Shaker Exercise Rehabilitation in Head and Neck Cancer and Stroke Patients with Dysphagia - A Pilot Study

Background: Dysphagia is a common sequela post (chemo) radiotherapy ([C]RT) for head and neck cancer (HNC) and after stroke. The Shaker maneuver is a promising rehabilitative exercise for improvement of swallowing function by means of strengthening neck musculature. This pilot study primarily aimed to evaluate the feasibility of the Shaker exercise and, secondarily, to evaluate its impact on dysphagia and health-related quality of life in patients with radiation-induced or stroke-related dysphagia. Method: A prospective pilot study incorporating six patients treated with (C)RT for HNC and four patients post stroke. Compliance to the training was documented in an exercise diary. Outcome measures included videoradiography (VRG), fiberendoscopic evaluation of swallowing (FEES) and patient-reported outcomes including the European Organisation of Research and Treatment for Cancer (EORTC) Quality-of-Life Questionnaire Core 30 (QLQ-C30) and Head and Neck 35 Module (H&N35) and M.D. Anderson Dysphagia Inventory (MDADI). Patients underwent Shaker training for eight weeks. Assessment was performed pre and post training with an additional followup at three months post training for patient-reported outcomes. Results: Nine out of ten patients were able to perform the Shaker exercise. Patients reported improved scores in all domains of the MDADI and improvements in the EORTC Social eating post-training which remained or improved further at the three month follow-up. Similar results were not reflected by the objective measurements VRG and FEES, which demonstrated diverging results. Conclusion: The intensified and extended Shaker exercise program was easy to learn and possible to perform. Improvements were reflected in the patient-reported outcomes but instrumental assessment showed diverging results and missing data making conclusions difficult to draw. To assess the actual effect of the Shaker exercise on dysphagia, randomised controlled studies are needed with a larger number of patients in more homogenous groups.