Intensive swallowing and orofacial contracture rehabilitation after severe burn injury: A pilot study

Nicola A Clayton1,2,3, Elizabeth C Ward3,4, Peter K Maitz2

1 Speech Pathology Department, Building 42, Hospital Rd, Concord Repatriation General Hospital, Sydney NSW Australia 2139
2 Burns Unit, Level 7 North, Hospital Rd, Concord Repatriation General Hospital, Sydney NSW Australia 2139
3 School of Health and Rehabilitation Sciences, The University of Queensland QLD Australia 4072
4 Centre for Functioning and Health Research, Metro South Hospital and Health Service, QLD Australia 4102

Background

Dysphagia following severe burns can be significant and protracted, yet there is little evidence describing the rehabilitation principles, process or outcomes.

Purpose

To describe clinical outcomes following a multifaceted intensive treatment program aimed at rehabilitating dysphagia by strengthening swallow function and minimising orofacial contractures after severe head and neck burns.

Methods

Two males (54 and 18 years) with full thickness head and neck burns and inhalation injury underwent intensive orofacial scar management and dysphagia rehabilitation. Therapy was prescribed, consisting of scar stretching, splinting as well as pharyngeal swallow tasks targeting the base of tongue and hypopharyngeal musculature. Horizontal and vertical range of movement (HROM; VROM), physiological swallow features as defined by Fibreoptic Endoscopic Evaluation of Swallowing (FEES), functional swallowing outcomes and swallowing related distress measures, were collected at baseline and routinely until complete dysphagia resolution and scar stabilisation.

Results

At presentation, both cases demonstrated severely reduced HROM and VROM, profound dysphagia on FEES and moderate dysphagia related distress. Therapy adherence was high for both participants. Resolution of dysphagia to full oral diet, nil physiological swallowing impairment on FEES, and nil dysphagia related distress was achieved by 222 and 77 days post injury respectively. VROM and HROM achieved normal range by 237 and 204 days though scar stabilisation was ongoing.

Conclusion

Active rehabilitation achieved full functional outcomes for both swallowing and orofacial range of movement. A protracted duration of therapy however, can be anticipated in this complex population.

Key Words

Burn, swallowing, orofacial contractures, rehabilitation, outcomes

Biography

Nicola Clayton is a Clinical Specialist Speech Pathologist at Concord Repatriation General Hospital, highly experienced in the assessment and treatment of complex swallowing disorders. She specialises in the field of critical care, acute surgery and severe burn injury. With 17 years experience in the field, Nicola has contributed considerably to the evidence base of speech pathology applications in severe burn injury and this presentation summarises the 4th study in her PhD.

About ANZBA

ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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