Treatment for head and neck cancer often results in significant swallowing problems because of reduced range of motion of the larynx, tongue base and pharyngeal walls. Therapy procedures to improve range of motion including swallowing maneuvers have been shown in pilot data to be efficacious in patients with reduced range of motion. In this project, we propose to compare two rehabilitation programs introduced for one month beginning at 1 month post-treatment in a randomized longitudinal design involving 198 patients who have been treated for head and neck cancer with chemoradiation, supraglottic laryngectomy, anterior resection with primary or skin graft closure, anterior resection with distal or free flap closure, posterior resection with primary or skin graft closure, or posterior resection with distal or free flap closure: 1) aggressive range of motion with postural sensory therapy and 2) postural sensory therapy. After the one-month of therapy, patients in both therapy arms will receive a one-month rest period followed by a one-month therapy refresher at month 3 post-treatment. We hypothesize that the patients randomized to range of motion with postural sensory therapy will exhibit significantly more oral intake at 2 months post cancer treatment, will maintain their gains better after 1 month rest and will have a more normal diet at 4 months post-treatment and significantly better pharyngeal flexibility at 4, 6 and 12 months after tumor treatment completion as measured by the duration and width of cricopharyngeal opening during swallows of various volumes than patients receiving postural sensory therapy. We also hypothesize that patients in the range of motion program will maintain tongue base, hyoid, laryngeal and cricopharyngeal range of motion at 4, 6 and 12 months after completion of their tumor treatment and that it will be significantly better than that of patients who were on the postural sensory programs. Cost-effectiveness is a critical factor in today's health care system. We believe that patients in the range of motion/postural sensory group will exhibit less cost for medically needed services at 4, 6 and 12 months after completion of tumor treatment (immediately after, 2 and 8 months after completion of swallowing therapy) than patients in the postural sensory therapy group.
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