The MetroHealth Comprehensive Burn Care Center treats more than 1,700 burn injuries a year. It’s the only one in Ohio verified for the care of both adults and children by the American Burn Association and the American College of Surgeons Committee on Trauma. Yet, until recently, it did not offer speech therapy for facial burn survivors—a significant care gap.
Now, thanks to the resourcefulness of the Burn Care Center team and speech-language pathologists (SLPs) at MetroHealth, people with facial burns can get the care they need. Erin Nutt, MS, CCC-SLP, began seeing patients in the outpatient setting this fall.
“Facial burns can cause scarring and contractures that affect a person’s ability to speak, swallow, and make facial expressions” says Nutt. “They may have difficulty opening their mouth wide enough to take food from a fork or even brush their teeth.”
Recognizing the Care Gap
Scarring and contractures tend to worsen over time for people with neck and facial burns. But early intervention with exercises, stretching and massage can make a meaningful difference.
That need became clear last year when Kristina Cardamone, MA, CCC-SLP, Speech-Language Pathologist with MetroHealth, attended a national conference. There, two clinicians from The University of Texas Medical Branch at Galveston gave a compelling presentation about the importance of integrating SLPs into burn care teams.
“MetroHealth has one of the best burn centers in the region, yet many patients weren’t getting any therapeutic involvement from our team,” she says. “It was a giant disparity in care.”
The burn team welcomed Cardamone’s involvement from the start, with Burn Program Manager Andrew Neading BSN, RN, CBRN, inviting her to join weekly inpatient rounds. Cardamone began advocating for patients who could benefit from speech therapy. Over time, the burn team started requesting speech consults on their own.
That growing collaboration paved the way for Nutt’s outpatient role, which provides continuity of care from the inpatient setting to the long recovery after discharge.
What Treatment Looks Like
Today, Nutt leads the outpatient side of this work. Based in MetroHealth’s ENT clinic, her primary role is to treat adults with head and neck cancer. This patient population often faces the similar challenges burn survivors experience, including swallowing difficulties and restricted mouth opening. The clinic provides access to the tools and expertise necessary to evaluate swallowing and oral function, including specialized assessments such as flexible endoscopic evaluation of swallowing (FEES).
Nutt’s overarching goal with therapy is to help patients consume a regular solid and thin-liquid diet without limitations. This typically involves increasing mouth opening so the patient can chew, use utensils and brush their teeth more easily, and improving lip seal to prevent leakage when drinking.
“Therapy can involve stretching and range-of-motion work for the lips, cheeks and jaw, hands-on massage, and the use of devices such as bite blocks and custom oral splints,” she says. “The treatment course can be pretty intense, with clinic visits every week or two for several months. It can be a lot for patients who are already seeing many other specialists for their recovery. But that frequency, plus doing stretching and exercises at home, can help people make significant gains.”
Improving Everyday Function
Nutt’s first patient was a 12-year-old boy with facial burns who could open his mouth only 15 mm, about the width of a pinky finger (40-50 mm is considered “normal”). “He had to eat very slowly and avoid food that might be hard to swallow,” Nutt says. “He was also having difficulty sipping from a cup, swallowing pills and brushing his teeth.”
After just a couple weeks of targeted stretching and the use of both bite blocks and a custom mandibular splint, the patient showed improvement. His mouth opening increased to 36 mm, and he reported improvements in eating and brushing his teeth.
Support for Patients After a Hospital Stay
Burn survivors often face an overwhelming number of follow-up visits, procedures and rehabilitation appointments, all while adjusting to the emotional impact of a facial burn. That’s why Nutt and Cardamone focus on making speech therapy as coordinated and accessible as possible. With close communication among the burn team, physical therapy, occupational therapy and social work, referrals happen quickly, and therapy is an option when it’s most likely to make a long-term difference.
For more information, call the Burn Outpatient Clinic at 216-778-1775 or email Kristina Cardamone [email protected] or Erin Nutt [email protected].
