Occupational therapy for accessory nerve palsy after radical neck dissection

The subjects in this study were ten patients with accessory nerve palsy after radical neck dissection. All the primary diseases that accounted for radical neck dissection were malignant tumors located at the head or neck. Every patient received occupational therapy and underwent evaluations before and after the therapy. The data we collected included the existence of resting pain and motion pain, and the active and passive range of motion during shoulder flexion and abduction. The occupational therapy programs were not adequately effective for resting and motion pain, however, every patient gained independence for activities of daily living and housekeeping activities. The occupational therapy significantly improved the patient's shoulder elevation in all movements; although, the active abduction was always significantly poor compared with flexion. In the meantime, there were no significant differences between passive shoulder flexion and abduction at all times. We can therefore understand that the accessory nerve palsy especially affects active shoulder abduction induced by the trapezius paralysis. Occupational therapy is an effective treatment for the improvement of shoulder function, however, the occupational therapy has limited effectiveness for coping with the pain. (C) 2002 Tohoku University Medical Press.