• Nicola A Clayton, Elizabeth C Ward, and Peter K Maitz.
• Speech Pathology Department, Building 42, Hospital Rd, Concord Repatriation General Hospital, Sydney, NSW 2139, Australia; Burns Unit, Level 7 North, Hospital Rd, Concord Repatriation General Hospital, Sydney, NSW 2139, Australia; School of Health & Rehabilitation Sciences, The University of Queensland, QLD 4072, Australia. Electronic address: nicola.clayton@sswahs.nsw.gov.au.
• Burns. 2017 Feb 1; 43 (1): e7-e17.

BackgroundDysphagia following severe burns can be significant and protracted, yet there is little evidence describing the rehabilitation principles, process or outcomes.PurposeOutline current evidence and detail the clinical outcomes of two cases who underwent a multifaceted intensive treatment programme aimed at rehabilitating dysphagia by strengthening swallow function and minimising orofacial contractures after severe head and neck burns.MethodsTwo men (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 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.ResultsAt 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.ConclusionActive rehabilitation achieved full functional outcomes for swallowing and orofacial range of movement. A protracted duration of therapy can be anticipated in this complex population.Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

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