59 research outputs found

    Charting the recovery of dysphagia in two complex cases of post-thermal burn injury: physiological characteristics and functional outcomes

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    Purpose: This study examined the physiological deficits, recovery pattern, and outcomes observed clinically and instrumentally in two participants with dysphagia post-thermal burn. Methods: Participants were followed prospectively using clinical and instrumental tools of assessment until dysphagia recovery. Clinical swallowing examinations were carried out every 1-2 days, or as clinically indicated. Instrumental assessment using fiberoptic endoscopic examination of swallowing was carried out at fortnightly intervals. Results: Despite variability in the achievement of oral intake milestones, both cases demonstrated protracted recovery from dysphagia contributed to by medical instability and lengthy periods of ventilation and intubation. Instrumental assessment confirmed silent aspiration in both participants, likely owing to decreased laryngopharyngeal sensation. By discharge, participants had returned to their pre-morbid diets. Conclusions: This study highlights the protracted and complex recovery pattern associated with dysphagia following thermal burn injury. The presence of silent aspiration emphasizes the need for instrumental assessment to objectively assess aspiration risk and to facilitate dysphagia recovery within this population

    Clinical progression and outcome of dysphagia following thermal burn injury: A prospective cohort study

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    The objectives of this study were 1) to establish clinical profiles of dysphagic and nondysphagic individuals following thermal burn injury and 2) to provide a clinical profile of the progression and outcome of dysphagia resolution by hospital discharge for a dysphagic cohort. A total of 438 consecutively admitted patients with thermal burns were included. All patients underwent a clinical swallowing examination. Medical parameters regarding burn presentation and its treatment and speech-language pathology specific variables from admission to discharge were collected for each participant. Dysphagia was identified in 49 patients via clinical assessment, and their course of recovery was followed up until the point of dysphagia resolution or discharge. No significant difference was observed between the dysphagic and nondysphagic groups in age, gender, and injury etiology. However, the dysphagic cohort was significantly different from the nondysphagic group in all variables pertaining to injury presentation and medical management. Individuals with dysphagia took significantly longer to start, and maintain, oral intake and required nonoral supplementation for three and a half times longer than those who were nondysphagic. Length of speech-language pathology intervention averaged 1 month for the dysphagics and increased with dysphagia severity. Return to normal fluid consistencies occurred in >75% of dysphagic individuals by week 7 after injury, although resumption of normal diet textures was more protracted, with 75% resuming normal oral intake by week 9. Dysphagia had resolved in 50% of the cohort by week 6, and by hospital discharge, 85% of the dysphagic individuals had resumed normal oral intake of thin fluids and a general diet. This is the first large prospective cohort study to establish clinical profiles of dysphagic and nondysphagic cohorts and document the nature of dysphagia and patterns of recovery within the thermal burn population. These current data will assist the allocation and planning of speech-language pathology services and provide baseline data on the course of dysphagia resolution in the adult thermal burn population

    Keeping the voice fit in the group fitness industry: a qualitative study to determine what instructors want in a voice education program

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    This study aimed to provide a descriptive summary of (1) group fitness instructors' (GFIs') experiences of occupational voice use and education, and (2) the content and mode of delivery desired by GFIs in an education and training program.This is a qualitative inductive approach using a semi-structured interview.Semi-structured interviews were conducted with eight GFIs recruited via self-selection sampling. Participants were asked to comment on their experiences of voice use, voice education, and their preferences for future education and training.Participants reported experiencing occupational voice difficulties, and cited inadequate voice education, faulty equipment, and apathetic fitness industry attitudes as core barriers to vocal health. Content focusing on vocal hygiene, safe occupational voice use, use of amplification equipment, and addressing industry attitudes to voice was desired by participants. A combination of face-to-face, web-based, and app-based delivery options was suggested.The data from this study should be considered when designing a vocal education and training package tailored to the needs of GFIs and the fitness industry

    Charting the recovery of dysphagia in two complex cases of post-thermal burn injury: Physiological characteristics and functional outcomes

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    2 Charting the recovery of dysphagia in two complex cases of post-thermal burn injury: Physiological characteristics and functional outcomes 3 Abstract Purpose: The current study examined the physiological deficits, recovery pattern and outcomes observed clinically and instrumentally in two participants with dysphagia post thermal burn. Methods: Participants were followed prospectively using clinical and instrumental tools of assessment until dysphagia recovery. Clinical swallowing examinations were carried out every 1 to 2 days, or as clinically indicated. Instrumental assessment using fiberoptic endoscopic examination of swallowing was carried out at fortnightly intervals. Results: Despite variability in the achievement of oral intake milestones, both cases demonstrated protracted recovery from dysphagia contributed to by medical instability and lengthy periods of ventilation and intubation. Instrumental assessment confirmed silent aspiration in both participants, likely due to decreased laryngopharyngeal sensation. By discharge, participants had returned to their pre-morbid diets. Conclusions: This study highlights the protracted and complex recovery pattern associated with dysphagia following thermal burn injury. The presence of silent aspiration emphasizes the need for instrumental assessment to objectively assess aspiration risk and to facilitate dysphagia recovery within this population

    Speech-language pathology services in Australian and New Zealand pediatric burn units and chemical ingestion injury

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    To date, little is known regarding the extent and nature of involvement of speech-language pathology (SLP) services within pediatric burn settings. The aim of this clinical service study was to investigate the role of SLP services within burn teams across Australia and New Zealand. Eleven pediatric burn units were identified as members of the Australian and New Zealand Burn Association Bi National Burns Registry. Representatives from both burn units and SLP departments at each setting were sent a link to a purpose-built online questionnaire. Seven responses from eight centers were received, with paired responses (burn units and SLP departments) being obtained from six centers. Pediatric burn units and SLP departments were found to differ in perceptions of SLP involvement in burn care. No burn units reported utilization of a protocol for referral to SLP. Dysphagia, followed by orofacial contracture management was the most frequently reported areas of SLP involvement, and multidisciplinary contribution within these areas was recognized. A majority (71%) of SLP departments reported involvement with chemical ingestion injury; however, referral rates were low. This study confirms that SLP services are utilized within Australian and New Zealand pediatric burn units, and SLPs are involved with pediatric patients with chemical ingestion injuries. However, potential exists for increased SLP input. There is also evident needed for established guidelines surrounding referrals and greater education regarding the role of SLPs within pediatric burn care

    Communication changes following non-glottic head and neck cancer management: The perspectives of survivors and carers

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    Purpose. Head and neck cancer (HNC) survivors may experience functional changes to their voice, speech and hearing following curative chemoradiotherapy. However, few studies have explored the impact of living with such changes from the perspective of the HNC survivor and their carer. The current study employed a person-centred approach to explore the lived experience of communication changes following chemoradiotherapy treatment for HNC from the perspective of survivors and carers. Method. Participants included 14 survivors with non-glottic HNC and nine carers. All participants took part in in-depth interviews where they were encouraged to describe their experiences of living with and adjusting to communication changes following treatment. Interviews were analysed as a single data set. Result. Four themes emerged including: (1) impairments in communication sub-systems; (2) the challenges of communicating in everyday life; (3) broad ranging effects of communication changes; and (4) adaptations as a result of communication changes. Conclusion. These data confirm that communication changes following chemoradiotherapy have potentially negative psychosocial impacts on both the HNC survivor and their carer. Clinicians should consider the impact of communication changes on the life of the HNC survivor and their carer and provide adequate and timely education and management to address the needs of this population

    Developing clinical skills in paediatric dysphagia management using human patient simulation (HPS)

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    Purpose: The use of simulated learning environments to develop clinical skills is gaining momentum in speech-language pathology training programs. The aim of the current study was to examine the benefits of adding Human Patient Simulation (HPS) into the university curriculum in the area of paediatric dysphagia. Method: University students enrolled in a mandatory dysphagia course (n = 29) completed two, 2-hour HPS scenarios: (a) performing a clinical feeding assessment with a medically complex infant; and (b) conducting a clinical swallow examination (CSE) with a child with a tracheostomy. Scenarios covered technical and non-technical skills in paediatric dysphagia management. Surveys relating to students' perceived knowledge, skills, confidence and levels of anxiety were conducted: (a) pre-lectures; (b) post-lectures, but pre-HPS; and (c) post-HPS. A fourth survey was completed following clinical placements with real clients. Result: Results demonstrate significant additive value in knowledge, skills and confidence obtained through HPS. Anxiety about working clinically reduced following HPS. Students rated simulation as very useful in preparing for clinical practice. Post-clinic, students indicated that HPS was an important component in their preparation to work as a clinician. Conclusion: This trial supports the benefits of incorporating HPS as part of clinical preparation for paediatric dysphagia management

    Physiological characteristics of dysphagia following thermal burn injury

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    The study aim was to document the acute physiological characteristics of swallowing impairment following thermal burn injury. A series of 19 participants admitted to a specialised burn centre with thermal burn injury were identified with suspected aspiration risk by a clinical swallow examination (CSE) conducted by a speech-language pathologist and referred to the study. Once medically stable, each then underwent more detailed assessment using both a CSE and fiberoptic evaluation of swallowing (FEES). FEES confirmed six individuals (32%) had no aspiration risk and were excluded from further analyses. Of the remaining 13, CSE confirmed that two had specific oral-phase deficits due to orofacial scarring and contractures, and all 13 had generalised oromotor weakness. FEES revealed numerous pharyngeal-phase deficits, with the major findings evident in greater than 50% being impaired secretion management, laryngotracheal edema, delayed swallow initiation, impaired sensation, inadequate movement of structures within the hypopharynx and larynx, and diffuse pharyngeal residue. Penetration and/or aspiration occurred in 83% (n = 10/12) of thin fluids trials, with a lack of response to the penetration/aspiration noted in 50% (n = 6/12 penetration aspiration events) of the cases. Most events occurred post swallow. Findings support the fact that individuals with dysphagia post thermal burn present with multiple risk factors for aspiration that appear predominantly related to generalised weakness and inefficiency and further impacted by edema and sensory impairments. Generalised oromotor weakness and orofacial contractures (when present) impact oral-stage swallow function. This study has identified a range of factors that may contribute to both oral- and pharyngeal-stage dysfunction in this clinical population and has highlighted the importance of using a combination of clinical and instrumental assessments to fully understand the influence of burn injury on oral intake and swallowing

    Dysphagia following thermal burn injury: Clinical risk factors, anatomical and physiological characteristics and road to resolution and recovery

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    Over the last two decades, burn injury mortality rate has been decreasing and patient morbidity have been improving due to significant improvements in both medical and surgical techniques and the adoption of a multidisciplinary team approach to care. The role of the speech-language pathologist as a member of the multidisciplinary burn care team is relatively new, and as such, the professional knowledge base is yet to be fully established. Many authors, at an anecdotal level, have proposed moderate to severe dysphagia to be a common sequela following thermal burn injury, whilst others note it to be a consistent and prominent dysfunction associated with this population. Even so, authors continue to recognise that a systematic research base to support the incidence and anticipated severity of dysphagic symptoms in this population is minimally represented. Furthermore, it is not possible to determine exactly who is at risk for dysphagia post burn or what we can expect regarding prognosis, which limits optimal care for this population. The current series of investigations aimed to address this current lack of clinical evidence through a systematic program of research that was prospective in nature and had sufficient participant numbers to enable informed data analysis for incidence, determination of dysphagia risk and patterns of dysphagia resolution. Additionally, utilisation of small cohort and individual case study designs allowed insight into the heterogeneity of the burn population, the nature of the dysphagia, and justifies the need for speech pathology involvement. A total of 438 adults who were admitted to a specialised burn centre for treatment of a thermal burn injury during a 24-month period participated in this research. Patients admitted for other burn types (i.e., chemical, electrical), those who were to receive only palliative management and those with existing neurological or structural impairment that could influence swallowing behaviour, or a prior history of a swallowing disorder were excluded. Participants underwent a clinical swallow examination (CSE) by a speech-language pathologist experienced in managing burn patients directly following determination of medical stability and suitability for oral intake by a medical officer. Individuals were subsequently diagnosed with dysphagia (n = 49) or normal swallow function (n = 389). In addition to dysphagia status, parameters relating to the burn presentation and medical treatment received from admission to discharge were collected for each participant. Those with dysphagia then received weekly repeated CSE’s and traditional dysphagia therapy and contracture management up until the point of dysphagia resolution or discharge from the burns unit. Dysphagia severity and variables relating to the recovery of safe oral intake as determined from CSE were also recorded for all individuals. For a small subset of individuals with dysphagia (n = 19), for whom instrumental examination of swallow function using fiberoptic endoscopic evaluation of swallowing (FEES) was deemed clinically appropriate were assessed to objectively examine the physiological characteristics associated with dysphagia post burn. Results revealed the incidence of dysphagia in the admitted cohort of 11.18%. In addition a core set of parameters (known within the first 24 hours post injury) were identified to have high levels of strong sensitivity and specificity for detection of dysphagia risk. These included, in isolation or in combination, with the consideration of increasing age: total body surface area burnt greater than or equal to 18%, head and neck burns, need for escharotomy, inhalation injury, need for intensive care admission and need for mechanical ventilation. Analysis of the clinical recovery of the dysphagic cohort highlighted the heterogeneity of the sample, however group patterns revealed the potential for the majority of patients (50% by week 6 and 75% by week 9 post burn) to return to normal oral intake, with only a small proportion having unresolved dysphagia still at discharge. Investigation into the nature of the dysphagia via CSE and FEES revealed generalised oromotor weakness in the majority of the cohort, with functional deficits of the oral phase reserved for the few individuals with severe dysphagia and orofacial contractures. Observable physiological deficits on FEES that were identified as being prominent across the cohort included: laryngotracheal pathology, decreased ability to manage secretions, delayed swallow initiation, decreased laryngopharyngeal sensation, diffuse pharyngeal residue and a high risk of silent aspiration. These deficits and their remediation were detailed further through two detailed case studies of individuals with severe swallowing impairment after thermal burn injury. These cases, followed from admission to hospital discharge highlight challenges for both the patient and the treating speech-language pathologist and emphasise benefits of working within an interdisciplinary and multidisciplinary team. The current series of investigations mark the first large prospective cohort investigation of dysphagia in the thermal burn population. Continued research to firmly establish the validity and reliability of the criteria set for dysphagia risk, with the goal of developing evidence-based guidelines for referral to speech-language pathology was recognised as an imperative direction for future research. The need for ongoing investigation of swallow function via instrumental means has been highlighted due to the multifaceted nature of dysphagia and the propensity for silent aspiration in this population. Furthermore, the need for ongoing evaluation, development and expansion of traditional dysphagia treatment practices in this population was emphasised
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