Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.
Physical and Rehabilitation Medicine Department, University and University Hospital of Liège, Avenue de l'Hopital 1, 4000, Liège, Belgium.
Dysphagia. 2023 Feb;38(1):42-64. doi: 10.1007/s00455-022-10452-2. Epub 2022 Jun 30.
This literature review explores a wide range of themes addressing the links between swallowing and consciousness. Signs of consciousness are historically based on the principle of differentiating reflexive from volitional behaviors. We show that the sequencing of the components of swallowing falls on a continuum of voluntary to reflex behaviors and we describe several types of volitional and non-volitional swallowing tasks. The frequency, speed of initiation of the swallowing reflex, efficacy of the pharyngeal phase of swallowing and coordination between respiration and swallowing are influenced by the level of consciousness during non-pathological modifications of consciousness such as sleep and general anesthesia. In patients with severe brain injury, the level of consciousness is associated with several components related to swallowing, such as the possibility of extubation, risk of pneumonia, type of feeding or components directly related to swallowing such as oral or pharyngeal abnormalities. Based on our theoretical and empirical analysis, the efficacy of the oral phase and the ability to receive exclusive oral feeding seem to be the most robust signs of consciousness related to swallowing in patients with disorders of consciousness. Components of the pharyngeal phase (in terms of abilities of saliva management) and evoked cough may be influenced by consciousness, but further studies are necessary to determine if they constitute signs of consciousness as such or only cortically mediated behaviors. This review also highlights the critical lack of tools and techniques to assess and treat dysphagia in patients with disorders of consciousness.
这篇文献综述探讨了广泛的主题，涉及吞咽和意识之间的联系。意识的迹象在历史上是基于区分反射和意志行为的原则。我们表明，吞咽的组成部分的顺序落在从自愿到反射行为的连续体上，我们描述了几种类型的自愿和非自愿吞咽任务。在非病理性意识改变（如睡眠和全身麻醉）期间，吞咽反射的频率、起始速度、吞咽咽期的效果以及呼吸和吞咽之间的协调性受意识水平的影响。在严重脑损伤的患者中，意识水平与吞咽相关的几个成分有关，例如拔管的可能性、肺炎的风险、喂养方式或与吞咽直接相关的成分，如口腔或咽部异常。基于我们的理论和实证分析，口腔期的效果和接受单独口服喂养的能力似乎是与意识障碍患者吞咽相关的最可靠的意识迹象。咽期的成分（在唾液管理能力方面）和诱发咳嗽可能受意识影响，但需要进一步研究以确定它们是否构成意识本身的迹象或仅仅是皮质介导的行为。这篇综述还强调了评估和治疗意识障碍患者吞咽困难的工具和技术的严重缺乏。
