The swallow, a target to follow the restauration of consciousness in acquired brain injury

Abstract

Introduction: Brain injuries are the leading cause of disorders of consciousness and are often complicated by swallowing disorders. The aim of this study was to determine whether a correlation existed between swallowing and level of consciousness in patients with acquired brain injury.

Methods: This pilot and observational study was conducted in the post intensive care coma arousal rehabilitation on 10 patients with acquired brain injury with disorder of consciousness and swallowing disorder evaluated with the Coma Recovery Scale-Revised (CRS-R) CRS-R evaluation or WHIM scale and a SWallowing Disorders in Disorders of Consciousness (SWADOC) assessment, both conducted in the same timeline frame. Swallowing function was assessed using the SWADOC scale. The level of consciousness was evaluated with the CRS-R and the Wessex Head Injury Matrix (WHIM). A Pearson correlation analysis was performed to examine the potential relationship between swallowing capacity and level of consciousness.

Results: A strong correlation was identified between the CRS-R and WHIM scales with the SWADOC evaluation. Indeed, the correlation between SWADOC and CRS-R reached 0.70, while the correlation between SWADOC and WHIM was above 0.60.

Conclusion: These findings highlight the importance of integrating swallowing evaluation within the multimodal assessment of consciousness recovery.

Fig. 1

Flowchart resenting the number of patients included after meeting the inclusion criteria and exclusion criteria. Of 19 patients, 10 patients remained, with a mean ± SD of 10.80 ± 4.02 observations per patient. After exclusion of the missing SWADOC and CRS-R data, only 31 observations concerning 9 patients remained, with a mean ± SD of 3.44 ± 1.74 observations per patient (minimum = 1, maximum = 6). After exclusion of missing SWADOC and WHIM data, only 36 observations remained for 10 patients, with a mean ± SD of 3.60 ± 2.46 observations per patient (minimum = 1, maximum = 9).

Fig. 2

Box plots representing thanks to a Pearson correlation the relationship between level of consciousness separated into UWS, MCS–, MCS+, and EMCS (in the abscissa), and the total, oral, and pharyngeal score of the SWADOC (in the ordinates). Individual observations are represented by circles. The Pearson correlation coefficient between CRS-R and total SWADOC was estimated at 0.78 (95% CI 0.28 to 0.95, p = 0.008); between CRS-R and oral SWADOC it was estimated at 0.76 (95% CI 0.22 to 0.94, p = 0.01); between CRS-R and pharyngeal SWADOC it was estimated at 0.70 (95% CI 0.23 to 0.90, p = 0.009); between oral and pharyngeal SWADOC it was estimated at 0.76 (95% CI 0.44 to 0.91, p = 0.0005).