Publications of Aude Lagier
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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 detailApproche expérimentale de la collision entre les plis vocaux en phonation et du phonotraumatisme : Études in vivo et sur larynx humains excisés
Lagier, Aude ULiege

Doctoral thesis (2016)

The collision between the vocal folds during phonation is a physiological phenomenon with a powerful role in the synchronization of their vibration. This collision is also a component of the phonotrauma ... [more ▼]

The collision between the vocal folds during phonation is a physiological phenomenon with a powerful role in the synchronization of their vibration. This collision is also a component of the phonotrauma. The role of phonotrauma in the pathophysiology of dysphonia is commonly accepted but its nature still unclear and its quantification remains difficult. This work proposes, an in vivo study in healthy subjects, and ex vivo ones on excised human larynges. The purpose of this work was to study the laryngeal behavior when the larynx is subjected to extremely high subglottic pressure. In vivo, the shouted voice was recorded with constant measure of subglottic pressure. Ex vivo, the subglottic pressure was directly manipulated independently from other parameters. The ex vivo study required a methodological development to modernize the experimental bench used for animal larynges studies and to adapt it to the human larynx. The results showed, in healthy speakers the existence of a "plateau" in the vocal intensity and in the electroglottographic signal for very high levels of subglottic pressure. The studies on excised larynges measured the collision force between the vocal folds and its changes depending on subglottic pressure. They also highlighted the existence of a "plateau" in the collision force when subglottic pressure was very high. The observations presented in this work are, to our knowledge, unprecedented. They have important clinical interest for understanding the concept of phonotrauma. Their interpretation in physical terms remains very incomplete. [less ▲]

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