Is oral feeding compatible with an unresponsive wakefulness syndrome?

Mélotte, Evelyne; Maudoux, Audrey; Delhalle, Sabrina; Martial, Charlotte; Antonopoulos, Georgios; Larroque, Stephen Karl; Wannez, Sarah; Faymonville, Marie-Élisabeth; Kaux, Jean-François; Laureys, Steven; Gosseries, Olivia; Vanhaudenhuyse, Audrey

doi:10.1007/s00415-018-8794-y

Cited by 27 publications

(21 citation statements)

References 42 publications

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“…Oral feeding implies a full and complex oral phase, which as a whole is considered a sign of consciousness. However, it is not known which of its components are necessary to infer the presence of 'conscious' swallowing as opposed to reflex [49].…”

Section: Discussionmentioning

confidence: 99%

Joint Neuropsychological Assessment through Coma/Near Coma and Level of Cognitive Functioning Assessment Scales Reduces Negative Findings in Pediatric Disorders of Consciousness

et al. 2020

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The present study aimed to: (a) characterize the emergence to a conscious state (CS) in a sample of children and adolescents with severe brain injury during the post-acute rehabilitation and through two different neuropsychological assessment tools: the Rappaport Coma/Near Coma Scale (CNCS) and Level of Cognitive Functioning Assessment Scale (LOCFAS); (b) compare the evolution in patients with brain lesions due to traumatic and non-traumatic etiologies; and (c) describe the relationship between the emergence to a CS and some relevant clinical variables. In this observational prospective longitudinal study, 92 consecutive patients were recruited. Inclusion criteria were severe disorders of consciousness (DOC), Glasgow Coma Scale (GCS) score ≤8 at insult, age 0 to 18 years, and direct admission to inpatient rehabilitation from acute care. The main outcome measures were CNCS and LOCFAS, both administered three and six months after injury. The cohort globally shifted towards milder DOC over time, moving from overall ‘moderate/near coma’ at three months to ‘near/no coma’ at six months post-injury. The shift was captured by both CNCS and LOCFAS. CNCS differentiated levels of coma at best, while LOCFAS was superior in characterizing the emergence from coma. Agreement between scales was fair, and reduced negative findings at less than 10%. Patients with traumatic brain injury (TBI) vs. non-traumatic brain injury (NTBI) were older and had neurosurgical intervention more frequently. No relation between age and the level of consciousness was found overall. Concurrent administration of CNCS and LOCFAS reduced the rate of false negatives and better detected signs of arousal and awareness. This provides indication to administer both tools to increase measurement precision.

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Section: Discussionmentioning

confidence: 99%

Joint Neuropsychological Assessment through Coma/Near Coma and Level of Cognitive Functioning Assessment Scales Reduces Negative Findings in Pediatric Disorders of Consciousness

et al. 2020

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“…Our second hypothesis is that the subscores (oral phase and pharyngeal phase) and the total score are related to the patient's level of consciousness. Moreover, based on previous studies ( 13 , 15 ), we expect that UWS patients will be at level 0 for oral phase items 1, 3, and 4 of the SWADOC-scored: no mouth opening at spoon approach, no spontaneous lip prehension, and no appropriate tongue propulsion.…”

Section: Methods and Analysismentioning

confidence: 95%

“…First, we examined literature in the field of consciousness and swallowing, and looked for existing scales (deductive method). The construction of the tool was inspired by actual knowledge on dysphagia in DOC patients based on the few studies dedicated to swallowing in DOC patients ( 13 , 15 , 18 , 20 ).…”

Section: Methods and Analysismentioning

confidence: 99%

“…Almost all patients with DOC have severe dysphagia ( 13 ), requiring the use of ventilation and nutritional support (i.e., tracheostomy, gastrostomy) to limit the occurrence of comorbidities (e.g., bronchopulmonary infection, undernutrition). Individuals with DOC classically receive hydration and nutrition through an enteral feeding tube ( 14 ), and a large majority will not be able to return to exclusively oral feeding ( 13 , 15 ). An objective swallowing assessment using fiber-optic endoscopic or videofluoroscopic swallowing evaluations is required in patients with DOC, for whom the possibility of partial or total oral feeding is being considered.…”

Section: Introductionmentioning

confidence: 99%

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The Development and Validation of the SWADOC: A Study Protocol for a Multicenter Prospective Cohort Study

et al. 2021

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Background: After a coma, patients with severe brain injury may present disorders of consciousness (DOC). A substantial proportion of these patients also suffer from severe dysphagia. Assessment of and therapy for swallowing disabilities of patients with DOC are essential because dysphagia has major functional consequences and comorbidities. Dysphagia evaluation in patients with DOC is impeded by the lack of adapted tools. The first aim of this study was to create a new tool, the SWallowing Assessment in Disorders Of Consciousness (SWADOC), and propose a validation protocol. The SWADOC was developed to help therapists assess factors related to swallowing in patients with DOC. The second aim was to investigate the relationship between patients' level of consciousness and SWADOC items and scores.Method/Design: In this multicenter prospective cohort, 104 patients with DOC will be tested three times over five consecutive days with the SWADOC. Statistical analyses will focus on the reliability and validity of the SWADOC, especially the intrarater and interrater reliability, internal consistency, measures of dispersion, and concurrent validity with the Facial Oral Tract Therapy Swallowing Assessment of Saliva (FOTT-SAS). The level of consciousness will be assessed with the Simplified Evaluation of CONsciousness Disorders (SECONDs) and the Coma Recovery Scale-Revised (CRS-R).Discussion: The assessment of swallowing abilities among patients with DOC is the first necessary step toward the development of a customized dysphagia care plan. A validated scoring tool will be essential for clinicians to better assess dysphagia in patients with DOC and document the evolution of their disorders.Trial Registration: NCT04706689.

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“…Scales akin to the CRS-R yet customized to specific settings, such as intensive care, are emerging [33]. The utility of even more subtle clinical signs suggestive of preserved responsiveness is increasingly recognized: for instance, low-cost bedside markers that lack sufficient formal evidence but, nevertheless, appear promising include command following as assessed by automated pupillometry [34,35]; resistance to eye opening [36]; habituation of the auditory startle reflex [37]; quantitative assessment of visual tracking [38,39]; standardized rating of spontaneous motor behavior [40]; possibility of oral feeding [41]; exploitation of vegetative responses, such as increased salivation following gustatory stimuli [42], olfactory sniffing [43], or modulations of the cardiac cycle [44,45]; evidence of circadian rhythms [46]; and observations made by nursing staff [47]. Simple clinical tools may provide substantial insights-carinal stimulation (by tracheal suctioning in an intubated or tracheostomized patient [48]) can produce intense arousal and improve motor responsiveness-suggesting the potential for progress in the acute phase or (potentially) responsiveness to pharmacological arousal agents in the chronic phase.…”

Section: Tiermentioning

confidence: 99%

A Precision Medicine Framework for Classifying Patients with Disorders of Consciousness: Advanced Classification of Consciousness Endotypes (ACCESS)

et al. 2021

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Background: Consciousness in patients with brain injury is traditionally assessed based on semiological evaluation at the bedside. This classification is limited because of low granularity, ill-defined and rigid nomenclatures incompatible with the highly fluctuating nature of consciousness, failure to identify specific brain states like cognitive motor dissociation, and neglect for underlying biological mechanisms. Here, the authors present a pragmatic framework based on consciousness endotypes that combines clinical phenomenology with all essential physiological and biological data, emphasizing recovery trajectories, therapeutic potentials and clinical feasibility. Methods:The Neurocritical Care Society's Curing Coma Campaign identified an international group of experts who convened in a series of online meetings between May and November 2020 to discuss and propose a novel framework for classifying consciousness. Results:The expert group proposes Advanced Classification of Consciousness Endotypes (ACCESS), a tiered multidimensional framework reflecting increasing complexity and an aspiration to consider emerging and future approaches. Tier 1 is based on clinical phenotypes and structural imaging. Tier 2 adds functional measures including EEG, PET and functional MRI, that can be summarized using the Arousal, Volition, Cognition and Mechanisms (AVCM) score (where "Volition" signifies volitional motor responses). Finally, Tier 3 reflects dynamic changes over time with a (theoretically infinite) number of physiologically distinct states to outline consciousness recovery and identify opportunities for therapeutic interventions. Conclusions:Whereas Tiers 1 and 2 propose an approach for low-resource settings and state-of-the-art expertise at leading academic centers, respectively, Tier 3 is a visionary multidimensional consciousness paradigm driven by continuous incorporation of new knowledge while addressing the Curing Coma Campaign's aspirational goals.

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Is oral feeding compatible with an unresponsive wakefulness syndrome?

Cited by 27 publications

References 42 publications

Joint Neuropsychological Assessment through Coma/Near Coma and Level of Cognitive Functioning Assessment Scales Reduces Negative Findings in Pediatric Disorders of Consciousness

Joint Neuropsychological Assessment through Coma/Near Coma and Level of Cognitive Functioning Assessment Scales Reduces Negative Findings in Pediatric Disorders of Consciousness

The Development and Validation of the SWADOC: A Study Protocol for a Multicenter Prospective Cohort Study

A Precision Medicine Framework for Classifying Patients with Disorders of Consciousness: Advanced Classification of Consciousness Endotypes (ACCESS)

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