Long Hua, Lu Bixia, Tan Qiao, Dai Dongmei, Zeng Fengfei
Department of Clinical Nursing, Second Xiangya Hospital, Central South University, Changsha, China.
Department of Neurosurgery, Second Xiangya Hospital, Central South University, Changsha, China.
Front Neurosci. 2025 Apr 16;19:1595393. doi: 10.3389/fnins.2025.1595393. eCollection 2025.
Patients with disorders of consciousness often have concurrent swallowing difficulties, although the assessment methods, interventions, and their effectiveness have not been systematically described. This study aims to conduct a comprehensive review of assessment methods and rehabilitation interventions for swallowing function in patients with disorders of consciousness.
This scoping review was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guideline. Studies that describe a screening method to examine swallowing function or assess a kind of swallowing management intervention among individuals with disorders of consciousness (DoC) were included. Following Arksey and O'Malley's five-stage framework, databases including CNKI, WangFan, VIP, SinoMed, PubMed, Web of Science, Embase, ClinicalTrials.gov, Cochrane, Scopus, and Medline were systematically searched, from the inception of each database to June 2024. Relevant studies were extracted and analyzed. The main review question is "What has been studied about swallowing function management in patients with DoC?".
Assessment methods for swallowing function in patients with disorders of consciousness primarily included clinical swallowing assessments, scale-based evaluations, and instrument-based assessments. Rehabilitation interventions for swallowing function encompassed sensory stimulation, K-point stimulation, functional oral intake therapy, oral intermittent tube feeding, neuromuscular electrical stimulation, and acupuncture therapy. Most of the included studies did not explicitly specify the timing of swallowing assessment and intervention.
A standardized approach for evaluating and intervening in swallowing function among patients with disorders of consciousness is notably lacking. Selecting appropriate swallowing assessment tools and devising evidence-based management plans tailored to assessment results could improve the swallowing function and patient outcomes. More high-quality designing research that compares the assessment accuracy of different evaluation methods, as well as develops personalized interventions are imperative.
意识障碍患者常并发吞咽困难，尽管评估方法、干预措施及其效果尚未得到系统描述。本研究旨在对意识障碍患者吞咽功能的评估方法和康复干预措施进行全面综述。
本范围综述按照系统评价和Meta分析扩展版的首选报告项目（PRISMA-ScR）指南进行实施和报告。纳入描述对意识障碍（DoC）个体进行吞咽功能检查的筛查方法或评估某种吞咽管理干预措施的研究。遵循阿克斯西和奥马利的五阶段框架，对包括中国知网、万方、维普、中国生物医学文献数据库、PubMed、科学网、Embase、ClinicalTrials.gov、考克兰、Scopus和Medline在内的数据库进行系统检索，检索时间从各数据库建库至2024年6月。提取并分析相关研究。主要综述问题是“关于意识障碍患者吞咽功能管理的研究有哪些？”
意识障碍患者吞咽功能的评估方法主要包括临床吞咽评估、基于量表的评估和基于仪器的评估。吞咽功能的康复干预措施包括感觉刺激、K点刺激、功能性经口摄食疗法、口腔间歇性管饲、神经肌肉电刺激和针刺疗法。大多数纳入研究未明确规定吞咽评估和干预的时机。
明显缺乏针对意识障碍患者吞咽功能进行评估和干预的标准化方法。选择合适的吞咽评估工具并根据评估结果制定循证管理计划，可改善吞咽功能和患者预后。迫切需要开展更多高质量的设计研究，比较不同评估方法的评估准确性，并制定个性化干预措施。
