Abstract
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.
Highlights
After a coma, some patients with severe brain injury will develop an altered state of consciousness before recovering partial or complete consciousness
A validated scoring tool will be essential for clinicians to better assess dysphagia in patients with Disorders of consciousness (DOC) and document the evolution of their disorders
Disorders of consciousness (DOC) consist of three states ranging from no awareness and no arousal to the preservation of arousal with fluctuating awareness (1): coma (2), vegetative state/unresponsive wakefulness syndrome (UWS) (3, 4), and minimally conscious state (MCS) (5)
Summary
Some patients with severe brain injury will develop an altered state of consciousness before recovering partial or complete consciousness. Patients with UWS typically exhibit only oromotor reflexes, blinks, and startle responses, as well as withdrawal from noxious stimuli (3). These patients do not respond to command and do not show visual pursuit or fixation. Individuals with MCS show reproducible but inconsistent signs of consciousness, such as following commands, visual pursuit or fixation, and localization of noxious stimuli (5). The Simplified Evaluation of CONsciousness Disorders (SECONDs) scale (10, 11) was developed based on the most prevalent signs of consciousness observed using the CRS-R (12). This tool is quick and easy to administer (11). The second aim was to investigate the relationship between patients’ level of consciousness and SWADOC items and scores
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