Publications of Sabrina DELHALLE
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See detailSwallowing in individuals with disorders of consciousness: A cohort study
MELOTTE, Evelyne ULiege; MAUDOUX, Audrey ULiege; DELHALLE, Sabrina ULiege et al

in Annals of Physical and Rehabilitation Medicine (in press)

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 ... [more ▼]

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. [less ▲]

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See detailIs oral feeding compatible with an unresponsive wakefulness syndrome?
MELOTTE, Evelyne ULiege; MAUDOUX, Audrey ULiege; DELHALLE, Sabrina ULiege et al

in Journal of Neurology (2018), 265(4), 954-961

The aim of the study is to explore the possibility of oral feeding in unresponsive wakefulness syndrome/vegetative state (UWS/VS) patients. Method: We reviewed the clinical information of 68 UWS/VS ... [more ▼]

The aim of the study is to explore the possibility of oral feeding in unresponsive wakefulness syndrome/vegetative state (UWS/VS) patients. Method: We reviewed the clinical information of 68 UWS/VS patients (mean age 45 ± 11; range 16-79 years) searching for mention of oral feeding. UWS/VS diagnosis was made after repeated behavioural assessments using the Coma Recovery Scale–Revised. Patients also had complementary neuroimaging evaluations (positron emission tomography, functional magnetic resonance imaging and electroencephalography and diffusion tensor imaging). Results: Out of the 68 UWS/VS patients, only two could resume oral feeding (3%). The first patient had oral feeding (only liquid and semi liquid) in addition to gastrostomy feeding and the second one could achieve full oral feeding (liquid and mixed solid food). Clinical assessments concluded that they fulfilled the criteria for a diagnosis of UWS/VS. Results from neuroimaging and neurophysiology were typical for the first patient with regard to the diagnosis of UWS/VS but atypical for the second patient. Conclusion: Oral feeding that implies a full and complex oral phase could probably be considered as a sign of consciousness. However, we actually do not know which components are necessary to consider the swallowing conscious as compared to reflex. We also discussed the importance of swallowing assessment and management in all patients with altered state of consciousness. [less ▲]

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See detailIs oral feeding compatible with an unresponsive wakefulness syndrome?
MELOTTE, Evelyne ULiege; MAUDOUX, Audrey ULiege; DELHALLE, Sabrina ULiege et al

Conference (2018, January)

Introduction : Vegetative state/unresponsive wakefulness syndrome (VS/UWS) is defined by the presence of eye-opening and the absence of awareness and voluntary movement [1]. VS/UWS patients classically ... [more ▼]

Introduction : Vegetative state/unresponsive wakefulness syndrome (VS/UWS) is defined by the presence of eye-opening and the absence of awareness and voluntary movement [1]. VS/UWS patients classically receive hydration and nutrition through an enteral feeding tube. Objective - Methods : We retrospectively reviewed the clinical information of 65 VS/UWS patients (aged 45±12; range 16-85 years) evaluated at the CHU hospital of liege searching for mention of oral feeding. VS/UWS diagnosis was made after repeated behavioral assessments using the standardized coma recovery scale–revised (CRS-R, [2]) in association with complementary evaluations using neuroimaging techniques. Results : Of the 65 VS/UWS patients, two could resume oral feeding (3%). One could achieve full oral feeding and the other had oral feeding in addition to gastrostomy feeding. Neuroimaging evaluations showed in both patients a massive decrease in the spontaneous brain activity and its functional connectivity (using functional magnetic resonance imaging), bilateral cerebral cortex hypometabolism and preserved metabolism in the brainstem and cerebellum (using positron emission tomography). Discussion – Conclusion – Clinical message : oral feeding is rare in VS/UWS patients (3% in our cohort). Based on neuroimaging results, this behaviour does not seem to be incompatible with the diagnosis of VS/UWS but the neuromecanistic root, which allows this behavior, still needs to be elucidate. This study also emphasizes the importance of assess and manage deglutition in patients with altered state of consciousness regardless of their level of consciousness. Tactile oro-facial stimulation, manual therapy, taste stimulation and therapeutic feeding can be another “gateway” to interact with these patients and improve their quality of life. [less ▲]

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See detailIs oral feeding compatible with an unresponsive wakefulness syndrome?
MELOTTE, Evelyne ULiege; MAUDOUX, Audrey ULiege; DELHALLE, Sabrina ULiege et al

Conference (2017, May)

INTRODUCTION AND AIMS Vegetative state/Unresponsive wakefulness syndrome (VS/UWS) is defined by the presence of eye-opening and the absence of awareness and voluntary movement (Laureys et al., 2010). VS ... [more ▼]

INTRODUCTION AND AIMS Vegetative state/Unresponsive wakefulness syndrome (VS/UWS) is defined by the presence of eye-opening and the absence of awareness and voluntary movement (Laureys et al., 2010). VS/UWS patients classically receive hydration and nutrition through an enteral feeding tube. We present the cases of two patients that were diagnosed as VS/UWS but were able to resume oral feeding. It is however unclear if the presence of oral feeding is compatible with the diagnosis of VS/UWS or if this observation should lead to a modification of the diagnosis. METHODS AND RESULTS We retrospectively reviewed the clinical information of 65 VS/UWS patients (aged 45±12; range 16-85 years) evaluated at the CHU hospital of Liege searching for mention of oral feeding. VS/UWS diagnosis was made after repeated behavioral assessments using the standardized Coma Recovery Scale–Revised (CRS-R, (Teasdale & Jennet, 1974)) in association with complementary evaluations using neuroimaging techniques. Of the 65 VS/UWS patients, two could resume oral feeding (3%). One could achieve full oral feeding (mixed texture and liquid) and the other had oral feeding (liquid and semi-liquid) in addition to gastrostomy feeding. Neuroimaging evaluations showed in both patients a massive decrease in the spontaneous brain activity and its functional connectivity (using functional magnetic resonance imaging), bilateral cerebral cortex hypometabolism (fronto- parietal associative areas, posterior parietal areas, cingulate cortices, precuneus) and preserved metabolism in the brainstem and cerebellum (using positron emission tomography). CONCLUSIONS Oral feeding is rare in VS/UWS patients (3% in our cohort). Based on neuroimaging results, this behaviour does not seem to be incompatible with the diagnosis of VS/UWS but the neuromecanistic root, which allows this behavior, still needs to be elucidate. This study also emphasizes the importance of systematic swallowing evaluation in patients with altered state of consciousness regardless of their level of consciousness. Moreover, tactile oro-facial stimulation, manual therapy, taste stimulation and therapeutic feeding can be another “gateway” to interact with these patients and improve their quality of life. [less ▲]

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See detailDYSPHAGIE, DEGLUTITION ET ALIMENTATION
ALLEPAERTS, Sophie ULiege; JAMAR, Marie-Cécile ULiege; DELCOURT, Sandrine ULiege et al

Conference (2012, February 16)

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