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Respiratory-Swallow Training in Head and Neck Cancer: Impact on Swallowing Safety and Efficiency.

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Title: Respiratory-Swallow Training in Head and Neck Cancer: Impact on Swallowing Safety and Efficiency.
Authors: Martin-Harris B; Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL.; Otolaryngology-Head and Neck Surgery, Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL., Davidson K; Division of Speech-Language Pathology, Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston., McFarland D; École d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, Quebec, Canada.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine, Montréal, Quebec, Canada.; Centre for Research on Brain, Language and Music, McGill University, Montréal, Quebec, Canada.
Source: Journal of speech, language, and hearing research : JSLHR [J Speech Lang Hear Res] 2026 Oct 13; Vol. 69 (10), pp. 4625-4635. Date of Electronic Publication: 2026 Aug 31.
Publication Type: Journal Article; Review
Language: English
Journal Info: Publisher: American Speech-Language-Hearing Association Country of Publication: United States NLM ID: 9705610 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1558-9102 (Electronic) Linking ISSN: 10924388 NLM ISO Abbreviation: J Speech Lang Hear Res Subsets: MEDLINE
Imprint Name(s): Original Publication: Rockville, MD : American Speech-Language-Hearing Association, c1997-
MeSH Terms: Head and Neck Neoplasms*/complications , Head and Neck Neoplasms*/physiopathology , Head and Neck Neoplasms*/rehabilitation , Head and Neck Neoplasms*/therapy , Deglutition Disorders*/etiology , Deglutition Disorders*/rehabilitation , Deglutition Disorders*/physiopathology , Deglutition*/physiology , Breathing Exercises*/methods, Humans ; Respiration
Abstract: Purpose: This review article provides a programmatic translational synthesis of a research program investigating respiratory-swallow coordination as a modifiable physiologic target underlying swallowing impairment and safety, with a focus on individuals treated for head and neck cancer (HNC). The purpose is to synthesize physiologic evidence, clinical trial outcomes, and translational advances supporting respiratory-swallow training (RST) as a mechanism-based intervention.
Method: Evidence is drawn from a series of experimental, observational, and interventional studies conducted over more than 3 decades. Methods include synchronized videofluoroscopy and respiratory measurement to characterize respiratory-swallow coordination, clinical trials evaluating RST across chronic and earlier recovery-stage HNC populations, and ongoing work incorporating wearable sensor technology and synchronous telehealth delivery to support ambulatory monitoring and home-based training. Data from Phase I, Phase II, and ongoing randomized efficacy trials are summarized to illustrate mechanistic and clinical effects of RST.
Results: Across studies, swallowing was most safely and efficiently initiated during mid- to low-quiet (tidal) breathing expiratory lung volumes, whereas deviations from this pattern were associated with increased airway invasion and physiologic impairment. RST reliably increased expiratory-phase swallow initiation and was associated with improvements in swallowing impairment, airway protection, bolus clearance, functional oral intake, and patient-reported outcomes. Phases I and IIa trial data demonstrated significant reductions in physiologic impairment scores and penetration-aspiration severity following training.
Conclusions: Collectively, these findings support respiratory-swallow coordination as a modifiable target for dysphagia rehabilitation that results in important physiologic and airway protection advantages. RST represents a mechanism-driven approach that extends beyond compensatory strategies and shows promise for scalable, technology-enabled delivery in both clinical and ambulatory settings. This work has implications for swallowing assessment, intervention, and future research across clinical populations.
References: Arch Phys Med Rehabil. 2005 Aug;86(8):1516-20. (PMID: 16084801)
Clin Otolaryngol. 2025 Jul;50(4):785-789. (PMID: 40237280)
Arch Otolaryngol Head Neck Surg. 2005 Sep;131(9):762-70. (PMID: 16172351)
Am J Physiol. 1995 Oct;269(4 Pt 1):G577-83. (PMID: 7485510)
Dysphagia. 2023 Jun;38(3):756-767. (PMID: 36097215)
Arch Otolaryngol Head Neck Surg. 2001 Jul;127(7):870-6. (PMID: 11448365)
PLoS One. 2024 Jul 11;19(7):e0305560. (PMID: 38990865)
Dysphagia. 1996 Spring;11(2):93-8. (PMID: 8721066)
Dysphagia. 2013 Jun;28(2):167-77. (PMID: 23089830)
Int J Chron Obstruct Pulmon Dis. 2020 Jul 13;15:1689-1696. (PMID: 32764914)
Arch Phys Med Rehabil. 2015 May;96(5):885-93. (PMID: 25498307)
NPJ Digit Med. 2022 Sep 20;5(1):147. (PMID: 36123384)
Respir Physiol Neurobiol. 2016 Dec;234:89-96. (PMID: 27612587)
Head Neck. 2020 May;42(5):898-904. (PMID: 31880375)
Dysphagia. 2016 Jun;31(3):339-51. (PMID: 27098922)
Support Care Cancer. 2024 May 1;32(5):320. (PMID: 38691143)
J Neurophysiol. 1995 Oct;74(4):1509-17. (PMID: 8989389)
Dysphagia. 2023 Aug;38(4):1049-1058. (PMID: 36378345)
Trends Neurosci. 2016 Feb;39(2):114-123. (PMID: 26774345)
Int J Chron Obstruct Pulmon Dis. 2015 Mar 05;10:489-96. (PMID: 25784795)
J Neurosci. 2014 Feb 12;34(7):2451-63. (PMID: 24523536)
J Speech Lang Hear Res. 2026 Jan 8;69(1):32-45. (PMID: 41329938)
Am J Speech Lang Pathol. 2020 Jul 10;29(2S):1012-1021. (PMID: 32650659)
J Neurophysiol. 1994 Nov;72(5):2431-7. (PMID: 7884469)
Head Neck. 2008 Feb;30(2):148-58. (PMID: 17786992)
J Speech Lang Hear Res. 2008 Feb;51(1):S225-39. (PMID: 18230848)
Head Neck. 2021 May;43(5):1398-1408. (PMID: 33496044)
Head Neck. 2017 Aug;39(8):1516-1523. (PMID: 28452175)
Dysphagia. 2008 Dec;23(4):392-405. (PMID: 18855050)
Int J Radiat Oncol Biol Phys. 2009 Feb 1;73(2):410-5. (PMID: 18635320)
Head Neck. 2010 Apr;32(4):481-9. (PMID: 19780056)
Dysphagia. 2025 Aug;40(4):841-850. (PMID: 39540921)
Am J Respir Crit Care Med. 1999 Jun;159(6):1898-902. (PMID: 10351937)
Curr Opin Otolaryngol Head Neck Surg. 2008 Jun;16(3):194-9. (PMID: 18475070)
Geriatrics (Basel). 2020 Aug 24;5(3):. (PMID: 32847110)
J Speech Lang Hear Res. 2008 Feb;51(1):S276-300. (PMID: 18230851)
Cancer. 1996 Jun 1;77(11):2294-301. (PMID: 8635098)
Grant Information: I01 RX002352 United States RX RRD VA; K24 DC012801 United States DC NIDCD NIH HHS; R01 CA262502 United States CA NCI NIH HHS; R13 DC003383 United States DC NIDCD NIH HHS
Entry Date(s): Date Created: 20260831 Date Completed: 20261013 Latest Revision: 20261022
Update Code: 20261022
PubMed Central ID: PMC13678537
DOI: 10.1044/2026_JSLHR-26-00075
PMID: 42671926
Database: MEDLINE
Description
ISSN:1558-9102
DOI:10.1044/2026_JSLHR-26-00075