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Randomized Controlled Trial
. 2020 Aug 6;15(8):e0237133.
doi: 10.1371/journal.pone.0237133. eCollection 2020.

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  1   2 , Chi-Rung Lin  2 , Wei-An Liang  2 , Cheng-Ya Huang  1
Affiliations
Randomized Controlled Trial

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 et al. PLoS One. .

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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. CONSORT flow diagram.
Fig 2
Fig 2. The EMG activities under the 4 MVIC conditions.
(A) Upper trapezius. (B) Middle trapezius. (C) Lower trapezius. (D) Serratus anterior. The p values are shown if any significant difference (p<0.05) between the groups or pre-post tests in that muscle.
Fig 3
Fig 3. Muscle activites in each muscle to perform shoulder shrug.
(A) Upper trapezius. (B) Middle trapezius. (C) Lower trapezius. (D) Serratus anterior. The p values are shown if any significant difference (p<0.05) between the groups or pre-post tests in that muscle.
Fig 4
Fig 4. Muscle activites in each muscle to perform horrizontal adduction and flexion.
(A) Upper trapezius. (B) Middle trapezius. (C) Lower trapezius. (D) Serratus anterior. The p values are shown if any significant difference (p<0.05) between the groups or pre-post tests in that muscle.
Fig 5
Fig 5. Muscle activites in each muscle to perform one-arm row.
(A) Upper trapezius. (B) Middle trapezius. (C) Lower trapezius. (D) Serratus anterior. The p values are shown if any significant difference (p<0.05) between the groups or pre-post tests in that muscle.
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