Motor control integrated into muscle strengthening exercises has more effects on scapular muscle activities and joint range of motion before initiation of radiotherapy in oral cancer survivors with neck dissection: A randomized controlled trial.

Wei-An Liang,Yueh-Hsia Chen,Leonardo A Peyré-Tartaruga,Chi-Rung Lin,Cheng-Ya Huang

doi:10.1371/journal.pone.0237133

Abstract

BackgroundAccessory nerve shoulder dysfunction is common after neck dissection in oral cancer survivors. This study aimed to investigate the short-term effects of scapular muscle strengthening exercises with motor-control techniques on neck dissection-related shoulder dysfunction in oral cancer survivors before the initiation of radiotherapy.MethodsThirty-eight participants were randomly allocated into the motor-control and regular-exercise groups. Each group received conventional physical therapy and specific scapular muscle strengthening exercises for 1 month immediately after neck dissection. Motor control techniques were integrated with scapular strengthening exercises for the motor-control group. Shoulder pain, active range of motion (AROM) of shoulder abduction, and scapular muscle activities including upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA) when performing maximal voluntary isometric contraction (MVIC) and scapular muscle exercises were evaluated at baseline and after 1 month of training.ResultsBoth groups reduced shoulder pain and increased muscle activity of maximum voluntary isometric contraction (MVIC) of each muscle after the intervention. Increased AROM of shoulder abduction was only observed in the motor-control group (95% CI 3.80 to 20.51, p = 0.004). Relative to baseline evaluation, muscle activities of UT decreased in the motor-control group when performing shoulder shrug with 1-kg weight (95% CI -33.06 to -1.29, p = 0.034). Moreover, the SA activity decreased in the motor-control group (95% CI -29.73 to -27.68, p<0.001) but increased in the regular-exercise group (95% CI 28.16 to 30.05, p<0.001) when performing shoulder horizontal adduction and flexion.ConclusionEarly strengthening exercise with motor control techniques has greater benefits for improving AROM of shoulder abduction, muscle economy, and reducing compensatory scapular muscle activities in patients with neck dissection-related shoulder dysfunction before the initiation of radiotherapy.

Highlights

Accessory nerve shoulder dysfunction is one of the most frequent complications after neck dissection
Active range of motion (AROM) of shoulder abduction, and scapular muscle activities including upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA) when performing maximal voluntary isometric contraction (MVIC) and scapular muscle exercises were evaluated at baseline and after 1 month of training
To the best of our knowledge, this is the first study to investigate the effects of early intervention of specific scapular strengthening exercises with motor control techniques on shoulder behavior and scapular muscle activation during the interval between surgery and initiation of radiotherapy in oral cancer survivors with shoulder dysfunction

Summary

Introduction

Accessory nerve shoulder dysfunction is one of the most frequent complications after neck dissection. Electromyogram (EMG) studies showed significant spinal accessory nerve impairment [2] and decreased trapezius muscle activity after neck dissection [6, 7]. Behavior phenomena of accessory nerve shoulder dysfunction (e.g., pain and limited active range of motion (AROM) of shoulder joint) are often observed in head and neck cancer (HNC) survivors with neck dissection [9,10,11]. Few articles have addressed the effects of scapular muscle training in HNC patients with neck dissection, which showed an improvement in behavior phenomena (e.g., shoulder pain and AROM) after scapular muscle training [11, 17, 18]. This study aimed to investigate the short-term effects of scapular muscle strengthening exercises with motor-control techniques on neck dissection-related shoulder dysfunction in oral cancer survivors before the initiation of radiotherapy

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