2017-18 HSC Section 3 Green Book

Reprinted by permission of Burns. 2017; 43(1):e7-e17.

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Case report Intensive swallowing and orofacial contracture rehabilitation after severe burn: A pilot study and literature review Nicola A. Clayton a , b , c , * , Elizabeth C. Ward c , d , Peter K. Maitz b a Speech Pathology Department, Building 42, Hospital Rd, Concord Repatriation General Hospital, Sydney, NSW 2139, Australia b Burns Unit, Level 7 North, Hospital Rd, Concord Repatriation General Hospital, Sydney, NSW 2139, Australia c School of Health & Rehabilitation Sciences, The University of Queensland, QLD 4072, Australia d Centre for Functioning and Health Research, Metro South Hospital and Health Service, QLD 4102, Australia

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Background: Dysphagia following severe burns can be significant and protracted, yet there is little evidence describing the rehabilitation principles, process or outcomes. Purpose: Outline current evidence and detail the clinical outcomes of two cases who underwent a multifaceted intensive treatment programme aimed at rehabilitating dyspha- gia by strengthening swallow function and minimising orofacial contractures after severe head and neck burns. Methods: Two [6_TD$DIFF] men (54 and 18 years) with full-thickness head and neck burns and inhalation injury underwent intensive orofacial scar management and dysphagia rehabilitation. Ther- apy was prescribed, consisting of scar stretching, splinting and pharyngeal swallow tasks. Horizontal and vertical range of movement (HROM; VROM), physiological swallow features, functional swallowing outcomes and related distress, were collected at baseline and routinely until dysphagia resolution and scar stabilisation. Results: At presentation, both cases demonstrated severely reduced HROM and VROM, profound dysphagia and moderate dysphagia related distress. Therapy adherence was high. Resolution of dysphagia to full oral diet, nil physiological swallowing impairment, 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. Conclusion: Active rehabilitation achieved full functional outcomes for swallowing and orofacial range of movement. A protracted duration of therapy can be anticipated in this complex population. # 2016 Elsevier Ltd and ISBI. All rights reserved.

Article history: Accepted 14 July 2016

Keywords: Burn Swallowing Orofacial contractures Rehabilitation Outcomes

* Corresponding author at : Speech Pathology Department – Building 42, Hospital Rd, Concord Repatriation General Hospital, NSW 2139, Australia. E-mail address: nicola.clayton@sswahs.nsw.gov.au (N.A. Clayton).

http://dx.doi.org/10.1016/j.burns.2016.07.006 0305-4179/ # 2016 Elsevier Ltd and ISBI. All rights reserved.

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