Swallowing in individuals with disorders of consciousness: A cohort study

Mélotte, Evelyne; Maudoux, Audrey; Delhalle, Sabrina; Lagier, Aude; Thibaut, Aurore; Aubinet, Charlène; Kaux, Jean-François; Vanhaudenhuyse, Audrey; Ledoux, Didier; Laureys, Steven; Gosseries, Olivia

doi:10.1016/j.rehab.2020.04.008

Cited by 31 publications

(37 citation statements)

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“…Our recent DOC cohort study ( 13 ) found some links between swallowing and the level of consciousness. In particular, none of the patients with UWS and only a minority of the patients in MCS exhibited an effective oral phase of swallowing (adequate lip prehension, tongue propulsion, and no post-swallowing oral stasis).…”

Section: Introductionmentioning

confidence: 97%

“…Almost all patients with DOC have severe dysphagia ( 13 ), requiring the use of ventilation and nutritional support (i.e., tracheostomy, gastrostomy) to limit the occurrence of comorbidities (e.g., bronchopulmonary infection, undernutrition). Individuals with DOC classically receive hydration and nutrition through an enteral feeding tube ( 14 ), and a large majority will not be able to return to exclusively oral feeding ( 13 , 15 ). An objective swallowing assessment using fiber-optic endoscopic or videofluoroscopic swallowing evaluations is required in patients with DOC, for whom the possibility of partial or total oral feeding is being considered.…”

Section: Introductionmentioning

confidence: 99%

“…These examinations, performed by experienced clinicians, constitute the gold standard tool for assessing dysphagia in this population. Indeed, these examinations allow clinicians to precisely analyze the mechanisms at play during swallowing and to detect possible silent aspirations, which are very prevalent in patients with DOC ( 13 ). As Mélotte et al ( 13 ) showed in a cohort of 92 patients, the risk of silent aspiration is high for these patients, as 48% of DOC patients do not have a cough reflex.…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, these examinations allow clinicians to precisely analyze the mechanisms at play during swallowing and to detect possible silent aspirations, which are very prevalent in patients with DOC ( 13 ). As Mélotte et al ( 13 ) showed in a cohort of 92 patients, the risk of silent aspiration is high for these patients, as 48% of DOC patients do not have a cough reflex. Moreover, 28% presented saliva aspiration, 13% aspiration with thick texture, and 32% aspiration with liquid texture.…”

Section: Introductionmentioning

confidence: 99%

“…A lack of knowledge of the specific features of DOC prevents some clinicians from performing these exams. Moreover, performing a functional swallowing test (liquid and food test) can be difficult in patients with severe trismus (lockjaw) or total absence of the oral phase of swallowing, but as long as a partial oral phase with initiation of swallowing exists, thick or liquid swallowing can be tested ( 13 , 16 – 18 ).…”

Section: Introductionmentioning

confidence: 99%

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The Development and Validation of the SWADOC: A Study Protocol for a Multicenter Prospective Cohort Study

et al. 2021

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Background: After a coma, patients with severe brain injury may present disorders of consciousness (DOC). A substantial proportion of these patients also suffer from severe dysphagia. Assessment of and therapy for swallowing disabilities of patients with DOC are essential because dysphagia has major functional consequences and comorbidities. Dysphagia evaluation in patients with DOC is impeded by the lack of adapted tools. The first aim of this study was to create a new tool, the SWallowing Assessment in Disorders Of Consciousness (SWADOC), and propose a validation protocol. The SWADOC was developed to help therapists assess factors related to swallowing in patients with DOC. The second aim was to investigate the relationship between patients' level of consciousness and SWADOC items and scores.Method/Design: In this multicenter prospective cohort, 104 patients with DOC will be tested three times over five consecutive days with the SWADOC. Statistical analyses will focus on the reliability and validity of the SWADOC, especially the intrarater and interrater reliability, internal consistency, measures of dispersion, and concurrent validity with the Facial Oral Tract Therapy Swallowing Assessment of Saliva (FOTT-SAS). The level of consciousness will be assessed with the Simplified Evaluation of CONsciousness Disorders (SECONDs) and the Coma Recovery Scale-Revised (CRS-R).Discussion: The assessment of swallowing abilities among patients with DOC is the first necessary step toward the development of a customized dysphagia care plan. A validated scoring tool will be essential for clinicians to better assess dysphagia in patients with DOC and document the evolution of their disorders.Trial Registration: NCT04706689.

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Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Development and Validation of the SWADOC: A Study Protocol for a Multicenter Prospective Cohort Study

et al. 2021

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The relationship between neurogenic dysphagia, stroke-associated pneumonia and functional outcome in a cohort of ischemic stroke patients treated with mechanical thrombectomy

Schumann-Werner,

Becker,

Nikoubashman

et al. 2023

J Neurol

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Introduction Mechanical thrombectomy (MT) is an established treatment approach in acute ischemic stroke patients with large vessel occlusion (LVO). Recent studies suggest that the prevalence of dysphagia and pneumonia risk is increased in this patient population. The aim of this study was to systematically evaluate the prevalence, predictors, and influence of neurogenic dysphagia for 3-month outcome in a large population of patients receiving MT and to elucidate the relationship between dysphagia, stroke-associated pneumonia (SAP) and medium-term functional outcome. Materials and methods Data of a prospective collected registry of patients with LVO and MT between 2016 and 2019 were analyzed retrospectively. Binary logistic regression was carried out to determine predictors for dysphagia and 3-month outcome as measured by the modified Rankin Scale, respectively. A mediation analysis was performed to investigate the mediating influence of intercurrent SAP. Results A total of 567 patients were included in the study. Mean age was 73.4 years, 47.8% of the patients were female, and median NIHSS was 15.0. The prevalence of dysphagia was 75.1% and 23.3% of all patients developed SAP. In the regression analysis, dysphagia was one of the main independent predictors for poor functional outcome at 3 months. The mediator analysis revealed that the effect of dysphagia on the functional outcome at 3 months was not mediated by the occurrence of SAP. Discussion The prevalence of dysphagia is high and exerts both negative short- and medium-term effects on patients with large vessel occlusion who undergo MT.

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