Feasibility of Instrumental Swallowing Assessments in Patients With Prolonged Disordered Consciousness While Undergoing Inpatient Rehabilitation

Brady, Susan; Pape, Theresa; Darragh, Meghan; Escobar, Nelson; Rao, Noel

doi:10.1097/htr.0b013e3181a8d38e

Cited by 11 publications

(4 citation statements)

References 18 publications

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“…Authors on this topic state that all patients should have an instrumental assessment but provide limited evidence for their view (Brady et al . , , O'Neil‐Pirozzi et al . ).…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, neither of the studies by Brady et al . (, ) reported how many patients had a videofluoroscopy versus FEES, and therefore this cannot be compared to the available literature.…”

Section: Discussionmentioning

confidence: 99%

“…A small number of studies focus on dysphagia, and specifically the use of instrumental swallowing assessment and appropriateness of therapeutic feeding (having small amounts of oral intake for therapeutic purposes) in this population (Brady et al . , , O'Neil‐Pirozzi et al . ).…”

Section: Introductionmentioning

confidence: 99%

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Speech and language therapy best practice for patients in prolonged disorders of consciousness: a modified Delphi study

Roberts

Greenwood

2019

Intl J Lang & Comm Disor

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Background: Research regarding speech and language therapy (SLT) for patients in prolonged disorders of consciousness (PDOC) is very limited. The Royal College of Physicians' (RCP) PDOC guideline provides recommendations regarding best practice, but does not give detail about many aspects of assessment and management. As a result, SLTs have little information regarding best practice for this complex patient group. Aims: To ascertain the degree of consensus amongst expert SLTs regarding SLT best practice for patients in PDOC in order to inform the future development of SLT guidelines. Methods & Procedures:A two-round modified Delphi technique was used. Participants were recruited from major trauma centres and neurorehabilitation units in England and national SLT clinical excellence networks. To participate, SLTs had to be working on neurosciences, neurosurgery or neurorehabilitation wards that treat adult PDOC patients, or have ࣙ 3 years' experience of working with PDOC. The Round 1 questionnaire was developed from the RCP's PDOC guideline and from existing research literature. It included ratings of statements regarding SLT best practice using Likert or temporal scales, with optional written justifications/comments and opportunities for participants to suggest additional statements. The percentage agreement amongst participants was calculated for each Round 1 statement. Written justifications for views were analysed using content analysis. The Round 2 questionnaire contained both quantitative and qualitative feedback from Round 1, allowing participants to reappraise their views. The final degree of consensus was then calculated after completion of both rounds. Outcomes & Results: A total of 40 SLTs completed Round 1, with 36 completing Round 2 (90% response rate). Consensus was achieved for 87% (67/77) of statements regarding best practice on a variety of topics including communication, tracheostomy, dysphagia and oral hypersensitivity. The statements represented assessment, management and service delivery components of SLT practice. Conclusions & Implications: A total of 67 best practice statements were created. The statements provide a useful starting point for the creation of SLT guidelines to support best practice, and also have the potential to be used to advocate for the provision of SLT services for patients in PDOC. Future studies should focus on whether the expert opinion generated here can be borne out in experimental research.

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“…Authors on this topic state that all patients should have an instrumental assessment but provide limited evidence for their view (Brady et al . , , O'Neil‐Pirozzi et al . ).…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Speech and language therapy best practice for patients in prolonged disorders of consciousness: a modified Delphi study

Roberts

Greenwood

2019

Intl J Lang & Comm Disor

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“…A recent review underlines the importance of using FEES [52,53] or even a VFSS [46], since patients diagnosed by means of these two instruments have better oral intake outcomes than those who do not. Then, a systematic evaluation of swallowing should be performed to guide clinical decisions about oral intake and not rely on level of consciousness [28,54]. Although FEES has been suggested as the gold standard in dysphagia assessment and management [55], further studies are needed to better understand its use as well as the pathomechanisms of swallowing in patients with DOC.…”

Section: Assessment Of Dysphagiamentioning

confidence: 99%

Neurogenic Dysphagia and Nutrition in Disorder of Consciousness: An Overview with Practical Advices on an “Old” but Still Actual Clinical Problem

Raciti

Pulejo

et al. 2022

Medicines

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Neurogenic dysphagia is a difficulty in swallowing food caused by disease or impairment of the nervous system, including stroke and traumatic brain injury. The most clinically apparent complication of neurogenic dysphagia is pulmonary aspiration, which may manifest itself acutely as choking or coughing, respiratory distress, wheezing, gasping or gurgling, and tachycardia. However, chronic symptoms, including weight loss, production of excessive oral secretions and aspiration pneumonia, may be also present, especially in patients with a disorder of consciousness (DOC). Usually, patients with dysphagia after the acute phase need to be treated with enteral nutrition using a feeding tube. This avoids patient malnutrition and supports the rehabilitation program. This narrative review aims to investigate dysphagia and its complications and management in patients with DOC. Clinical indications and practical advice on how to assess and treat this complex problem are also provided.

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Percutaneous endoscopic gastrostomy versus percutaneous radiological gastrostomy for swallowing disturbances

Yao

Zhao

Xie

et al. 2016

Cochrane Database of Systematic Reviews

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Feasibility of Instrumental Swallowing Assessments in Patients With Prolonged Disordered Consciousness While Undergoing Inpatient Rehabilitation

Cited by 11 publications

References 18 publications

Speech and language therapy best practice for patients in prolonged disorders of consciousness: a modified Delphi study

Speech and language therapy best practice for patients in prolonged disorders of consciousness: a modified Delphi study

Neurogenic Dysphagia and Nutrition in Disorder of Consciousness: An Overview with Practical Advices on an “Old” but Still Actual Clinical Problem

Percutaneous endoscopic gastrostomy versus percutaneous radiological gastrostomy for swallowing disturbances

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