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How is SLP treatment for trismus similar, different, and collaborative with PT treatment for trismus?
JULY TRISMUS TRIVIA!
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Trismus Therapy: SLP or PT Territory?


When a patient suffers from trismus, perhaps as the result of a stroke, head and neck cancer, or mandibular trauma, who should get the referral for trismus therapy from the physician or surgeon: the physical therapist or speech-language pathologist? This is a tricky question because the answer depends on the treatment goals of the patient. Trained PTs and SLPs are both qualified to treat trismus, but these two kinds of therapists utilize differing treatment approaches, apply different measures of progress, and have different treatment objectives. Ultimately, trismus therapy is an opportunity for PTs and SLPs to work collaboratively to achieve the best treatment outcomes for patients. 

Let's get one disappointing fact (for SLPs) out of the way. While a small number of reputable sources, such as Memorial-Sloan Kettering Cancer Center and UNC Medical Center, recommend that trismus patients see a SLP for treatment, the majority of recommendations are for physical therapy (for example, this recent article at Cure.com). Unfortunately for SLPs, PTs are more likely to get the referral if no professional relationships have been built between the rehabilitation department and the physician. Why? Physical Therapists are known for treating impaired range of movement, pain, loss of function, and physical disability as a result of injuries. Physicians often think of physical therapy first when they recommend rehab for their patients. Knowing this fact should encourage more SLPs to seek training in trismus for their patients and create professional relationships with neurologists, oral and maxillofacial surgeons, head and neck surgeons, otolaryngologists, and radiation oncologists...and physical therapists.

Is the trismus patient mostly concerned about pain and loss of jaw range of movement? Or, is the trismus patient complaining of difficulty eating the kinds of foods he wants to eat and poor speech intelligibility? PTs treat pain, reduced range of motion, and loss of function caused by trismus. SLPs also treat these deficits, but only in relation to dysarthria and dysphagia as a result of trismus. Although the SLP's treatment goals will look very different than the PT's treatment goals, the SLP and PT can tackle the whole picture of the patient's trismus if they collaborate. The PT and SLP need to communicate to ensure they are not overlapping in therapy goals and that they are covering all of the patient's trismus needs.

In terms of treatment and evaluation approaches between the two therapy disciplines, PTs use dry-needling, electrical stimulation, ultrasound, icing and heating, and Kinesio taping, as well as jaw mobility exercises with devices such as Therabite or OraStretch to reduce trismus pain and increase jaw and neck range of motion. Physical therapists gauge trismus therapy progress by pain reduction and increased jaw and neck range of motion. SLPs mostly treat trismus with jaw mobility devices with active and passive jaw stretching exercises and myofascial release. SLPs measure progress based on increased jaw range of motion and pain reduction to achieve improved speech intelligibility and mastication skills. A physical therapist with extensive experience in treating trismus will present at the ARK-J Program Trismus Intervention Certification Course this October to share more about what physical therapy does differently and ways SLPs and PTs could collaborate in trismus intervention.

Because SLPs are not typically trained in trismus therapy during graduate school or during their careers, there is a long list of reasons to become certified in trismus intervention, especially due to the risks of patient injury involved. Developing working relationships with physicians, surgeons, and physical therapists will promote a interdisciplinary rehabilitative approach for the greater good of trismus patients. As long as the two types of therapists have dissimilar therapy objectives and they are trained in providing trismus therapy, we argue that SLPs and PTs share trismus therapy territory.

July Trismus Trivia

Many people know this important neurologist from history, but do not know he suffered from severe trismus. This famous man in the photo above lived from 1856-1939 in Austria. He had buccal and palatoglossal carcinoma, which led to a maximal jaw opening of 12 mm. He underwent radiation, sustained close to twenty surgical procedures, including several skin grafts, flaps, and resections, endured necrosis of his right cheek, and wore a palatal obturator ("the curse of my life," he said about his palatal prosthesis). He reportedly smoked 20 cigars a day despite being forbidden to smoke. His extensive oral cancer eventually resulted in coma and death in September of 1939. Who was this man with devastating trismus?

The correct answer to this month's trivia question will earn you 15% OFF registration for the October course and a chance to win a Kinesio Gift Basket if you register in the month of July. The first person to register this month will get a Kinesio Gift Basket, courtesy of Sun Seminars and ABC Therapies! 

Send your answer to contact@ARKJProgram.com for the discount code or submit your answer at the bottom of the ARK-J Program homepage

Register Now
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