The Validation of the SWADOC: a novel tool to assess swallowing in patients with disorders of Consciousness.

BACKGROUND: After a severe brain injury and a period of coma, some patients may develop disorders of consciousness (DoC). Severe dysphagia is present nearly systematically in these patients, leading to major functional consequences and comorbidities. Assessment and swallowing therapy in patients with DoC are therefore essential aspects of their management.
METHODS: We will conduct a multicenter prospective cohort study. One hundred and four patients with DoC will receive behavioural measure at baseline with the Coma Recovery Scale-Revised (CRS-R) followed by three sessions combining consciousness assessment with the Simplified Evaluation of CONsciousness Disorders (SECONDs) and swallowing assessment with the SWADOC within five working days. Internal consistency, test-retest reliability, concurrent validity (with the Facial Oral Tract Therapy Swallowing Assessment of Saliva – FOTT-SAS), intra-judge reliability, inter-judge reliability and the links between the SWADOC-scored and the level of consciousness will be assessed.
RESULTS: With one third of the sample completed so far, we found substantial agreements between (r=0.84; p=0.001) and within raters (r=0.84; p=0.001) and a positive association between swallowing abilities and the level of consciousness (r=0.66; p=0.001).
CONCLUSION: This study aims to validate the SWADOC as a reliable bedside tool for the swallowing assessment in DoC patients and to give a better understanding of relationship between consciousness and swallowing components. These results may help the development of new diagnostic guidelines for DoC that would include swallowing components in their criteria.