A case study of the resolution of paediatric dysphagia following brainstem injury: clinical and instrumental assessment.
The coexistance of a swallowing impairment can severely impact upon the medical condition and recovery of a child with traumatic brain injury [ref.: Journal of Head Trauma Rehabilitation 9 (1) (1994) 43]. Limited data exist on the progression or outcome of dysphagia in the paediatric population with brainstem injury. The present prospective study documents the resolution of dysphagia in a 14-year-old female post-brainstem injury using clinical, radiological and endoscopic evaluations of swallowing. The subject presented with a pattern of severe oral-motor and oropharyngeal swallowing impairment post-injury that resolved rapidly for the initial 12 weeks, slowed to gradual progress for weeks 12-20, and then plateaued at 20 weeks post-injury. Whilst a clinically functional swallow was present at 10 months post-injury, radiological examination revealed a number of residual physiological impairments, reduced swallowing efficiency, and reduced independence for feeding, indicating a potential increased risk for aspiration. The data highlight the need for early and continued evaluation and intensive treatment programs, to focus on the underlying physiological swallowing impairment post-brainstem injury, and to help offset any potential deleterious effects of aspiration that may affect patient recovery, such as pneumonia.
Morgan
Angela
A
Department of Speech Pathology and Audiology, University of Queensland, St. Lucia, Qld. 4072, Brisbane, Australia. a.morgan1@uq.edu.au
Ward
Elizabeth
E
Murdoch
Bruce
B
D000293:Adolescent; D001930:Brain Injuries / Q000150:complications*; D001933:Brain Stem / Q000473:pathology*; D003679:Deglutition; D003680:Deglutition Disorders / Q000209:etiology*; D018450:Disease Progression; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D011446:Prospective Studies