The world’s first full-face transplant demonstrates several different aspects to speech & language therapy.
One item in this week’s global news really caught the public’s attention. Doctors in Barcelona introduced a patient known only as ‘Oscar’ who has undergone the world’s first full-face transplant.
For more information about Oscar and his condition, see here: http://www.bbc.co.uk/news/health-10765005
Previously a farmer, Oscar accidentally shot himself five years ago, losing his nose, lips, jaw and other parts of his face. Despite many operations it became clear that a full-face transplant was the only realistic option for him. Oscar could not breathe, eat, swallow or speak by himself.
After a 2 year wait for an appropriate donor, in March this year Oscar underwent a 24 hour transplant operation in Barcelona. 30 specialists operated to transplant lips, nose, teeth, jaws, cheekbones and tear ducts onto Oscar.
Despite his body rejecting the transplants twice, Oscar is now able to drink fluids, eat pureed foods and speak a little.
So how may a Speech & Language Therapist have supported Oscar throughout his rehabilitation?
Swallowing
Speech & language therapists are interested in the mechanisms of swallowing. If an individual’s ability to swallow is affected (as in Oscar’s case, he lost his lips, teeth, parts of his jaw and facial muscles) then it is possible that food can pass into the voice-box or wind-pipe instead of the food-pipe.
This is a dangerous situation, as it can lead to recurrent chest infections, pneumonia and even death if the individual is already weakened by other medical conditions.
Swallowing is therefore taken very seriously by speech & language therapists, who may recommend alterations to diet or alternative methods of feeding if the risk to health is high enough.
In Oscar’s case, his transplant has allowed him to return to a diet of pureed food. It is possible that with physiotherapy and speech therapy, he will hopefully regain enough use of his muscles and nerves to be able to chew and swallow ‘normal’ food again.
Clarity of Speech
As his operation involved the transplantation of a donor’s facial muscles and nerves directly onto his face, Oscar will need to re-learn how to use them. Neuromuscular speech therapy may be of great help to him here, although there is conflicting research into how useful this can actually be.
Direct or indirect therapy strategies can also help to improve clarity of speech. Examples include reminders to speak slowly/loudly, removing background noise from the environment or educating conversation partners about supportive conversation techniques. Working on articulating speech sounds precisely may also be of great benefit to increasing Oscar’s clarity of speech.
Doctors have said that it is possible for Oscar to recover up to 90% of his facial functions if he continues well with his rehabilitation.
Psychosocial Assessment
Many individuals with communication difficulties are affected by low self-esteem, low confidence, depression and anxiety. Instances are particularly high in people with acquired difficulties, like Oscar, who had no problems with his speech & language until his accident. Coming to terms with such an enormous change in such a short space of time can be extremely difficult.
On a practical level, it can also be extremely difficult to talk about feelings and emotions if you have suddenly lost your ability to communicate.
Speech & language therapists have a number of visual scales, questionnaires and techniques available to ensure that an individual’s emotional wellbeing can be assessed despite any speech or language difficulties.
Sarah Bennington – July 2010
Written on behalf of Integrated Treatment Services. ITS is a private Speech and Language Therapy service based in Leicestershire and the East Midlands. It specialises in providing highly-skilled Speech and Language Therapists, but also associates with other therapeutic professionals, including Occupational Therapists, Physiotherapists, Psychologists and Arts Therapists.
