Feasibility and Safety of Fiberoptic Endoscopic Evaluation of Swallowing in People with Disorder of Consciousness: A Systematic Review

Checklin, Martin; Dahl, Tanya; Tomolo, Gracie

doi:10.1007/s00455-021-10327-y

Cited by 6 publications

(4 citation statements)

References 29 publications

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“…Collaboration with ENT specialists can also guide clinicians during the process of tracheostomy weaning. A systematic review aiming to assess the feasibility and safety of FEES in patients with DoC showed that FEES can be used in this population and has the potential to facilitate advancement in the patients' oral intake (Checklin et al, 2022). Finally, whilst noting that objective swallowing assessments are essential to determine the possibility to feed a patient orally.…”

Section: New Advances In the Evaluation Of Swallowing In Patients Wit...mentioning

confidence: 99%

Swallowing dysfunctions in patients with disorders of consciousness: Evidence from neuroimaging data, assessment, and management

Regnier,

Mélotte,

Aubinet

et al. 2024

NRE

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Following severe brain injuries, a subset of patients may remain in an altered state of consciousness; most of these patients require artificial feeding. Currently, a functional oral phase and the presence of exclusive oral feeding may constitute signs of consciousness. Additionally, the presence of pharyngo-laryngeal secretions, saliva aspiration, cough reflex and tracheostomy are related to the level of consciousness. However, the link between swallowing and consciousness is yet to be fully understood. The primary aim of this review is to establish a comprehensive overview of the relationship between an individual’s conscious behaviour and swallowing (reflexive and voluntary). Previous studies of brain activation during volitional and non-volitional swallowing tasks in healthy subjects are also reviewed. We demonstrate that the areas activated by voluntary swallowing tasks (primary sensorimotor, cingulate, insula, premotor, supplementary motor, cerebellum, and operculum) are not specific to deglutitive function but are shared with other motor tasks and brain networks involved in consciousness. This review also outlines suitable assessment and treatment methods for dysphagic patients with disorders of consciousness. Finally, we propose that markers of swallowing could contribute to the development of novel diagnostic guidelines for patients with disorders of consciousness.

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Section: New Advances In the Evaluation Of Swallowing In Patients Wit...mentioning

confidence: 99%

Swallowing dysfunctions in patients with disorders of consciousness: Evidence from neuroimaging data, assessment, and management

Regnier,

Mélotte,

Aubinet

et al. 2024

NRE

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“…Mélotte et al published a validation protocol of a swallowing assessment tool for patients with DOC, called SWADOC. This tool allows us to objectively evaluate the efficacy of therapy, and to provide a clear and accurate summary of the patient's limits favoring dysphagia-oriented therapy [55][56][57]. Finally, the Functional Oral Intake Scale (FOIS), a reliable tool to assess functional oral intake of food and liquids [57], could support the diagnosis.…”

Section: Assessment Of Dysphagiamentioning

confidence: 99%

“…Then, a systematic evaluation of swallowing should be performed to guide clinical decisions about oral intake and not rely on level of consciousness [28,54]. Although FEES has been suggested as the gold standard in dysphagia assessment and management [55], further studies are needed to better understand its use as well as the pathomechanisms of swallowing in patients with DOC. Moreover, the use of appropriate scales, i.e., the Swallowing Rating Scale and the DOSS-dysphagia Outcome and Severity Scale of O'Neil (see Appendices A and B), are necessary to improve the functional prognosis of the patients as well as ensure the appropriate treatment and planning of a therapeutic path to follow (weaning from aids such as PEG, the SNG and the tracheostomy tube), especially for patients with nasogastric tube.…”

Section: Rehabilitation Of Dysphagiamentioning

confidence: 99%

Neurogenic Dysphagia and Nutrition in Disorder of Consciousness: An Overview with Practical Advices on an “Old” but Still Actual Clinical Problem

Raciti

Pulejo

et al. 2022

Medicines

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Neurogenic dysphagia is a difficulty in swallowing food caused by disease or impairment of the nervous system, including stroke and traumatic brain injury. The most clinically apparent complication of neurogenic dysphagia is pulmonary aspiration, which may manifest itself acutely as choking or coughing, respiratory distress, wheezing, gasping or gurgling, and tachycardia. However, chronic symptoms, including weight loss, production of excessive oral secretions and aspiration pneumonia, may be also present, especially in patients with a disorder of consciousness (DOC). Usually, patients with dysphagia after the acute phase need to be treated with enteral nutrition using a feeding tube. This avoids patient malnutrition and supports the rehabilitation program. This narrative review aims to investigate dysphagia and its complications and management in patients with DOC. Clinical indications and practical advice on how to assess and treat this complex problem are also provided.

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“…The assessment of swallowing in patients with DoC is challenging, since most of these patients cannot communicate or actively participate. Instrumental methods such as fiber-optic endoscopy or videofluoroscopy are particularly valuable in this population, given their heightened risk of aspiration and fluctuating swallowing abilities, especially in cases where oral feeding, whether partial or complete, is being considered [ 13 , 14 , 15 ]. However, videofluoroscopy may not always be feasible for all DoC patients, as it requires patient transportation, positioning in an upright posture and the ingestion of a bolus [ 16 ], unlike fiber-optic endoscopy, which can be performed at the bedside and allows the observation of spontaneous saliva swallowing [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Swallowing Assessment in Post-Comatose Patients: A Feasibility Study on the SWADOC Tool

Herr,

Regnier,

Belorgeot

et al. 2024

JCM

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Background: After a severe brain injury and a coma, patients may develop disorders of consciousness (DoC), frequently accompanied by severe dysphagia. The evaluation and therapy of swallowing are therefore essential aspects of their management. Objectives: This study aims to evaluate the SWallowing Assessment in Disorders of Consciousness (SWADOC) tool in the assessment of swallowing in post-comatose patients. Here, we validate its quantitative items, describe preliminary results and identify limitations. Methods: Fourteen post-comatose patients were repeatedly evaluated with the Simplified Evaluation of CONsciousness Disorders (SECONDs) and with the SWADOC. Results: The internal consistency of the oral and pharyngeal subscales of the SWADOC was good. The test–retest reliability showed that all items, all subscores and the total score were stable except for two items (endo-buccal secretions and bronchial congestion). A comparison to the Facial Oral Tract Therapy Swallowing Assessment of Saliva (F.O.T.T-SAS) confirmed that scoring with the SWADOC offers a greater potential for quantitative observations in assessing swallowing abilities among patients with DoC. The SECONDs scores and SWADOC total scores showed a significant positive correlation (τ = 0.78, p < 0.001). Conclusions: This study provides preliminary but encouraging results on the psychometric properties of the SWADOC tool. It shows that this tool is relevant and feasible as a bedside assessment of dysphagia in patients with DoC.

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Feasibility and Safety of Fiberoptic Endoscopic Evaluation of Swallowing in People with Disorder of Consciousness: A Systematic Review

Cited by 6 publications

References 29 publications

Swallowing dysfunctions in patients with disorders of consciousness: Evidence from neuroimaging data, assessment, and management

Swallowing dysfunctions in patients with disorders of consciousness: Evidence from neuroimaging data, assessment, and management

Neurogenic Dysphagia and Nutrition in Disorder of Consciousness: An Overview with Practical Advices on an “Old” but Still Actual Clinical Problem

Swallowing Assessment in Post-Comatose Patients: A Feasibility Study on the SWADOC Tool

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