Can Verbal Cues Enhance Respiratory-Swallow Coordination for Individuals Following Head and Neck Cancer?

Atypical respiratory-swallow coordination is associated with increased aspiration risk and swallow inefficiency. While verbal cueing has been shown to influence respiratory–swallow coordination in people with Parkinson’s disease, its effect in individuals following head and neck cancer remains unclear. This study aimed to explore the effect of verbal cuing on respiratory-swallow coordination in this population. A prospective, with-in subjects’ design was employed. Respiratory Inductance Plethysmography, nasal airflow and submental electromyograms were used to capture respiratory-swallow patterning, lung volume at swallow initiation (LVSI) and respiratory pause duration. Participants were verbally cued to swallow at four different points within tidal breathing: high inhalation, low inhalation, high exhalation, low exhalation. Non-cued swallow trials served as a control condition. Eighteen participants contributed a total of 360 analysable swallow trials. A significant increase was observed in optimal phasing (exhale-swallow-exhale) in the high inhalation and high exhalation cued conditions, compared to the non-cued condition OR [95% CI] = 4.74 [1.86, 12.09]; OR [95% CI] = 2.55 [1.11, 5.86] respectively. Verbal cueing significantly increased LVSI at low inhalation relative to non-cued swallows by 19%. In contrast, verbal cues at high and low exhalation significantly decreased LVSI, with mean decreases of 28% and 32%, respectively. This study shows that verbal cueing influences respiratory-coordination in individuals with head and neck cancer and suggests cuing at high inhalation is more likely to elicit optimal respiratory-swallow coordination (exhale-swallow-exhale pattern initiated at mid tidal lung volumes), highlighting the potential for introducing targeted cueing strategies to enhance respiratory-swallow coordination.