment and cues for rehabilitation of head and neck cancer patients -

Chapter 6
0.64) were also significantly increased (figures 5b and 5c). Thus, the combination of the three SEA exercises activated three relevant muscle groups for swallowing and chewing (i.e., lateral pterygoid, suprahyoid and infrahyoid muscles) plus the sternocleidomastoid muscles.
Median T2-values before and after the conventional exercises without exercise tool are presented in Table 4 and Figure 8. The Shaker exercise significantly increased the suprahyoid muscles (effect size 0.64), infrahyoid muscles (effect size 0.58) and sternocleidomastoid muscles (effect size 0.64) (Figures 8a, 8b, and 8c). After cES and Masako, none of the muscles showed significantly increased T2-values in this set-up. Thus, the Shaker exercise activated two relevant muscle groups for swallowing (i.e., suprahyoid and infrahyoid muscles) plus the sternocleidomastoid muscles (effect sizes of 0.64 and 0.58), whereas the effortful swallow and Masako do not show significant muscle activation in this experiment.
The T2-values of the masseter, intrinsic and extrinsic tongue muscles and superior pharyngeal constrictor muscle were not significantly increased after any of the exercises. A schematic overview of the activated muscles after SEA and standard exercises is shown in Figure 9.
Table 3 Median T2 values (in milliseconds) per muscle (group) before and after signed rank test are presented. Bold faced p values are below .05 and effect sizes
SEA exercises. P values of Wilcoxon are above 0.50.
.753 0.09 .753 0.09 .249 0.33 .753 0.09 .345 0.27 .028 0.64 .046 0.58 .028 0.64 .249 0.33
.463 0.21
.028 0.64
.917 0.03 .917 0.03 .753 0.09 .028 0.64 .116 0.45 .249 0.33 .753 0.09
T2-value before exercise (ms) Median (min–max)
T2-value after exercise (ms) Median (min–max)
p value
|r|
CTAR+
Masseter muscle
Lateral pterygoid muscle
Medial pterygoid muscle
Intrinsic tongue muscle
Extrinsic tongue muscle
Suprahyoid muscles
Infrahyoid muscles
Sternocleidomastoid muscle
Superior pharyngeal constrictor muscles
Masseter muscle
Lateral pterygoid muscle
Medial pterygoid muscle
Intrinsic tongue muscle
Extrinsic tongue muscle
Suprahyoid muscles
Infrahyoid muscles
Sternocleidomastoid muscle
Superior pharyngeal constrictor muscles
44 (37–46) 48 (38–52) 40 (36–43) 48 (45–54) 43 (40–45) 37 (37–38) 38 (33–44) 36 (29–40) 45 (42–51)
42 (40–47) 48 (47–52) 39 (36–41) 58 (53–61) 41 (40–43) 36 (36–39) 37 (34–40) 40 (33–44) 44 (38–51)
44 (39–46) 48 (40–51) 41 (38–44) 50 (47–54) 42 (40–48) 40 (39–42) 42 (34–49) 40 (33–48) 44 (42–48)
43 (41–44) 56 (52–61) 40 (34–41) 58 (54–62) 41 (39–47) 47 (42–52) 40 (35–42) 39 (33–41) 44 (40–47)
JOAR+
156