Swallowing Disorders in Severe Brain Injury in the Arousal Phase

Abstract

The objective of this study was to determine the clinical characteristics of swallowing disorders in severe brain injury in the arousal phase after coma. Between December 1, 2013 and June 30, 2014, eleven patients with severe acquired brain injury who were admitted to rehabilitation center (Male 81.8 %; 40.7 ± 14.6 years) were included in the study. Evaluation of swallowing included a functional examination, clinical functional swallowing test, and naso-endoscopic swallowing test. All patients had swallowing disorders at admission. The first functional swallowing test showed oral (77.8 %) and pharyngeal (66.7 %) food bolus transport disorders; and alterations in airway protection mechanisms (80 %). Swallowing test under endoscopic control showed a disorder in swallowing coordination in 55.6 % of patients tested. Seven (63.6 %) patients resumed oral feeding within an average of 6 weeks after admission to rehabilitation center and 14 weeks after acquired brain injury. Six (85.7 %) of these seven patients continued to require modified solid and liquid textures. Swallowing disorders are a major concern in severe brain injury in the arousal phase. Early bedside assessment of swallowing is essential for detection of swallowing disorders to propose appropriate medical rehabilitation care to these patients in a state of altered consciousness.

Is oral feeding compatible with an unresponsive wakefulness syndrome?

“…We share Brady's opinion and we insist on the importance of the realization of a systematic swallowing evaluation including instrumental assessments of swallowing such as VFSS or FEES, as they are the only reliable way to identify silent aspiration due to poor cough reflex [40]. Combined to VFSS or FEES, swallowing function clinical evaluation will give complementary information on the pre-swallowing and swallowing abilities [38,39].…”

“…More than 30 years ago, it was demonstrated that some assessments (pre-feeding assessment and functional assessment) could be performed in severe head-injured patients [34]. Since then, other studies showed that objective swallowing assessments [realized with instrumental assessments such as fiberoptic endoscopic exam (FEES) or videofluoroscopy (VFSS)] could be performed safely in patients regardless their level of consciousness [37][38][39]. Brady et al [38] considered that the decision to introduce oral food or liquid in DOC patients should only be made after the completion of an objective swallowing evaluation.…”

Association between oropharyngeal dysphagia, oral functionality, and oral sensorimotor alteration

“…One study found that one in nine older healthy people living in the community will have symptoms that amount to dysphagia, which are likely to be underreported and underrecognized (Holland et al., ). However, the scientific community has been prioritizing studies and discussions on dysphagia in the hospital environment (Miles, Friary, Jackson, Sekula, & Braakhuis, ; Su et al., ), in progressive neurological diseases (Alali, Ballard, & Bogaardt, ; Troche, Schumann, Brandimore, Okun, & Hegland, ), and in severe cases (Bremare, Rapin, Veber, Beuret‐Blanquart, & Verin, ; Saito, Hayashi, Nakazawa, & Ota, ). It is known that dysphagia is associated with an increase in early mortality (Wilson, ), aspiration pneumonia (Martino et al., ), malnutrition, dehydration (Morris, ), and longer hospital stays (Cabre et al., ).…”

Aspectos funcionais da deglutição na população com trauma cranioencefálico

“…Schurr et al 73 63 , 75% dos indivíduos já tinham via oral introduzida em 17 dias de acompanhamento. Para todos os estudos 33,63,74 , a evolução relacionou-se com a gravidade do TCE, aspectos cognitivos, com ECG e com resultado inicial em escala funcional de deglutição 33,63,74 .…”

“…Hansen et al 33 , em 2008, verificaram que em, no máximo, 126 dias todos os indivíduos com TCE retornaram com via oral sem restrições; e após 56 dias mais de 50% dos indivíduos já estavam com dieta por via oral sem restrições. Já para Bremare et al74 , 2016, 63,6% dos indivíduos retomaram a alimentação oral em uma média de 44 dias e apenas um (9,1%) recuperou a alimentação oral…”