Swallowing Rehabilitation with Motor Imagery in Patients Undergoing Radiation for Head & Neck Cancer: A Prospective...

Radiation therapy (RT) for head and neck cancer (HNC) commonly causes dysphagia. Swallowing rehabilitation programs (SRPs) during RT improve functional outcomes, but adherence remains low due to RT-related pain. Motor imagery (MI) incorporated into SRPs may provide a low-burden adjunct to improve participation and outcomes. The purpose of this prospective pilot study is to evaluate adherence and clinical outcomes of an MI-based SRP for HNC patients undergoing RT.

Between April 2021 and November 2023, 20 HNC patients receiving RT enrolled in an MI-incorporated SRP at a tertiary care center were compared with historical data of 36 HNC patients undergoing RT with standard-of-care SRP. MI-approach participants performed motor execution (ME) exercises for the first 3 weeks of RT, switching to MI-based exercises thereafter. The standard-of-care approach was ME-based exercises throughout RT. The primary outcome was SRP adherence, measured as the percentage of prescribed exercises completed weekly. Exploratory outcomes included pain, opioid prescriptions, weight, feeding tube dependency, and swallowing-related quality-of-life. Linear and logistic mixed-effects models assessed changes over time and between approaches.

About 70% of MI participants achieved strong adherence ($\ge 70\%$ completion of prescribed exercises). Adherence increased after transitioning to MI at week 4 despite rising pain levels. Though not statistically significant, the MI-approach showed a greater decline in pain scores (slope $-1.67$ vs $-0.50$), lower final pain scores ($1.01$ vs $1.68$), reduced post-treatment opioid use (mean log-MME $2.85$ vs $3.97$), smaller average monthly slope of decline in log-weight (slope $-0.125$ vs $-0.132$), lower odds of feeding tube dependency (aOR $0.18$), coughing while drinking (aOR $0.75$), and discomfort while eating with others (aOR $0.68$) as compared to standard of care.

Incorporating MI into SRPs for HNC patients undergoing RT may improve SRP adherence and clinical outcomes. Larger, randomized studies are needed to validate the benefit.