Dr Nicola Clayton1,2,3,4,5, Ms Katina Skylas3,6, Ms Caroline Place3,7, Miss Rosemarie Giannone2,7, Dr Frank Li2,7, Ms Caroline Nicholls2,8, Mrs Cheryl Brownlow2,8, Dr Rosalba Cross3, Dr Justine O’Hara2, Dr Andrea Issler-Fisher2,9, Dr Mark Kol3, Prof Peter Maitz2,9
1Speech Pathology Department, Concord Repatriation General Hospital, Sydney, Australia, 2Burns Unit, Concord Repatriation General Hospital, Sydney, Australia, 3Intensive Care Unit, Concord Repatriation General Hospital, Sydney, Australia, 4School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia, 5Faculty of Heatlh Sciences, University of Sydney, Sydney, Australia, 6Department of Nursing, Concord Repatriation General Hospital, Sydney, Australia, 7Physiotherapy Department, Concord Repatriation General Hospital, Sydney, Australia, 8Department of Nutrition & Dietetics, Concord Repatriation General Hospital, Sydney, Australia, 9Faculty of Medicine, Concord Repatriation General Hospital, Sydney , Australia
Background: Severe deconditioning due to critical illness frequently manifests as debilitation of pulmonary musculature, resulting in impaired respiratory and swallow function. Evidence indicates that respiratory muscle strength training (RMST) can improve cough and swallowing outcomes in certain populations, however this method of rehabilitation, specifically Expiratory Muscle Strength Training (EMST), has not been previously examined in critical care or severe burn injury.
Aim: To examine the effect of RMST on cough and swallow function in patients with marked deconditioning post severe tissue loss.
Methods: Two male patients receiving treatment within Concord Burns Unit, (19-year-old with 80%TBSA burns and 45-year-old with Group-A Strep Myositis necessitating quadruple amputation), both experienced prolonged intensive care and mechanical ventilation. Routine intensive dysphagia rehabilitation was applied, however chronic aspiration and poor secretion clearance remained considerable issues. RMST was employed using EMST150 and Threshold-IMT devices. Peak expiratory flow (PEF) and anthropometry measures were obtained prior to commencing RMST and continually monitored throughout treatment. Swallow function was assessed via endoscopy and recorded using the Functional Oral Intake Scale (FOIS), Penetration-Aspiration Scale (PAS), Yale Pharyngeal Residue and New Zealand Secretion Rating Scales.
Results: Baseline PEF scores were recorded at 240 and 90L/min. Baseline scores of PAS-8 and FOIS-1 indicated profound swallowing impairment. Preliminary results indicate improvements in cough and swallow function, progression in tracheostomy weaning and transition to oral intake. Full results are pending following treatment program completion.
Conclusion: RMST should be considered as a potential treatment option to improve swallow and pulmonary function in those patients with profound deconditioning.
Dr Nicola Clayton is a Clinical Specialist Speech Pathologist employed at Concord Repatriation General Hospital for the past 19 years. She is recognised nationally and internationally for her clinical expertise and research in the assessment and treatment of complex swallowing disorders post burn injury and has presented and published widely in this field.