Effects of Electromyographic Visual Feedback for Spinal Accessory Nerve Dysfunction After Neck Dissection

Study Overview
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Brief Summary
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Patients with head and neck cancer and undergo neck dissection often suffer from spinal accessory nerve dysfunction (e.g. shoulder droop, shoulder pain, and decreased active range of motion (AROM) of the shoulder joint and scapular muscle strength), even the spinal accessory nerve is preserved during surgery. Abnormal muscle activities of scapular muscles, including upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), serratus anterior (SA) and rhomboid were reported in subsequent research articles. Particularly for the trapezius muscle, the decreased amplitudes were observed even after 9 months of neck dissection. It has been reported that conscious correction of scapular orientation during arm movement could increase trapezius muscle activities, and motor control training could change scapular kinematic such as increased posterior tilt and upward rotation during arm movement.

Detailed Description
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Patients with head and neck cancer and undergo neck dissection often suffer from spinal accessory nerve dysfunction (e.g. shoulder droop, shoulder pain, and decreased active range of motion (AROM) of the shoulder joint and scapular muscle strength), even the spinal accessory nerve is preserved during surgery. Abnormal muscle activities of scapular muscles, including upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), serratus anterior (SA) and rhomboid were reported in subsequent research articles. Particularly for the trapezius muscle, the decreased amplitudes were observed even after 9 months of neck dissection. It has been reported that conscious correction of scapular orientation during arm movement could increase trapezius muscle activities, and motor control training could change scapular kinematic such as increased posterior tilt and upward rotation during arm movement. The aim of this study is to explore the effects of electromyographic (EMG) visual feedback on scapular muscle activities and strength in oral cancer survivors with spinal accessory nerve dysfunction. Investigators will recruit 60 newly diagnosed oral cancer subjects through the plastic surgeon's referral from January 2020 to February 2021. The participants will be randomized separated into experimental or control group. Each group would receive regular physical therapy for shoulder function (e.g. transcutaneous electrical stimulation, shoulder joint range of motion exercise) and scapular-focused exercise. EMG visual feedback would be combined with scapular-focused exercise.

Official Title
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Effects of Electromyographic Visual Feedback for Spinal Accessory Nerve Dysfunction in Oral Cancer Survivors With Neck Dissection: a Randomized Clinical Trial

Conditions
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Oral Cancer

Intervention / Treatment
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* Other: scapular-focused exercise
* Other: visual feedback


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: newly diagnosed oral cancer subjects with neck dissection age between 20 and 65 years having the clinical signs of neck-dissection related shoulder dysfunction (e.g. shoulder droop, limited AROM of shoulder abduction, and insufficient muscle strength of shoulder abduction to against gravity) Exclusion Criteria: were pregnant or breastfeeding had distant metastasis or recurrence were unable to communicate or comprehend the questionnaires had a history of shoulder dysfunction before neck dissection (e.g. shoulder pain, tendinitis, tendon rupture, shoulder capsulitis, or neuropathy) had any disorder that could influence movement performance bilateral neck dissection

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: experimental group<br>EMG group | Other: scapular-focused exercise<br>* scapular-focused exercise<br>Other: visual feedback<br>* EMG visual feedback<br>|
| Active Comparator: control group<br>exercise group | Other: scapular-focused exercise<br>* scapular-focused exercise<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| shoulder pain | Visual Analog Scale, total range=0-10, 0 means no pain and 10 means the obvious pain | 0, 3 months | 
| shoulder joint range of motion | abduction measured by goniometer, total range: 0-180 | 0, 3 months | 
| scapular position | Modified Lateral Scapular Slide Test | 0, 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| quality of life C-30 | European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ)-C30, total range= 0-100. A higher score on the functional scale or global health scale represents a higher level of functioning or quality of life. | 0, 3 months | 
| shoulder function | The Disabilities of the Arm, Shoulder and Hand (DASH) Score, total range: 0-100. Higher scores indicate greater disability. | 3 months | 
| muscle activity to perform arm movement | EMG activities measure the muscle activities of the upper trapezius, middle trapezius, and lower trapezius | 3 months | 
| maximal isometric muscle strength (MVIC) | measurement of MVIC of the upper trapezius, middle trapezius, and lower trapezius | 3 months | 
| EMG activities of maximal isometric muscle strength (MVIC) | measurement of surface EMG activities of the upper trapezius, middle trapezius, and lower trapezius during MVIC | 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Scapular-focused exercise, Scapular Dyskinesis, Spinal accessory nerve, Physical therapy, Electromyography, Visual feedback