swallowing; dysphagia; consciousness disorders; severe brain injury; assessment
Abstract :
[en] Background: After a severe brain injury and a coma, patients may develop disorders of consciousness (DoC), frequently accompanied by severe dysphagia. The evaluation and therapy of swallowing are therefore essential aspects of their management. Objectives: This study aims to evaluate the SWallowing Assessment in Disorders of Consciousness (SWADOC) tool in the assessment of swallowing in post-comatose patients. Here, we validate its quantitative items, describe preliminary results and identify limitations. Methods: Fourteen post-comatose patients were repeatedly evaluated with the Simplified Evaluation of CONsciousness Disorders (SECONDs) and with the SWADOC. Results: The internal consistency of the oral and pharyngeal subscales of the SWADOC was good. The test–retest reliability showed that all items, all subscores and the total score were stable except for two items (endo-buccal secretions and bronchial congestion). A comparison to the Facial Oral Tract Therapy Swallowing Assessment of Saliva (F.O.T.T-SAS) confirmed that scoring with the SWADOC offers a greater potential for quantitative observations in assessing swallowing abilities among patients with DoC. The SECONDs scores and SWADOC total scores showed a significant positive correlation (τ = 0.78, p < 0.001). Conclusions: This study provides preliminary but encouraging results on the psychometric properties of the SWADOC tool. It shows that this tool is relevant and feasible as a bedside assessment of dysphagia in patients with DoC.
Disciplines :
Neurology
Author, co-author :
Herr, Roxanne ✱; Neurology Department, Haguenau Hospital, 67500 Haguenau, France
Regnier, Amandine ✱; Université de Liège - ULiège > GIGA > GIGA Consciousness - Coma Science Group ; Centre Hospitalier Universitaire de Liège - CHU > > Service de médecine de l'appareil locomoteur
Belorgeot, Marion ✱; Physical Medecine and Rehabilitation Medicine Department, University Hospital of Nîmes, 30029 Nîmes, France
Mélotte, Evelyne ; Université de Liège - ULiège > Département de Logopédie > Logopédie des troubles de la voix
Simon, Jessica ; Université de Liège - ULiège > Département de Psychologie > Psychologie quantitative
Sanz, Leandro ; Université de Liège - ULiège > GIGA > GIGA Consciousness - Coma Science Group
Lejeune, Nicolas ; Université de Liège - ULiège > GIGA > GIGA Consciousness - Coma Science Group ; William Lennox Neurological Hospital Center, 1340 Ottignies-Louvain-la-Neuve, Belgium ; Institute of NeuroScience, Université Catholique de Louvain, 1200 Brussels, Belgium
Chavet, Valérie; Physical Medicine and Rehabilitation Medicine Department, Center for Traumatology and Rehabilitation Erasme, 1070 Brussels, Belgium
PALUSZKIEWICZ, Jenny ; Centre Hospitalier Universitaire de Liège - CHU > > Service de médecine de l'appareil locomoteur
Pellas, Frédéric; Physical Medecine and Rehabilitation Medicine Department, University Hospital of Nîmes, 30029 Nîmes, France
Chevallier, Jean-Baptiste; EVC-EPR Unit, Functional Rehabilitation Center of Fontfroide, 34070 Montpellier, France
Laureys, Steven ; Université de Liège - ULiège > Département des sciences cliniques ; Joint International Research Unit on Consciousness, CERVO Brain Research Centre, Laval University, Québec, QC G1J2G3, Canada
Kaux, Jean-François ; Université de Liège - ULiège > Département des Sciences de l'activité physique et de la réadaptation > Médecine physique, réadaptation et traumatologie du sport ; Université de Liège - ULiège > Evaluation-Revalidation (EVAREVA) ; Centre Hospitalier Universitaire de Liège - CHU > > Service de médecine de l'appareil locomoteur
Gosseries, Olivia ; Université de Liège - ULiège > GIGA > GIGA Consciousness - Coma Science Group
CHU Liège - Central University Hospital of Liege Leon Fredericq Foundation F.R.S.-FNRS - Fonds de la Recherche Scientifique FRB - King Baudouin Foundation ESA - European Space Agency UET - Université Européenne du Travail FERB - Fondazione Europea Ricerca Biomedica Bial Foundation MSF - Mind Science Foundation EC - European Commission Mind Care Foundation NSCF - National Natural Science Foundation of China ULiège - University of Liège
Funding text :
We would like to express our gratitude to all the patients who took part in the assessments and their families. We thank the health care teams of the post-coma units and rehabilitation services in the William Lennox Neurological Hospital in Ottignies-Louvain-La Neuve, the Center of Traumatology and Rehabilitation Erasme in Brussels, the Neurological and Functional Rehabilitation Centre of University Hospital of Liège in Fraiture-en-Condroz and the Functional Rehabilitation Clinic of Fontfroide in Montpellier. We also extend our thanks to Naji Alnagger for his
assistance with the English revision; Horizon 2020 MSCA—Research and Innovation Staff Exchange
The European Task Force on Disorders of Consciousness Laureys S. Celesia G.G. Cohadon F. Lavrijsen J. León-Carrión J. Sannita W.G. Sazbon L. Schmutzhard E. von Wild K.R. et al. Unresponsive Wakefulness Syndrome: A New Name for the Vegetative State or Apallic Syndrome BMC Med. 2010 8 68 10.1186/1741-7015-8-68
The Multi-Society Task Force on PVS Medical Aspects of the Persistent Vegetative State N. Engl. J. Med. 1994 330 1499 1508 10.1056/NEJM199405263302107 7818633
Plum F. Posner J.B. The Diagnosis of Stupor and Coma Contemp. Neurol. Ser. 1972 10 1 286
Giacino J.T. Ashwal S. Childs N. Cranford R. Jennett B. Katz D.I. Kelly J.P. Rosenberg J.H. Whyte J. Zafonte R.D. et al. The Minimally Conscious State: Definition and Diagnostic Criteria Neurology 2002 58 349 353 10.1212/WNL.58.3.349 11839831
Golden K. Bodien Y.G. Giacino J.T. Disorders of Consciousness Phys. Med. Rehabil. Clin. N. Am. 2024 35 15 33 10.1016/j.pmr.2023.06.011
Giacino J.T. Katz D.I. Schiff N.D. Whyte J. Ashman E.J. Ashwal S. Barbano R. Hammond F.M. Laureys S. Ling G.S.F. et al. Practice Guideline Update Recommendations Summary: Disorders of Consciousness: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology; the American Congress of Rehabilitation Medicine; and the National Institute on Disability, Independent Living, and Rehabilitation Research Neurology 2018 91 450 460 10.1212/WNL.0000000000005926
Giacino J.T. Kalmar K. Whyte J. The JFK Coma Recovery Scale-Revised: Measurement Characteristics and Diagnostic Utility Arch. Phys. Med. Rehabil. 2004 85 2020 2029 10.1016/j.apmr.2004.02.033 15605342
Schnakers C. Clinical Assessment of Patients with Disorders of Consciousness Arch. Ital. Biol. 2012 150 36 43
Aubinet C. Cassol H. Bodart O. Sanz L.R.D. Wannez S. Martial C. Thibaut A. Martens G. Carrière M. Gosseries O. et al. Simplified Evaluation of CONsciousness Disorders (SECONDs) in Individuals with Severe Brain Injury: A Validation Study Ann. Phys. Rehabil. Med. 2021 64 101432 10.1016/j.rehab.2020.09.001
Speyer R. Cordier R. Farneti D. Nascimento W. Pilz W. Verin E. Walshe M. Woisard V. White Paper by the European Society for Swallowing Disorders: Screening and Non-Instrumental Assessment for Dysphagia in Adults Dysphagia 2022 37 333 349 10.1007/s00455-021-10283-7
Mélotte E. Maudoux A. Delhalle S. Lagier A. Thibaut A. Aubinet C. Kaux J.-F. Vanhaudenhuyse A. Ledoux D. Laureys S. et al. Swallowing in Individuals with Disorders of Consciousness: A Cohort Study Ann. Phys. Rehabil. Med. 2021 64 101403 10.1016/j.rehab.2020.04.008 32535170
Raciti L. Raciti G. Pulejo G. Conti-Nibali V. Calabrò R.S. Neurogenic Dysphagia and Nutrition in Disorder of Consciousness: An Overview with Practical Advices on an “Old” but Still Actual Clinical Problem Medicines 2022 9 16 10.3390/medicines9020016 35200759
Bremare A. Rapin A. Veber B. Beuret-Blanquart F. Verin E. Swallowing Disorders in Severe Brain Injury in the Arousal Phase Dysphagia 2016 31 511 520 10.1007/s00455-016-9707-9 27090424
Checklin M. Dahl T. Tomolo G. Feasibility and Safety of Fiberoptic Endoscopic Evaluation of Swallowing in People with Disorder of Consciousness: A Systematic Review Dysphagia 2022 37 778 787 10.1007/s00455-021-10327-y 34142244
Brady S.L. Wesling M.W. Donzelli J.J. Kaszuba S. Swallowing Frequency: Impact of Accumulated Oropharyngeal Secretion Levels and Gustatory Stimulation Ear. Nose. Throat J. 2016 95 E7 E9 10.1177/014556131609500203
Mayer V. The Challenges of Managing Dysphagia in Brain-Injured Patients Br. J. Community Nurs. 2004 9 67 73 10.12968/bjcn.2004.9.2.12420 15007283
Roberts H. Greenwood N. Speech and Language Therapy Best Practice for Patients in Prolonged Disorders of Consciousness: A Modified Delphi Study Int. J. Lang. Commun. Disord. 2019 54 841 854 10.1111/1460-6984.12489 31273875
Mélotte E. Belorgeot M. Herr R. Simon J. Kaux J.-F. Laureys S. Sanz L.R.D. Lagier A. Morsomme D. Pellas F. et al. The Development and Validation of the SWADOC: A Study Protocol for a Multicenter Prospective Cohort Study Front. Neurol. 2021 12 662634 10.3389/fneur.2021.662634
Aubinet C. Chatelle C. Gillet S. Lejeune N. Thunus M. Hennen N. Cassol H. Laureys S. Majerus S. The Brief Evaluation of Receptive Aphasia Test for the Detection of Language Impairment in Patients with Severe Brain Injury Brain Inj. 2021 35 705 717 10.1080/02699052.2021.1894482
Hansen T.S. Jakobsen D. A Decision-Algorithm Defining the Rehabilitation Approach: ‘Facial Oral Tract Therapy’® Disabil. Rehabil. 2010 32 1447 1460 10.3109/09638280903556482
Mortensen J. Jensen D. Kjaersgaard A. A Validation Study of the Facial-Oral Tract Therapy Swallowing Assessment of Saliva Clin. Rehabil. 2016 30 410 415 10.1177/0269215515584381 25920675
Kunieda K. Ohno T. Fujishima I. Hojo K. Morita T. Reliability and Validity of a Tool to Measure the Severity of Dysphagia: The Food Intake LEVEL Scale J. Pain Symptom Manag. 2013 46 201 206 10.1016/j.jpainsymman.2012.07.020
Bernardes R.A. Cruz A. Neves H. Parola V. Catela N. Screening Tools Designed to Assess and Evaluate Oropharyngeal Dysphagia in Adult Patients: A Scoping Review Nurs. Rep. 2022 12 245 258 10.3390/nursrep12020025 35466245
Wang J. Wang J. Hu X. Xu L. Tian J. Li J. Fang D. Huang W. Sun Y. He M. et al. The Initiation of Swallowing Can Indicate the Prognosis of Disorders of Consciousness: A Self-Controlled Study Front. Neurol. 2019 10 1184 10.3389/fneur.2019.01184 31798516
Mélotte E. Maudoux A. Delhalle S. Martial C. Antonopoulos G. Larroque S.K. Wannez S. Faymonville M.-E. Kaux J.-F. Laureys S. et al. Is Oral Feeding Compatible with an Unresponsive Wakefulness Syndrome? J. Neurol. 2018 265 954 961 10.1007/s00415-018-8794-y 29464377
Cichero J.A. Lam P. Steele C.M. Hanson B. Chen J. Dantas R.O. Duivestein J. Kayashita J. Lecko C. Murray J. et al. Development of International Terminology and Definitions for Texture-Modified Foods and Thickened Fluids Used in Dysphagia Management: The IDDSI Framework Dysphagia 2017 32 293 314 10.1007/s00455-016-9758-y
Sanz L.R.D. Aubinet C. Cassol H. Bodart O. Wannez S. Bonin E.A.C. Barra A. Lejeune N. Martial C. Chatelle C. et al. SECONDs Administration Guidelines: A Fast Tool to Assess Consciousness in Brain-injured Patients J. Vis. Exp. 2021 10.3791/61968 33616111
Schnakers C. Majerus S. Giacino J. Vanhaudenhuyse A. Bruno M.A. Boly M. Moonen G. Damas P. Lambermont B. Lamy M. et al. A French validation study of the Coma Recovery Scale-Revised (CRS-R) Brain Inj. 2008 22 786 792 10.1080/02699050802403557 18787989
Gollega A. Meghji C. Renton S. Lazoruk A. Haynes E. Lawson D. Ostapovitch M. Multidisciplinary assessment measure for individuals with disorders of consciousness Brain Inj. 2015 29 1460 1466 10.3109/02699052.2015.1071426 26305914
Senez C. Rééducation des Troubles de L'oralité et de la Deglutition 2nd ed. De Boeck Supérieur Mont-Saint-Guibert, Belgium 2015