consciousness; disorders of consciousness; minimally conscious state; prognosis; swallowing
Abstract :
[en] Objective: To detect the initiation of swallowing in patients with disorders of consciousness (DOC) as well as the relationship between the initiation of swallowing and the prognosis of DOC patients. Methods: Nineteen DOC patients were included in this study, and a self-controlled trial compared five different stimuli. The five different stimuli were as follows: (1) one command, as recommended by the Coma Recovery Scale-Revised (CRS-R), which was "open your mouth"; (2) placing a spoon in front of the patient's mouth without a command; (3) placing a spoon filled with water in front of the patient's mouth without a command; (4) one command-"there is a spoon; open your mouth"-with a spoon in front of the patient's mouth; (5) one command, "there is a spoon with water; open your mouth," with a spoon filled with water in front of the patient's mouth. All 19 patients were given these five stimuli randomly, and any one of the commands was presented four times to a patient, one at a time, at 15-s intervals. The sensitivity and specificity of the initiation of swallowing in detecting conscious awareness were determined. Results: None of the patients responded to the first four stimuli. However, six patients showed initiated swallowing toward the fifth stimulus. Among those six, five patients showed improvement in their consciousness state 6 months later. The sensitivity and specificity of the initiation of swallowing for DOC patients was 83.33% [95% CIs (36%, 100%)] and 92.31% [95% CIs (64%, 100%)], respectively. Conclusions: The initiation of swallowing can be an early indication of conscious behavior and can likely provide evidence of conscious awareness. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03508336; Date of registration: 2018/4/16.
Research Center/Unit :
CHU de Liège-Centre du Cerveau² - ULiège
Disciplines :
Neurology
Author, co-author :
Wang, Jianan; Hangzhou Normal University, Hangzhou, China > International Unresponsive Wakefulness Syndrome and Consciousness Science Institute
Wang, Jing; Hangzhou Normal University, Hangzhou, China > International Unresponsive Wakefulness Syndrome and Consciousness Science Institute
Hu, Xiaohua
Xu, Lingqi; Hospital of Hangzhou City, Hangzhou, China > Rehabilitation Center for Brain Damage, Wujing
Tian, Jinna; Hangzhou Normal University, Hangzhou, China > International Unresponsive Wakefulness Syndrome and Consciousness Science Institute
Li, Jiayin; Hangzhou Normal University, Hangzhou, China > International Unresponsive Wakefulness Syndrome and Consciousness Science Institute
Fang, Danruo; Hangzhou Normal University, Hangzhou, China > International Unresponsive Wakefulness Syndrome and Consciousness Science Institute
Huang, Wangshan; Hangzhou Normal University, Hangzhou, China > International Unresponsive Wakefulness Syndrome and Consciousness Science Institute
Sun, Yuxiao; Hangzhou Normal University, Hangzhou, China > International Unresponsive Wakefulness Syndrome and Consciousness Science Institute
He, Minhui; Hangzhou Normal University, Hangzhou, China > International Unresponsive Wakefulness Syndrome and Consciousness Science Institute
Laureys, Steven ; Université de Liège - ULiège > GIGA Consciousness - Coma Science Group
Di, Haibo; Hangzhou Normal University, Hangzhou, China > International Unresponsive Wakefulness Syndrome and Consciousness Science Institute
Language :
English
Title :
The Initiation of Swallowing Can Indicate the Prognosis of Disorders of Consciousness: A Self-Controlled Study.
Publication date :
2019
Journal title :
Frontiers in Neurology
eISSN :
1664-2295
Publisher :
Frontiers Media S.A., Switzerland
Volume :
10
Pages :
1184
Peer reviewed :
Peer Reviewed verified by ORBi
Funders :
National Natural Science Foundation of China (Grant nos. 81471100, 811247008) the National High Technology Research and Development Program of China (Grant no. 2015AA020514) the National Natural Science Foundation of China (Grant no. 81920108023) Hangzhou Normal University (Grant no. 2018PYXML007)
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