Oral Reintroduction of Feeding in Post-Surgical Chiari Malformation of Arnold

Abstract

Objective: To describe the outcomes of speech-language rehabilitation in the process of reintroduction and progression of oral feeding in patients with oropharyngeal dysphagia who underwent surgical correction of Arnold Chiari Malformation.

Methods: Retrospective case series study. Data were collected from medical records of 13 patients who underwent correction of Arnold Chiari Malformation in speech-language therapy from July to September 2023. Clinical and demographic data, structural and functional clinical evaluation of swallowing, level of oral intake, based on the PARD protocol and the Functional Oral Intake Scale (FOIS), were extracted for analysis.

Results: There was a predominance of females, with a median age of 44 years, with type I being the most described. Changes in phonoarticulation and vocal quality were found in (61.54%) of the cases and increased oral transit time (30.77%). Diet intake levels changed from the first assessment, with levels 1 and 4 in (30.7% n=4) and (46.2% n=6). In the final assessment, there was progression of levels, six patients presented level 5 (46.2% n=6) and one level 7 (7.7% n=1).

Conclusion: Patients with Arnold Chiari Malformation presented impairment in expressive oral communication and safe oral feeding, leading to the use of alternative routes, both for breathing and feeding. The outcome of the process of reintroducing oral feeding seems more effective in cases of less impairment of functions prior to surgical intervention, as well as in cases of less peri- and post-surgical impacts.