Evelyne Mélotte1, Audrey Maudoux2, Sabrina Delhalle3, Aude Lagier3, Aurore Thibaut4, Charlène Aubinet4, Jean-François Kaux5, Audrey Vanhaudenhuyse6, Didier Ledoux7, Steven Laureys4, Olivia Gosseries4. 1. Physical and Rehabilitation Medicine Department, University Hospital of Liege, Liege, Belgium; Coma Science Group, GIGA-Consciousness, University of Liege, Liege, Belgium; Centre du Cerveau(2), University Hospital of Liege, Liège, Belgium. Electronic address: evelyne.melotte@chuliege.be. 2. Sensation and Perception Research Group GIGA, University of Liege, Liege, Belgium; Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Liege, Liege, Belgium. 3. Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Liege, Liege, Belgium. 4. Coma Science Group, GIGA-Consciousness, University of Liege, Liege, Belgium; Centre du Cerveau(2), University Hospital of Liege, Liège, Belgium. 5. Physical and Rehabilitation Medicine Department, University Hospital of Liege, Liege, Belgium. 6. Sensation and Perception Research Group GIGA, University of Liege, Liege, Belgium; Algology Department, University Hospital of Liege, Liege, Belgium. 7. Intensive Care Unit Department, University Hospital of Liege, Liege, Belgium.
Abstract
BACKGROUND: After a period of coma, a proportion of individuals with severe brain injury remain in an altered state of consciousness before regaining partial or complete recovery. Individuals with disorders of consciousness (DOC) classically receive hydration and nutrition through an enteral-feeding tube. However, the real impact of the level of consciousness on an individual's swallowing ability remains poorly investigated. OBJECTIVE: We aimed to document the incidence and characteristics of dysphagia in DOC individuals and to evaluate the link between different components of swallowing and the level of consciousness. METHODS: We analyzed clinical data on the respiratory status, oral feeding and otolaryngologic examination of swallowing in DOC individuals. We analyzed the association of components of swallowing and participant groups (i.e., unresponsive wakefulness syndrome [UWS] and minimally conscious state [MCS]). RESULTS: We included 92 individuals with DOC (26 UWS and 66 MCS). Overall, 99% of the participants showed deficits in the oral and/or pharyngeal phase of swallowing. As compared with the MCS group, the UWS group more frequently had a tracheostomy (69% vs 24%), with diminished cough reflex (27% vs 54%) and no effective oral phase (0% vs 21%). CONCLUSION: Almost all DOC participants had severe dysphagia. Some components of swallowing (i.e., tracheostomy, cough reflex and efficacy of the oral phase of swallowing) were related to consciousness. In particular, no UWS participant had an efficient oral phase, which suggests that its presence may be a sign of consciousness. In addition, no UWS participant could be fed entirely orally, whereas no MCS participant orally received ordinary food. Our study also confirms that objective swallowing assessment can be successfully completed in DOC individuals and that specific care is needed to treat severe dysphagia in DOC.
BACKGROUND: After a period of coma, a proportion of individuals with severe brain injury remain in an altered state of consciousness before regaining partial or complete recovery. Individuals with disorders of consciousness (DOC) classically receive hydration and nutrition through an enteral-feeding tube. However, the real impact of the level of consciousness on an individual's swallowing ability remains poorly investigated. OBJECTIVE: We aimed to document the incidence and characteristics of dysphagia in DOC individuals and to evaluate the link between different components of swallowing and the level of consciousness. METHODS: We analyzed clinical data on the respiratory status, oral feeding and otolaryngologic examination of swallowing in DOC individuals. We analyzed the association of components of swallowing and participant groups (i.e., unresponsive wakefulness syndrome [UWS] and minimally conscious state [MCS]). RESULTS: We included 92 individuals with DOC (26 UWS and 66 MCS). Overall, 99% of the participants showed deficits in the oral and/or pharyngeal phase of swallowing. As compared with the MCS group, the UWS group more frequently had a tracheostomy (69% vs 24%), with diminished cough reflex (27% vs 54%) and no effective oral phase (0% vs 21%). CONCLUSION: Almost all DOC participants had severe dysphagia. Some components of swallowing (i.e., tracheostomy, cough reflex and efficacy of the oral phase of swallowing) were related to consciousness. In particular, no UWS participant had an efficient oral phase, which suggests that its presence may be a sign of consciousness. In addition, no UWS participant could be fed entirely orally, whereas no MCS participant orally received ordinary food. Our study also confirms that objective swallowing assessment can be successfully completed in DOC individuals and that specific care is needed to treat severe dysphagia in DOC.
Authors: Piergiuseppe Liuzzi; Alfonso Magliacano; Francesco De Bellis; Andrea Mannini; Anna Estraneo Journal: Sci Rep Date: 2022-08-05 Impact factor: 4.996
Authors: Daniel Kondziella; David K Menon; Raimund Helbok; Lionel Naccache; Marwan H Othman; Verena Rass; Benjamin Rohaut; Michael N Diringer; Robert D Stevens Journal: Neurocrit Care Date: 2021-07-08 Impact factor: 3.210
Authors: Flora M Hammond; Sheryl Katta-Charles; Mary Beth Russell; Ross D Zafonte; Jan Claassen; Amy K Wagner; Louis Puybasset; Satoshi Egawa; Steven Laureys; Michael Diringer; Robert D Stevens Journal: Neurocrit Care Date: 2021-07-08 Impact factor: 3.532