Case Study of Aspiration during Swallowing in a Patient Following Traumatic Brain Injury

Object: To explore the cause of aspiration during swallowing in a patient with traumatic brain injury and examine various rehabilitation treatment mechanisms. Materials and methods: A 47-year old male patient with traumatic brain injury, severe dysphagia, and nasal feeding demonstrated multiple causes of aspiration during swallowing by videofluoroscopic swallowing study (VFSS) and fiber optic endosopic evaluation of swallowing (FEES). Based on the results, a two-stage therapeutic strategy was employed: (1) cold balloon dilatation and vocal fold closure exercise; (2) the chin-down posture and vocal fold addition exercise. The oral transit time (OTT), pharyngeal transit time (PTT), initiation of laryngeal closure (ILC), and laryngeal closure duration (LCD) were noted. Data of both pre- and post- therapy from this case were analyzed by single subject A-B-C criterionalteration design. Results: After the first stage of the therapy, compared with pre-therapy, OTT and PTT significantly increased (p<0.001), and ILC significantly decreased (P=0.004＜0.05). After the second stage of the therapy using chin-down techniques, the LCD increased significantly (P＜0.001), but the PTT also increased (P＜0.001). Conclusion: Aspiration in traumatic brain injury can result from complicated causes requiring an integrated strategy of treatments. This case study proves that the combination of cold balloon dilatation and chin-down swallowing can providerehabilitationand overcome swallowing disorder in traumatic brain injury.