Page 65 - Functional impairment and cues for rehabilitation of head and neck cancer patients -

INTRODUCTION
Swallowing impairment, impaired passage of a bolus from mouth to stomach or dysphagia, is a frequently occurring and disabling consequence of head and neck cancer (HNC) treatment, with different phases of the swallow affected including mastication, oral and oropharyngeal transport and opening of the upper esophageal sphincter (1-3). Dysphagia leads to a deteriorated quality of life and can increase the risk of developing serious health problems such as malnutrition and aspiration pneumonia (4, 5). The importance of attention to the swallowing function for patients with HNC has been recognized by the World Health Organization (WHO), who have included eating and drinking in the head and neck core set of the International Classification of Functioning, Disability and Health (ICF) (6).
Numerous methods for evaluation of swallowing function are currently available (7). Frequently used objective assessment methods include the Videofluoroscopy of Swallowing (VFS), also known as Modified Barium Swallow (MBS), Fiberoptic Endoscopic Examination of Swallowing (FEES), and pharyngeal manometry (8-10). Furthermore, tools to quantify physical examination results are available, such as the MASA-C which scores parameters including current diet, mouth opening, oral preparation and bolus clearance (11). Also, several evaluation methods or grading systems of these objective outcomes have been developed, such as the Oropharyngeal Swallow Efficiency (OPSE), the Modified Barium Swallow Impairment Profile (MBSImP), and the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) (12-14). In addition to these objective measurements, subjective instruments are available including self-reported assessment methods which are being used to evaluate swallowing function as experienced by patients themselves. This includes, for example, the Swallowing Quality of Life Questionnaire (SWAL-QOL) and MD Anderson Dysphagia Inventory (MDADI) (15).
Despite the wide range of available assessment methods, the correlation between the objective and subjective assessment methods appears to be poor (16, 17). The objective methods mainly measure the physical function needed for swallowing, and thus for eating and drinking. Patient-reported or subjective measures, on the other hand, measure the perceived swallowing ability and the impact on daily functioning. This perception is an expression of performance in daily life and of the impact of any disability. The relationship between these two expressions of human functioning is not necessarily a linear one, as recognized by the ICF model (6, 18). To capture relevant facets of an individual’s swallowing problem, assessment of swallowing capacity in addition to function and perception is important. Swallowing capacity is defined as the time a person needs to swallow a predetermined amount/volume of liquids/ solids under standardized circumstances (18). Therefore, the speed with which a person can eat and drink reflects the swallowing capacity, and is also likely to reflect the impact of swallowing dis(ability) on subjective experience and functioning in daily life to a larger extent than measures of swallowing function. Identifying discrepancies and/or interactions between an individual’s physical functions, capacity, and performance can help guide the choice of rehabilitation interventions (6). Moreover, the assessment of capacity, in addition to function
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The SPEAD-test to objectify swallowing capacity
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