title: Intensive swallowing and orofacial contracture rehabilitation after severe burn: A pilot study and literature review.
abstract: BACKGROUND
  Dysphagia following severe burns can be significant and protracted, yet there is little evidence describing the rehabilitation principles, process or outcomes.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors: 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.
authors: Nicola A
authors: NA
authors: Clayton
authors: School of Health & Rehabilitation Sciences, The University of Queensland, QLD 4072, Australia; Centre for Functioning and Health Research, Metro South Hospital and Health Service, QLD 4102, Australia.
authors: Elizabeth C
authors: EC
authors: Ward
authors: Burns Unit, Level 7 North, Hospital Rd, Concord Repatriation General Hospital, Sydney, NSW 2139, Australia.
authors: Peter K
authors: PK
authors: Maitz
mesh_terms: D000293:Adolescent; D002056:Burns / Q000150:complications / Q000534:rehabilitation*; D002921:Cicatrix / Q000209:etiology / Q000534:rehabilitation*; D003286:Contracture / Q000209:etiology / Q000534:rehabilitation*; D003680:Deglutition Disorders / Q000209:etiology / Q000534:rehabilitation*; D005081:Exercise Therapy; D005151:Facial Injuries / Q000150:complications / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009059:Mouth Diseases / Q000209:etiology / Q000534:rehabilitation*; D019838:Neck Injuries / Q000150:complications / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D016059:Range of Motion, Articular; D015208:Smoke Inhalation Injury / Q000150:complications / Q000534:rehabilitation*
keywords: Burn; Orofacial contractures; Outcomes; Rehabilitation; Swallowing