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A randomized controlled trial of scapular exercises with electromyography biofeedback in oral cancer patients with accessory nerve dysfunction

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Abstract

Purpose

This study aims to investigate the effects of electromyography (EMG) biofeedback on scapular positions and muscle activities during scapular-focused exercises in oral cancer patients with accessory nerve dysfunction.

Methods

Twenty-four participants were randomly allocated to the motor-control with biofeedback group (N = 12) or the motor-control group (N = 12) immediately after neck dissection. Each group performed scapular-focused exercises with conscious control of scapular orientation for 3 months. EMG biofeedback of upper trapezius (UT), middle trapezius (MT), and lower trapezius (LT) was provided in the motor-control with biofeedback group. Scapular symmetry measured by modified lateral scapular slide test; shoulder pain; active range of motion (AROM) of shoulder abduction; upper extremity function; maximal isometric muscle strength of UT, MT, and LT; and muscle activities during arm elevation/lowering in the scapular plane were evaluated at baseline and the end of the intervention.

Results

After the 3-month intervention, only the motor-control with biofeedback group showed improving scapular symmetry. Although both groups did not show significant improvement in shoulder pain, increased AROM of shoulder abduction and muscle strength of the UT and MT were observed in both groups. In addition, only the motor-control with biofeedback group had improved LT muscle strength, upper extremity function, and reduced UT and MT muscle activations during arm elevation/lowering.

Conclusions

Early interventions for scapular control training significantly improved shoulder mobility and trapezius muscle strength. Furthermore, by adding EMG biofeedback to motor-control training, oral cancer patients demonstrated greater effectiveness in stabilizing scapular position, muscle efficiency, and upper extremity function than motor-control training alone.

Trial registration

Institutional Review Board: This study was approved by the Chang Gung Medical Foundation Institutional Review Board (Approval No: 201901788A3. Approval Date: 2 January, 2020).

Clinical trial Registration: This trial was registered at ClinicalTrials.gov (ClinicalTrials.gov ID: NCT04476004. Initial released Date: 16 July, 2020).

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Acknowledgements

The authors thank for the statistical assistance and acknowledge the support of the Maintenance Project of the Center for Big Data Analytics and Statistics (Grant CLRPG3D0048) at Chang Gung Memorial Hospital for statistical consultation and data analysis.

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Authors and Affiliations

  1. School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, 100, Taiwan

    Yueh-Hsia Chen & Cheng-Ya Huang

  2. Rehabilitation Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital Linkou Branch, Taoyuan City, Taiwan

    Yueh-Hsia Chen, Wei-An Liang & Chi-Rung Lin

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  1. Yueh-Hsia Chen
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  2. Wei-An Liang
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  4. Cheng-Ya Huang
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Contributions

Yueh-Hsia Chen and Cheng-Ya Huang contributed to the study conception and design. Data collection and analysis were performed by Yueh-Hsia Chen. Wei-An Liang and Chi-Rung Lin assisted in intervention protocols. The first draft of the manuscript was written by Yueh-Hsia Chen, and Cheng-Ya Huang commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Cheng-Ya Huang.

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Ethics approval and consent to participate

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Chang Gung Medical Foundation Institutional Review Board (Date: 2 January, 2020/No: 201901788A3) and Clinical Trials (Date: 16 July, 2020/No: NCT04476004). Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Chen, YH., Liang, WA., Lin, CR. et al. A randomized controlled trial of scapular exercises with electromyography biofeedback in oral cancer patients with accessory nerve dysfunction. Support Care Cancer 30, 8241–8250 (2022). https://doi.org/10.1007/s00520-022-07263-4

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  • DOI: https://doi.org/10.1007/s00520-022-07263-4

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