Table 4.

Overview of speech pathology interventions aimed at addressing problems in dysphagia, speech, voice, and trismus (n = 14).

Reference	Topic	General description of intervention and treatment intensity/duration	Description of specific exercises	Conclusions specific to therapy
Agarwal et al. 2009 [23]	Voice	All patients received counseling and voice therapy by a trained speech pathologist No specific data provided on treatment frequency/intensity	No description of exercises provided	Forty-seven of 50 patients showed compliance to the therapy. No specific conclusions of influence of provided therapy on primary outcomes described
Akst et al. 2004 [46]	Swallowing	Swallowing evaluation and intervention when clinically indicated	No description of exercises provided	No specific conclusions of influence of provided therapy on primary outcomes described
Buchbinder et al. 1993 [48]	Trismus	Six to 10 exercise sessions per day for a 10-week period	Group 1: unassisted exercises: reach maximum MIO and closing, jaw motion to left, right, and protrusively Group 2: unassisted exercises: reach maximum MIO and closing, jaw motion to left, right, and protrusively. Stacked tongue depressors, to mechanically increase MIO (5 × 30 seconds per session) Group 3: unassisted exercises: reach maximum MIO and closing, jaw motion to left, right, and protrusively. Combined with the TheraBite System (5 × 30 seconds per session)	The first four weeks no differences between groups were found. After week 4 minimal improvements in groups 1 and 2 were found and group 3 still improved. The highest increment in MIO was reached in group 3
Dijkstra et al. 2007 [52]	Trismus	Physical therapy for trismus, median of 4 sessions	Physical therapy consisting of (i) Active range of motion (ii) Hold and relax (iii) Manual stretching (iv) Joint distraction Following therapeutic tools are used in described cohort: (i) Rubber plugs (ii) Tong blades (iii) Dynamic bite opener (iv) TheraBite System	MIO increases significantly after physical therapy. History of HNC decreases the effect of physical therapy, compared to other trismus patients
Frowen et al. 2010 [16]	Swallowing	All patients were seen by a speech pathologist as an aspect of regular care	No description of exercises provided	No specific conclusions of influence of provided therapy on primary outcomes described
Hutcheson et al. 2014 [56]	Swallowing	All patients received prophylactic swallowing therapy to avoid nothing by mouth periods during treatment No specific data provided on treatment frequency/intensity	Targeted swallowing exercises	No specific conclusions of influence of provided therapy on primary outcomes described
Karlsson et al. 2015 [31]	Voice	Group 1: voice therapy group received 10 × 30-minute sessions over 10 weeks Group 2: vocal hygiene group: 1 session for vocal hygiene advice	Group 1: voice therapy consisting of relaxation, respiration, posture, and phonation exercises Group 2: vocal hygiene advice	Patients treated with voice therapy experienced greater improvements compared to patients that only received vocal hygiene advice. Group 1 showed a significant better functional communication and HRQoL
Kotz et al. 2012 [57]	Swallowing	Group 1: weekly treatment by speech pathologist and daily 3 × 10 home sessions of exercises. Group 2: swallowing assessment and treatment if necessary after treatment	Group 1: prophylactic swallowing therapy consisting of effortful swallow, tongue base retraction exercises, super supraglottic swallow, and the Mendelssohn maneuver Group 2: control group only receive symptomatic dysphagia treatment	Prophylactic swallowing therapy improves swallowing at 3 and 6 months; later there were no group differences found
Kraaijenga et al. 2014 [35]	Swallowing and voice	Daily practice from the start of the treatment until 1 year after treatment	Two combined groups: TheraBite System and standard logopedic swallowing exercises (the same cohort as van der Molen et al. 2011 [73])	Minimal voice and swallowing difficulties were found 60 months after treatment in patients treated with prophylactic swallowing exercises
Sanguineti et al. 2014 [40]	Voice	75.8% of the patients received speech therapy. No therapy was provided to 30 patients No specific data provided on treatment frequency/intensity	No description of exercises provided	No specific conclusions of influence of provided therapy on primary outcomes described
Starmer et al. 2014 [69]	Swallowing	Patients received prophylactic swallowing and trismus exercises	No description of exercises provided	No specific conclusions of influence of provided therapy on primary outcomes described
van der Molen et al. 2011 [73]	Swallowing	Patients received instructions in advance of their oncological treatment. Three times daily exercises	Group 1: range-of-motion exercises and three strengthening exercises, that is, the effortful swallow, the Masako maneuver, and the super supraglottic swallow. Stretch holding for 10–30 seconds at a point of mild discomfort Group 2: stretch of the mouth using the TheraBite System and a strengthening exercise: swallowing with the tongue elevated to the palate while maintaining mouth opening at 50% of its maximum. Stretch holding for 10–30 seconds at a point of mild discomfort	Similar outcomes in both groups were found. Preventive rehabilitation can improve early posttreatment functional outcomes
van der Molen et al. 2012 [44]	Voice	No specific speech or voice therapy	N/A	N/A
van der Molen et al. 2013 [74]	Swallowing and trismus	Study was aimed at describing dose-effect relationships in two treatment groups described in earlier study. References to other published study where treatment regime is described	Group 1: standard exercises Group 2: experimental exercises	Any possible difference between the two included treatment groups is not described, nor possible influence of the respective treatments

HNC: head and neck cancer; HRQoL: health-related quality of life; MIO: maximum incisal opening; ROM: range of motion.