2017-18 HSC Section 3 Green Book

b u r n s 4 3 ( 2 0 1 7 ) e 7 – e 1 7

[(Fig._2)TD$FIG] [(Fig._3)TD$FIG]

AusTOMS Swallowing Disorder Distress Outcomes

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0 AusTOMS Distress Score

Baseline

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DuraƟon of RehabilitaƟon (months)

Case 1 Case 2

Fig. 2 – Patient distress outcomes (AusTOMS). AusTOMS distress scale: 0, high and consistent levels of distress or concern; 1, severe concern, becomes distressed or concerned easily. [2_TD$DIFF] Benefits from constant reassurance. Loses emotional control easily; 2, moderately severe concern. Frequent emotional encouragement and reassurance [3_TD$DIFF] received; 3, moderate concern. May be able to manage emotions at times, although may [4_TD$DIFF] benefit from some encouragement; 4, nil concern. Able to manage emotions in most situations. Occasional emotional support or encouragement needed; 5, able to cope with most situations. Accepts and understands own limitations.

debridement and grafting of all areas including the face and neck, contracture releases to the mouth, as well as upper and lower eyelids with repeated full thickness skin grafts for reconstruction. Case 2 received non-oral nutrition via a nasogastric tube from the time of admission.

scale 2). At the point of initial FEES, Case 2 was also noted to have reduced movement of the left vocal cord, though it was difficult to ascertain the position due to the amount of secretions in the laryngeal vestibule precluding clear visuali- sation. Therapy adherence to the dysphagia rehabilitation programme was again high, facilitated by daily therapist and carer support. Table 3 illustrates patient progress in response to intensive dysphagia rehabilitation according to outcomes as demonstrated on repeated FEES examination. Compared to Case 1, Case 2 progressed from complete dependence on tube feeding (FOIS 1), to combined oral and non-oral intake (FOIS 3) within the first month of rehabilita- tion ( Fig. 1 ). At the end of the first month, FEES assessment

3.4.

Case 2: Outcomes data

At the time of initial swallow assessment Case 2 presented with severely reduced VROM (18 mm) and HROM (52 mm) compared to published normative data [20] and profound dysphagia (FOIS 1; PAS 7; Marianjoy secretion scale 5; Yale Pharyngeal Residue Severity Rating Scale 5; Patterson oedema

0 10 20 30 40 50 60 70 80 0 7 14 21 28 35 42 49 56 63 91 105 133 161 182 189 238 252 273 322 329 mm DuraƟon of RehabilitaƟon (days) Mouth opening record

Case 1 - VROM Case 1 - HROM Case 2 - VROM Case 2 - HROM

Fig. 3 – Orofacial outcome measure data (VROM and HROM). , time of surgical mouth angle release (Case 1). , time of surgical mouth angle release (Case 2). , lower limit of normal range for VROM (Clayton et al. [20] ). , lower limit of normal range for HROM (Clayton et al. [20] ).

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