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5.6.3.2 Ergonomics\u000DPatients may experience ergonomic limitations due to changes in body posture, body functions, mobility and strength. Among patients who have undergone treatment for head and neck cancer shoulder problems are particularly common (Sheikh, Shallwani et al. 2013). In the ergonomic sessions the patient is made conscious of their posture and of how they can protect the body from too much strain during daily life activities. The training is individualized and may incorporate such activities as vacuuming, reaching for things at the kitchen work top, one\u2019s sitting position at a computer/desk or on the couch, lying position, carrying groceries or standing in public transportation. When adjustments to the patient\u2019s posture do not reduce pain, improve mobility or increase energy levels, the occupational therapist and the patient will search for alternative solutions. Shimada and colleagues (2007) conducted a small, uncontrolled study among patients with shoulder problems as a result of complete paralysis of the nervus accessorius. All patients received physical exercises combined with massages, relaxation exercises and advice on action strategies.\u000DThe occupational therapy programme offered in this study was shown to have positive effects on mobility and self-management of activities of daily living. Pain during rest and during activities did not improve in this study (Shimada, Chida et al. 2007). Reducing the experienced pain burden as much as possible is part of the ergonomic performance of daily activities. On dealing with cancer-related pain, Cheville et al. describe the effectiveness of rehabilitation techniques aimed at increasing functioning and reducing the burden of pain (Cheville 2001). They stress the importance of compensation strategies, using (orthopaedic) aids and counselling on body posture.\u000DMany patients who have undergone treatment in the head and neck region experience voice and speech problems (Ward and Van As 2014). The speech therapist offers supportive care for the specific complaints (see paragraph 5.3). In collaboration with the occupational therapist, they may consider voice ergonomics (Decoster 2012). Voice ergonomics focuses on voice functioning in the context of occupational performance. This may, for instance, involve the use of voice amplifiers during presentations or in the work environment.\u000D5.6.3.3 Energy conservation\u000DDue to their reduced energy, patients who experience fatigue may end up in a downward spiral, ultimately becoming unable to perform activities meaningful for them (Kapoor, Singhal et al. 2015). If the performance of activities increases a patient\u2019s fatigue, they may reduce their activity level to prevent further fatigue. As a result, their energy and activity levels continue to drop. This type of passiveness is called the disuse syndrome (Geilen 2004). Occupational therapy primarily aims at obtaining meaningful daily activities while conserving one\u2019s energy levels. The occupational therapist helps the patient draw up daily and weekly activity lists with the aim of optimizing and improving activity and participation levels, at home, at work and during recreation. For this, the \u201Cactivity calculator\u201D can be used, which helps to increase or decrease one\u2019s activity level within a predetermined daily programme/list of daily activities.\u000DThe patient\u2019s activity level can be improved with the use of the \u2018graded activity\u2019 approach (Geilen 2004, Staal, Hlobil et al. 2004). Graded activity is a structured treatment, aimed at a step-by-step increase of the activity level. Activities are gradually increased in duration, frequency or strain. The focus is on patients\u2019 wellness experiences in order to resume activities and improve overall daily life functioning (Geilen 2004). The literature on the effectiveness of occupational therapy interventions on\u000D132\u000D