Medical Rehabilitation for Head and Neck Cancer

Comprehensive medical rehabilitation optimizes recovery following surgery or other treatment for cancer of the oral cavity, pharynx (throat) or other parts of the head and neck region.
 
This includes speech therapy, swallowing  rehabilitation, and dental and maxillofacial rehabilitation. In addition, patients may need physical therapy that is based on carefully designed program at a cancer center or other facility with professionals trained in cancer rehabilitation.  Restoring mobility is almost always necessary after head or neck surgery,  because the removal of lymph nodes, soft tissue and muscle from that area may affect the spinal accessory nerve, which controls the trapezius muscle. This muscle makes it possible to raise the head and shoulders.
 
While healing from surgery or treatment, patients benefit special rehabilitation exercises that help stretch tightened muscles and also strengthen muscles. Also, occupational therapy includes massage techniques to prevent scar tissue from limiting your movement.
 
Clinical Evaluation

The first step is a clinical evaluation, which includes a careful review of the patient’s medical history, an exam of the muscles and structures of the mouth and throat, assessment of speech quality, and assessment of swallowing function.  This may include administration of food and liquid while a clinician observes, noting any signs and symptoms of swallowing difficulty during the act of eating and drinking.  
 
The clinician reviews findings with the patient to develop treatment goals. Based on the results of the clinical exam, the speech pathologist may recommend more specific tests that will be described in terms of their purpose and procedure.
  

Diagnoses Addressed by Rehabilitation

  • Dysphagia  --  difficulty swallowing, difficulty moving food from the mouth to the throat, difficulty consuming normal sized meals, frequent coughing, food sticking in throat. Dysphagia is often a side effect of most types of head and neck cancer treatments. It can lead weight loss and even pneumonia and therefore should be evaluated promptly.

  • Trismus  -- inability to fully open the mouth. 

  • Dysphonia  -- abnormal change in voice quality; for example, hoarseness, strain, or breathiness.

Types of Therapy

Swallowing Therapy 

After surgery or radiation to the voice box, neck or chest, swallowing may be more difficult. Swallowing therapy may include: 1) physio-therapeutic exercise to strengthen the swallowing musculature; 2) modification of diet textures; 3) instruction in strategies and maneuvers to compensate for the swallowing problem; and, 4) active and passive stretching of musculature affected by radio-therapeutic  fibrosis.  

Speech Therapy

Speech therapy may include: 1) physio-therapeutic exercise to strengthen muscles within the oral cavity; 2) passive and active stretching of intraoral scar tissue; 3) training with techniques to improve speech      intelligibility; and 4) exercises/drills to improve articulation. It also can also include training with alternate communication methods, such as an Artificial Larynx and Esophageal Speech.

Voice Therapy

Many causes of hoarseness can be treated through voice therapy, a form of physical therapy for the voice conducted by a licensed, certified speech pathologist with special interest and expertise in the treatment of voice disorders. Treatment may include exercises for strengthening vocal musculature and   improving how one uses their voice for optimal results.      

Physical Therapy for Fatigue

Cancer-related fatigue is one of the most common side effects of cancer and its treatments. Cancer-related fatigue is more severe, and sometimes more distressing, than every day fatigue, because rest is not an effective remedy, and even a little activity may cause exhaustion.  Physical therapists can accurately assess the best exercise o help cope with cancer-related fatigue and restore energy.

Lymphedema Therapy 

Patients sometimes experience sensations of tightness or fullness after head and neck cancer treatment caused by lymphedema, which is the build-up of fluid in the tissue space. Lymphedema can cause discomfort and problems with swallowing, joint movement, infection, and bodily appearance. These complications can be reduced by manual lymph drainage, a kind of massage that helps decongest the fluid, and by using special garments prevent the fluid from returning.  If you have lymphedema, you can received manual lymph drainage treatment from a certified therapist with specialized training.
 
Alternative Therapies

Shore Regional Health’s Center for Integrative Medicine provide alternative therapies that complement medical rehabilitation by providing adequate pain control and emotional support. These include: Acupuncture, Reiki, Massage, Meditation Instruction, Pain Management, Wellness Coaching and Psychotherapy. 

In addition, our social workers can offer counseling for addiction, a problem affecting many patients with head and neck cancer.


For questions about Head and Neck Cancer Rehab, please contact:

Outpatient Rehabilitation
410-822-1000, ext. 2113

Cancer Center
410-822-1000, ext. 5100
Oncology Social Work Coordinator, ext. 5361