The Challenges of Dysphagia Management and Rehabilitation in Two Complex Cases Post Chemical Ingestion Injury Purpose Dysphagia is common sequelae of chemical ingestion injury, resulting from damage to critical swallowing structures. From a speech-language pathology perspective, this study outlines the physiological deficits in 2 individuals with severe injury (1 woman, acid; 1 man, alkali) and the pattern of dysphagia rehabilitation and recovery. Method ... Clinical Focus
Clinical Focus  |   November 01, 2016
The Challenges of Dysphagia Management and Rehabilitation in Two Complex Cases Post Chemical Ingestion Injury
 
Author Affiliations & Notes
  • Anna F. Rumbach
    The University of Queensland, Australia
  • Rebecca Cremer
    Royal Brisbane and Women's Hospital, Metro North Hospital Health Service, Queensland Health, Brisbane, Australia
  • Astra Chatwood
    The University of Queensland, Australia
  • Sari Fink
    The University of Queensland, Australia
  • Sadaf Haider
    The University of Queensland, Australia
  • Michelle Yee
    The University of Queensland, Australia
  • Disclosure: The authors have declared that no competing interests existed at the time of publication.
    Disclosure: The authors have declared that no competing interests existed at the time of publication. ×
  • Correspondence to Anna Rumbach: a.rumbach@uq.edu.au
  • Editor: Krista Wilkinson
    Editor: Krista Wilkinson×
  • Associate Editor: Julie Barkmeier-Kraemer
    Associate Editor: Julie Barkmeier-Kraemer×
Article Information
Swallowing, Dysphagia & Feeding Disorders / Clinical Focus
Clinical Focus   |   November 01, 2016
The Challenges of Dysphagia Management and Rehabilitation in Two Complex Cases Post Chemical Ingestion Injury
American Journal of Speech-Language Pathology, November 2016, Vol. 25, 470-480. doi:10.1044/2016_AJSLP-15-0043
History: Received April 27, 2015 , Revised September 4, 2015 , Accepted March 3, 2016
 
American Journal of Speech-Language Pathology, November 2016, Vol. 25, 470-480. doi:10.1044/2016_AJSLP-15-0043
History: Received April 27, 2015; Revised September 4, 2015; Accepted March 3, 2016

Purpose Dysphagia is common sequelae of chemical ingestion injury, resulting from damage to critical swallowing structures. From a speech-language pathology perspective, this study outlines the physiological deficits in 2 individuals with severe injury (1 woman, acid; 1 man, alkali) and the pattern of dysphagia rehabilitation and recovery.

Method A retrospective chart review of clinical and instrumental assessments was conducted to examine swallow characteristics and speech-language pathology management (compensatory and rehabilitation strategies) at multiple time points.

Results Chemical ingestion injury resulted in severe pharyngeal dysphagia for both participants, warranting speech-language pathology management. Dysphagia was characterized by poor base of tongue mobility and reduced laryngeal excursion. Decreased airway patency and protection, secondary to mucosal sloughing, widespread edema, and structural deficits necessitated tracheostomy. Recovery was complicated by physical alterations of pharyngeal and laryngeal structures (e.g., interarytenoid adhesions) and esophageal strictures. Participant 1 was discharged (Day 135) consuming a texture-modified diet; Participant 2 remained nil by mouth (Day 329).

Conclusions Dysphagia recovery subsequent to chemical ingestion is protracted and complex. Clinical outcomes may be improved through individualized and intensive rehabilitation by speech-language pathologists.

Acknowledgments
The authors would like to thank speech pathologists, Dr. Anna Farrell and Sarah Heaton, for their guidance during the preparation of this article.
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