Dysphagia; Deglutition; Disorders of consciousness; Brain injury
Abstract :
[en] 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. Univariate and multivariate logistic regression was used to analyse 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.
Research Center/Unit :
Giga Consciousness-Coma Science Group ; CHU de Liège - Centre du Cerveau²
Disciplines :
Neurology
Author, co-author :
MELOTTE, Evelyne ; Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Médecine de l'appareil locomoteur (RNCL - Neuropsychologie)
MAUDOUX, Audrey ; Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Service d'ORL, d'audiophonologie et de chir. cervico-faciale
DELHALLE, Sabrina ; Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Service d'ORL, d'audiophonologie et de chir. cervico-faciale
Lagier, Aude ; Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Service d'ORL, d'audiophonologie et de chir. cervico-faciale
Thibaut, Aurore ; Université de Liège - ULiège > Consciousness-Coma Science Group
Aubinet, Charlène ; Université de Liège - ULiège > Consciousness-Coma Science Group
KAUX, Jean-François ; Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Service de médecine de l'appareil locomoteur
VANHAUDENHUYSE, Audrey ; Centre Hospitalier Universitaire de Liège - CHU > Département d'Anesthésie et réanimation > Centre interdisciplinaire d'algologie
LEDOUX, Didier ; Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Service des soins intensifs
Laureys, Steven ; Université de Liège - ULiège > Giga Consciousness-Coma Science Group
Gosseries, Olivia ; Université de Liège - ULiège > Consciousness-Coma Science Group
Language :
English
Title :
Swallowing in individuals with disorders of consciousness: A cohort study
Alternative titles :
[en] La déglutition chez les individus avec altération de l'état de conscience : une étude de cohorte
Publication date :
July 2021
Journal title :
Annals of Physical and Rehabilitation Medicine
ISSN :
1877-0657
eISSN :
1877-0665
Publisher :
Elsevier Masson, Paris, France
Volume :
64
Issue :
4
Pages :
101403
Peer reviewed :
Peer Reviewed verified by ORBi
Funding text :
University and University Hospital of Liège; the Belgian National Funds for Scientific Research (FRS-FNRS); European Union’s Horizon 2020 Framework Programme for Research and Innovation under the Specific Grant Agreement No. 785907 & No. 945539 (Human Brain Project SGA2 and SGA3); Luminous project (EU-H2020- fetopen-ga686764); the BIAL Foundation; DOCMA project [EU-H2020- MSCA–RISE–778234]; the fund Generet; AstraZeneca Foundation; King Baudouin Foundation; the Wallonie-Bruxelles International; the James McDonnell Foundation; Mind Science Foundation; IAP research network P7/ 06 of the Belgian Government (Belgian Science Policy); the European Commission; the Public Utility Foundation ‘Universite´ Europe´enne du Travail’; ‘‘Fondazione Europea di Ricerca Biomedica’’; Fondation Benoit; and Belgian National Plan Cancer (139). CA is research follow, AT is postdoctoral researcher, OG is research associate and SL is research director at FRS-FNRS.
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