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

Yueh-Hsia Chen; Chi-Rung Lin; Wei-An Liang; Cheng-Ya Huang

doi:10.1371/journal.pone.0237133

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

PLoS One. 2020 Aug 6;15(8):e0237133. doi: 10.1371/journal.pone.0237133. eCollection 2020.

Authors

Yueh-Hsia Chen^{1

2}, Chi-Rung Lin², Wei-An Liang², Cheng-Ya Huang¹

Affiliations

¹ School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
² Rehabilitation Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan.

Abstract

Background: Accessory 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.

Methods: Thirty-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.

Results: Both 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.

Conclusion: Early 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.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Exercise Therapy / methods*
Female
Humans
Male
Middle Aged
Mouth Neoplasms / radiotherapy
Mouth Neoplasms / surgery*
Muscle Contraction
Muscle Strength*
Neck Dissection / adverse effects*
Postoperative Complications / therapy*
Range of Motion, Articular
Shoulder / physiopathology
Superficial Back Muscles / physiopathology

Grants and funding

This study was financially supported by the Chang Gung Medical Research Program (Grant CMRPG3H0891), Tauyuan, Taiwan. The statistical assistance and editing were supported by the Maintenance Project of the Center for Big Data Analytics and Statistics (Grant CLRPG3D0044, CLRPG3D0045) at Chang Gung Memorial Hospital. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.