Physical and Rehabilitation Medicine Department, University Hospital of Liege, Liege, Belgium; Coma Science Group, GIGA-Consciousness, University of Liege, Liege, Belgium; Centre du Cerveau(2), University Hospital of Liege, Liège, Belgium.
Sensation and Perception Research Group GIGA, University of Liege, Liege, Belgium; Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Liege, Liege, Belgium.
Ann Phys Rehabil Med. 2021 Jul;64(4):101403. doi: 10.1016/j.rehab.2020.04.008. Epub 2020 Jul 18.
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.
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.
We analyzed clinical data on the respiratory status, oral feeding and otolaryngologic examination of swallowing in DOC individuals. We analyzed the association of components of swallowing and participant groups (i.e., unresponsive wakefulness syndrome [UWS] and minimally conscious state [MCS]).
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%).
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.
在经历一段昏迷后，一部分严重脑损伤的个体在部分或完全恢复之前仍处于意识改变状态。意识障碍（DOC）患者传统上通过肠内喂养管进行水合和营养支持。然而，意识水平对个体吞咽能力的实际影响仍未得到充分研究。
我们旨在记录 DOC 个体吞咽困难的发生率和特征，并评估吞咽的不同组成部分与意识水平之间的联系。
我们分析了 DOC 个体的呼吸状态、经口喂养和耳鼻喉科吞咽检查的临床数据。我们分析了吞咽组成部分与参与者群体（即无反应觉醒综合征[UWS]和最小意识状态[MCS]）之间的关联。
我们纳入了 92 例 DOC 患者（26 例 UWS 和 66 例 MCS）。总体而言，99%的参与者存在口腔和/或咽期吞咽功能障碍。与 MCS 组相比，UWS 组更频繁地存在气管造口术（69% vs. 24%）、咳嗽反射减弱（27% vs. 54%）和无效口腔期（0% vs. 21%）。
几乎所有的 DOC 参与者都有严重的吞咽困难。一些吞咽组成部分（即气管造口术、咳嗽反射和口腔期吞咽的有效性）与意识有关。特别是，没有 UWS 参与者有有效的口腔期，这表明其存在可能是意识的标志。此外，没有 UWS 参与者可以完全经口进食，而没有 MCS 参与者可以经口摄入普通食物。我们的研究还证实，客观的吞咽评估可以在 DOC 个体中成功完成，并且需要特别注意治疗 DOC 患者的严重吞咽困难。
