Neural plasticity in patients treated for tongue cancer

Abstract

Justification: The ability to reorganize a function after muscle damage depends on brain adaptations. In case of tongue resection, for example, the brain must relearn how to use the new organ. This reorganization is the preliminary goal from neural recovery and to facilitate the function recovery and it can be influenced by experience, behavior, task practice and as an answer for brain damage. Information about cerebral cortical reorganization related to the swallow function after rehabilitation in patients treated for tongue cancer are absent and could be extremely useful on dysphagia treatment and prognostic, as to the knowledge about the tongue function during swallow. Validation studies on this hypothesis are important to justify the speech therapist as part of the routine treatment on head and neck cancer patients. Objectives: Evaluate the cortical activations during the swallowing function before and after surgery and swallow therapy on treated head and neck cancer patients. Methods: It is a prospective study that will be done on AC Camargo Hospital. Inclusion criteria are: adult patients, regardless of gender, with tongue cancer as a primary diagnosis in any stage that will be treated with glossectomy (partial, subtotal or total) after the first medical examination. The patients must assign the consent. Exclusion criteria are: patients previously treated for head and neck cancer, with comprehension deficit or language disorders or patients that refuse to participate. Patients will be evaluated in four stages: before surgery; between 15 and 30 days after surgery (swallowing evaluation will be done at this moment); after 8 therapy sessions and 1 month after the initial swallow evaluation. In case of radiotherapy necessity, the patient will be included in a different specific subgroup to a separate and descriptive analysis, with the same evaluation and treatment flow. The patients included in the study will be submitted to 3 evaluations: functional magnetic resonance image, videofluoroscopic and quality of life evaluation. After the first medical evaluation, patients will be randomized into 2 groups and initiate therapy after surgery. The patients will be submitted to traditional swallow therapy in different times: group 1 will initiate therapy right after surgery, and group 2 after the second evaluation. Both groups will follow the same evaluation and treatment flow, and in the end of the study, both groups will be compared with each other. (AU)