Full thickness facial burns: Outcomes following orofacial rehabilitation

Orofacial rehabilitation after severe orofacial and neck burn: Experience in a Brazilian burn reference centre

OBJECTIVE

To quantify the benefits of a functional oral rehabilitation program for impairment caused by full thickness orofacial and neck burns, comparing the effects of early and late intervention.

METHODS

An observational cross-sectional study was conducted in a burn reference center over a two-year period. Patients with full thickness orofacial and neck burns were divided in two groups: Group 1 was composed by 14 patients who began the rehabilitation program 3-12 months after the burn injury; Group 2 was composed by 15 patients who began the rehabilitation program more than 12 months after the burn injury. Treatment was based on current strategies of non-surgical exercises for orofacial contracture management. Outcome measurements included an oral motor clinical evaluation and the assessment of the mandibular range of movement.

RESULTS

The functional rehabilitation program was effective in reestablishing the oral motor functions (i.e deficits reduced to approximately 15% when compared to the optimal possible scores) and in restoring horizontal mouth opening dimensions, with more than 70% of the patients presenting measurements within the expected normal limits at the end of treatment. Our results did not indicate differences in performance between the group of patients in neither set of assessments, i.e. pre and post treatment (p > 0.05).

CONCLUSION

The results of this study indicate that non-invasive orofacial contracture management is effective for patients with orofacial and neck burns, including those with long term sequelae.

Reabilitação motora orofacial em queimaduras em cabeça e pescoço: uma revisão sistemática de literatura

RESUMO Objetivos Investigar estudos sobre o tratamento das queimaduras em cabeça e pescoço, nas diversas áreas da saúde envolvidas na assistência a queimados (médica, enfermagem, fonoaudiologia, fisioterapia e terapia ocupacional), avaliando a eficácia das técnicas empregadas, principalmente no que se refere à reabilitação da funcionalidade da musculatura em cabeça e pescoço. Estratégia de pesquisa Os artigos foram selecionados por meio da base de dados PubMed, utilizando os descritores “burn and face and speech-language pathology”, “burn and face and speech language”, “burn and face and rehabilitation”, “burn and face and myofunctional rehabilitation”, “burn and face and myofunctional therapy”, “nonsurgical and scar and management”, “burn and face and nonsurgical” e “burn and face and scar and management”. Critérios de seleção Foram incluídos artigos que investigaram os tratamentos das queimaduras em cabeça e pescoço, associados à reabilitação da funcionalidade da musculatura em cabeça e pescoço, utilizando exercícios musculares e/ou terapias manuais. Resultados A maioria dos tratamentos descritos apresentou efeitos benéficos para pacientes com queimaduras. Foi observada grande variabilidade da metodologia adotada para a aplicação e verificação dos efeitos dos tratamentos. Conclusão Apesar do crescente número de pesquisas, ainda não existe consenso quanto à melhor técnica terapêutica e ao real benefício de cada uma delas. Existe uma grande diversidade nos protocolos de tratamento, sendo que um número pequeno de estudos de tratamento visa a funcionalidade do sistema miofuncional orofacial. A maioria dos estudos tem, como foco, atividades motoras isoladas, que visam à mobilidade mandibular.

Intensive swallowing and orofacial contracture rehabilitation after severe burn: A pilot study and literature review

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 dysphagia by strengthening swallow function and minimising orofacial contractures after severe head and neck burns.

METHODS

Two 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.

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.

Orofacial Contracture Management: Current Patterns of Clinical Practice in Australian and New Zealand Adult Burn Units

Burn injury to the face can lead to scarring and contractures that may impair oral competence for articulation, feeding, airway intubation access, oral/dental hygiene, aesthetics, and facial expression. Although a range of therapy interventions has been discussed for preventing contracture formation, there is minimal information on current practice patterns. This research examined patterns of clinical practice for orofacial burns management during a 4-year period to determine the nature and extent of clinical consistency in current care. Allied health clinicians involved in orofacial contracture management in Australia and New Zealand were surveyed at two time points (2010 and 2014). Twenty and 23 clinicians, respectively, across a range of allied health professions completed the surveys. Both surveys revealed multiple allied health disciplines, predominantly occupational therapy, speech language pathology, and physiotherapy, were involved orofacial burn management. A high degree of variation was observed across clinical practices in the 2010 survey. In the 2014 survey, although, greater consistency in practice patterns was observed with more clinicians commencing intervention earlier, with greater treatment intensity observed and more treatment modalities being used. Furthermore, in 2014, there was an increased use of assessment tools and clinical indicators to guide patient treatment. Agreement regarding clinical practice pathways for orofacial contracture rehabilitation is still emerging, and treatment continues to be predominantly guided by clinical experience. There is an urgent need for treatment efficacy research utilizing validated outcome measure tools to inform clinical consensus and practice guidelines.

The speech-language pathologist's role in multidisciplinary burn care: An international perspective

PURPOSE

To explore international practices of speech-language pathology (SLP) within burn care in order to provide direction for education, training and clinical practice of the burns multidisciplinary team (MDT).

METHOD(S)

A 17-item online survey was designed by two SLPs experienced in burn care with a range of dichotomous, multiple choice and open-ended response questions investigating the availability and scope of practice for SLPs associated with burn units. The survey was distributed via professional burn association gatekeepers. All quantitative data gathered were analysed using descriptive statistics and qualitative data were analysed using content analysis.

RESULT(S)

A total of 240 health professionals, from 6 different continents (37 countries) participated within the study. All continents reported access to SLP services. Referral criteria for SLP were largely uniform across continents. The most dominant area of SLP practice was assessment and management of dysphagia, which was conducted in concert with other members of the MDT.

CONCLUSION

SLP has an international presence within burn care that is currently still emerging.