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

Raciti, Loredana; Raciti, Gianfranco; Pulejo, Grazia; Conti-Nibali, Valeria; Calabrò, Rocco Salvatore

doi:10.3390/medicines9020016

Cited by 7 publications

(2 citation statements)

References 87 publications

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“…Swallowing is a complex, dynamic sensorimotor process, involving voluntary and reflexive motor activity. In particular, the oral phase of swallowing is described as the voluntary (conscious) part of swallowing [28,29]. Therefore, certain components of swallowing, for example lip prehension, lingual propulsion or mastication, might be severely affected by altered states of consciousness.…”

Section: Discussionmentioning

confidence: 99%

Prevalence, recovery and phenotype of dysphagia in patients with ischaemic cerebellar stroke

Schaefer,

Luft,

Seiler

et al. 2024

Euro J of Neurology

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Background and purposeSwallowing is a complex task, moderated by a sophisticated bilateral network including multiple supratentorial regions, the brainstem and the cerebellum. To date, conflicting data exist about whether focal lesions to the cerebellum are associated with dysphagia. Therefore, the aim of the study was to evaluate dysphagia prevalence, recovery and dysphagia pattern in patients with ischaemic cerebellar stroke.MethodsA retrospective analysis of patients consecutively admitted to an academic stroke centre with ischaemic stroke found only in the cerebellum was performed. The presence of dysphagia was the primary end‐point and was assessed by a speech‐language pathologist, according to defined criteria. Dysphagia pattern was evaluated by analysing the videos of the flexible endoscopic evaluation of swallowing. Brain imaging was used to identify lesion size and location associated with dysphagia.ResultsBetween January 2016 and December 2021, 102 patients (35.3% female) with a mean age of 52.8 ± 17.3 years were included. Thirteen (12.7%) patients presented with dysphagia. The most frequently observed flexible endoscopic evaluation of swallowing phenotype was premature spillage (n = 7; 58.3%), whilst significant residues or aspiration did not occur. One patient died (7.7%); the other patients showed improvement of dysphagia and one patient (7.7%) was discharged with dietary restrictions.ConclusionsAlthough the involvement of the cerebellum in deglutition has become increasingly evident, isolated lesions to the cerebellum are less likely to cause clinically relevant and persisting dysphagia compared to other brain regions. The observed dysphagia pattern shows a lack of coordination and control, resulting in premature spillage or fragmented bolus transfer in some patients.

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Section: Discussionmentioning

confidence: 99%

Prevalence, recovery and phenotype of dysphagia in patients with ischaemic cerebellar stroke

Schaefer,

Luft,

Seiler

et al. 2024

Euro J of Neurology

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“…These results are of particular interest in the diagnosis of consciousness, as they may lead to the integration of swallowing behaviors into diagnostic criteria. Moreover, the assessment of swallowing disorders in patients with DoC is essential due to their frequent comorbidities (e.g., aspiration pneumonia, malnutrition) and their functional consequences (e.g., tracheostomy to assist ventilation and gastrostomy for nutritional support) [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Swallowing Assessment in Post-Comatose Patients: A Feasibility Study on the SWADOC Tool

Herr,

Regnier,

Belorgeot

et al. 2024

JCM

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Background: After a severe brain injury and a coma, patients may develop disorders of consciousness (DoC), frequently accompanied by severe dysphagia. The evaluation and therapy of swallowing are therefore essential aspects of their management. Objectives: This study aims to evaluate the SWallowing Assessment in Disorders of Consciousness (SWADOC) tool in the assessment of swallowing in post-comatose patients. Here, we validate its quantitative items, describe preliminary results and identify limitations. Methods: Fourteen post-comatose patients were repeatedly evaluated with the Simplified Evaluation of CONsciousness Disorders (SECONDs) and with the SWADOC. Results: The internal consistency of the oral and pharyngeal subscales of the SWADOC was good. The test–retest reliability showed that all items, all subscores and the total score were stable except for two items (endo-buccal secretions and bronchial congestion). A comparison to the Facial Oral Tract Therapy Swallowing Assessment of Saliva (F.O.T.T-SAS) confirmed that scoring with the SWADOC offers a greater potential for quantitative observations in assessing swallowing abilities among patients with DoC. The SECONDs scores and SWADOC total scores showed a significant positive correlation (τ = 0.78, p < 0.001). Conclusions: This study provides preliminary but encouraging results on the psychometric properties of the SWADOC tool. It shows that this tool is relevant and feasible as a bedside assessment of dysphagia in patients with DoC.

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Neuromedical Comorbidities and Their Management in Patients with DoC

Formisano,

Aloisi,

Pistoia

2023

Coma and Disorders of Consciousness

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

Cited by 7 publications

References 87 publications

Prevalence, recovery and phenotype of dysphagia in patients with ischaemic cerebellar stroke

Prevalence, recovery and phenotype of dysphagia in patients with ischaemic cerebellar stroke

Swallowing Assessment in Post-Comatose Patients: A Feasibility Study on the SWADOC Tool

Neuromedical Comorbidities and Their Management in Patients with DoC

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