Selective rehabilitative approach to neurological dysfunctions of the oro-pharyngo-laryngeal trivium

Abstract

Conclusion: A dedicated team proved to provide the optimal approach for the rehabilitation of patients with neurological oro-pharyngo-laryngeal dysfunctions. Objectives: To assess the effectiveness of a dedicated and specialist team (otolaryngologist, phoniatrician, speech therapist) in the management of patients with severe neurological impairments of the upper airways and digestive routes. Methods: Fifty-one subjects with neurological impairment of the upper airways and digestive tract due to either central or peripheral causes, who underwent tracheotomy if needed, were recruited at a tertiary university hospital. Two different rehabilitative approaches were used: the classic approach (CA), where a specialist ENT consultation was requested by the professionals if needed; and a selective approach (SA) where a specialist team directly followed and monitored the different phases of management and rehabilitation. Different temporal parameters, in relation to tracheotomy, fenestration of the tracheal tube, and decannulation time, were taken into account and compared between these two approaches. Results: The decannulation time, management of the tracheal tube, and recovery of swallowing function were significantly shorter in patients who were treated according to the SA (p < 0.05). The presence of the tracheal tube and the site of the damage did not affect the outcome in the different study groups (p > 0.05).