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Jang SH, Kwak S, Lee MY. Prognosis prediction for impaired consciousness recovery in stroke patients using videofluoroscopic swallowing study: A retrospective observational study. Medicine (Baltimore) 2023; 102:e33860. [PMID: 37335688 DOI: 10.1097/md.0000000000033860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Prognosis prediction of impaired consciousness is clinically important for establishing therapeutic strategies, determining a rehabilitative goal and functional outcome, and estimating rehabilitative therapy duration. In this study, we investigated the prognosis prediction value of videofluoroscopic swallowing study (VFSS) in recovery of impaired consciousness in stroke patients. Fifty-one patients with impaired consciousness who underwent VFSS during the early stage of stroke between 2017 and 2021 were recruited in this retrospective study. VFSS were performed using modified Logemann protocol, and bonorex was used as the liquid contrast medium. The penetration-aspiration scale (PAS) was graded for all patients, and they were classified into 2 groups depending on the presence of aspiration on liquid material: the aspiration-positive group with a PAS score ≥ 6, and the aspiration-negative group with a PAS score < 6. The coma recovery scale-revised (CRS-R) was used to evaluate patients' conscious state at the time of VFSS and 3 months after. Statistical analysis was performed using independent t test and Pearson's correlation. The increase in total CRS-R score from time of VFSS to 3 months later was greater in aspiration-negative group than in aspiration-positive group (P < .05). A moderate negative correlation was observed between liquid PAS score and the increase in total CRS-R score (r = -0.499, P < .05). Among 6 CRS-R subscales, a strong negative correlation was observed between liquid PAS score and the communication score increase (r = -0.563, P < .05), while moderate negative correlations were detected between liquid PAS score and the increases in auditory (r = -0.465, P < .05), motor (r = -0.372, P < .05), oromotor (r = -0.426, P < .05), and arousal (r = -0.368, P < .05) scores. We observed that patients without aspiration on videofluoroscopic swallowing study showed better recovery of impaired consciousness, and the degree of penetration and aspiration had a predictive value for impaired consciousness prognosis in the early stage of stroke.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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2
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Mélotte E, Maudoux A, Panda R, Kaux JF, Lagier A, Herr R, Belorgeot M, Laureys S, Gosseries O. Links Between Swallowing and Consciousness: A Narrative Review. Dysphagia 2023; 38:42-64. [PMID: 35773497 DOI: 10.1007/s00455-022-10452-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 12/06/2021] [Indexed: 01/27/2023]
Abstract
This literature review explores a wide range of themes addressing the links between swallowing and consciousness. Signs of consciousness are historically based on the principle of differentiating reflexive from volitional behaviors. We show that the sequencing of the components of swallowing falls on a continuum of voluntary to reflex behaviors and we describe several types of volitional and non-volitional swallowing tasks. The frequency, speed of initiation of the swallowing reflex, efficacy of the pharyngeal phase of swallowing and coordination between respiration and swallowing are influenced by the level of consciousness during non-pathological modifications of consciousness such as sleep and general anesthesia. In patients with severe brain injury, the level of consciousness is associated with several components related to swallowing, such as the possibility of extubation, risk of pneumonia, type of feeding or components directly related to swallowing such as oral or pharyngeal abnormalities. Based on our theoretical and empirical analysis, the efficacy of the oral phase and the ability to receive exclusive oral feeding seem to be the most robust signs of consciousness related to swallowing in patients with disorders of consciousness. Components of the pharyngeal phase (in terms of abilities of saliva management) and evoked cough may be influenced by consciousness, but further studies are necessary to determine if they constitute signs of consciousness as such or only cortically mediated behaviors. This review also highlights the critical lack of tools and techniques to assess and treat dysphagia in patients with disorders of consciousness.
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Affiliation(s)
- Evelyne Mélotte
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.
- Physical and Rehabilitation Medicine Department, University and University Hospital of Liège, Avenue de l'Hopital 1, 4000, Liège, Belgium.
- Centre du Cerveau², University Hospital of Liège, Liège, Belgium.
| | - Audrey Maudoux
- Sensation and Perception Research Group, GIGA, University and University Hospital of Liège, Liège, Belgium
- Otorhinolaryngology Head and Neck Surgery Department, Robert Debré University Hospital, APHP, Paris, France
| | - Rajanikant Panda
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
| | - Jean-François Kaux
- Physical and Rehabilitation Medicine Department, University and University Hospital of Liège, Avenue de l'Hopital 1, 4000, Liège, Belgium
| | - Aude Lagier
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Liège, Liège, Belgium
| | - Roxanne Herr
- Department of Speech and Language Pathology, Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - Marion Belorgeot
- Physical and Rehabilitation Medicine Department, University Hospital of Nîmes, Nîmes, France
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau², University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau², University Hospital of Liège, Liège, Belgium
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3
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Mat B, Sanz L, Arzi A, Boly M, Laureys S, Gosseries O. New behavioral signs of consciousness in patients with severe brain injuries. Semin Neurol 2022; 42:259-272. [PMID: 35738292 DOI: 10.1055/a-1883-0861] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Beril Mat
- Neurology, University of Wisconsin-Madison, Madison, United States.,Coma Science Group, University of Liege, Liege, Belgium
| | - Leandro Sanz
- Coma Science Group, University of Liege, Liege, Belgium
| | - Anat Arzi
- The Hebrew University of Jerusalem Department of Cognitive and Brain Sciences, Jerusalem, Israel
| | - Melanie Boly
- Neurology, University of Wisconsin-Madison, Madison, United States.,Psychiatry, University of Wisconsin-Madison, Madison, United States
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4
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Michelutti A, D'Angelo M, Szulin M, Stroppolo G, Bargellesi S, Giorgini T, Quattrin R, Biasutti E. The tracheotomy tube weaning in patients with severe acquired brain injury: comparison of two operative procedures in a postacute rehabilitation hospital. Eur J Phys Rehabil Med 2021; 57:347-355. [PMID: 33448751 DOI: 10.23736/s1973-9087.21.06342-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Despite the high frequency of tracheotomy in severe acquired brain injury (sABI) patients, available literature about the weaning procedure is mainly represented by expert opinions with no standardized and evidence-based criteria. AIM The Institute of Physical and Rehabilitation Medicine "Gervasutta" adopted a new decannulation procedure, recommended by the Italian Society of Physical Medicine and Rehabilitation (SIMFER). This study evaluates whether the new procedure helps to improve the decannulation process of sABI patients. DESIGN A prospective observational with historical control was performed by dividing sABI patients into two groups depending on whether they were treated with or without the new procedure. SETTING The Department of Neurorehabilitation of the Institute of Physical and Rehabilitation Medicine "Gervasutta" in Udine, Italy. POPULATION sABI patients with tracheal cannula admitted to the Institute of Physical and Rehabilitation Medicine "Gervasutta" from January 2015 to March 2019. METHODS Clinical data were collected as both process and outcome indicators before and after the adoption of the new procedure. Data have been processed with Simple Interactive Statistical Analysis (SISA; Irving, TX, USA) software. RESULTS A sample of 141 patients was analysed. Among the 141 patients, 57 (40.4%) were treated with the new procedure. No differences were found between the two groups in terms of complications, functional independence measure (FIM), or level of cognitive functioning (LCF) at the admission. When the new procedure was applied, the decannulation rate was significantly higher (OR=1.8; 95% CI=1.2-9.8; P=0.01) and the time (days) between admission and oral feeding resumption was significantly lower (P<0.001; 95% CI=-10, -34 days). CONCLUSIONS The introduction of the new protocol allowed the safe achievement of both oral feeding resumption and decannulation, which are two of the main early rehabilitation goals. CLINICAL REHABILITATION IMPACT The standardization of the decannulation process has determined the achievement of a significantly faster oral feeding resumption and an increase in the decannulation rate during the rehabilitation of sABI patients.
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Affiliation(s)
- Alessandro Michelutti
- Institute of Physical and Rehabilitation Medicine "Gervasutta", Friuli Centrale University Health Service (ASU-FC), Udine, Italy
| | - Matteo D'Angelo
- Department of Medicine, University of Udine, Udine, Italy - matteo.dangeluniud.it
| | - Michela Szulin
- Institute of Physical and Rehabilitation Medicine "Gervasutta", Friuli Centrale University Health Service (ASU-FC), Udine, Italy
| | - Giulia Stroppolo
- Institute of Physical and Rehabilitation Medicine "Gervasutta", Friuli Centrale University Health Service (ASU-FC), Udine, Italy
| | - Stefano Bargellesi
- Unit of Severe Brain Injury, Department of Physical and Rehabilitation Medicine, Marca Trevigiana AULSS, Treviso Hospital, Treviso, Italy
| | - Tullio Giorgini
- Institute of Physical and Rehabilitation Medicine "Gervasutta", Friuli Centrale University Health Service (ASU-FC), Udine, Italy
| | - Rosanna Quattrin
- Unit of Accreditation, Clinical Risk Management and Performance Assessment, Friuli Centrale University Health Service (ASU-FC), Udine, Italy
| | - Emanuele Biasutti
- Institute of Physical and Rehabilitation Medicine "Gervasutta", Friuli Centrale University Health Service (ASU-FC), Udine, Italy
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Hakiki B, Pancani S, Draghi F, Portaccio E, Tofani A, Binazzi B, Anna Maria R, Scarpino M, Macchi C, Cecchi F. Decannulation and improvement of responsiveness in patients with disorders of consciousness. Neuropsychol Rehabil 2020; 32:520-536. [PMID: 33100115 DOI: 10.1080/09602011.2020.1833944] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Decannulation is a rehabilitation milestone in patients with Disorders of Consciousness (DoC). investigate the relationship between decannulation and improvement of responsiveness (IR) in DoC. 236 tracheostomized patients with severe Acquired Brain Injury and DoC admitted in the Intensive Rehabilitation Unit were retrospectively included. They received personalized interdisciplinary rehabilitation. At discharge, IR was evaluated. The association between IR and demographic/clinical data was investigated using a logistic regression analysis, both in the Unresponsive Wakefulness Syndrome (UWS) and Minimal Consciousness State (MCS) group, divided according to their Coma Recovery Scale-Revised score at admission. In the UWS group (N = 107), only decannulation was associated with IR at discharge (OR: 5.94, CI: 2.08-16.91, p = .001). In the MCS group (N = 129) time post-injury (OR: 0.983, CI: 0.97-0.99, p = .012) and decannulation were associated with IR at discharge (OR: 17.9, CI: 6.39-50.13, p < .001). Decannulation and IR were found to be strongly related, independently from the initial clinical state. While the retrospective nature of the study could not exclude that decannulation may be a consequence of a spontaneous recovery, the obtained results may disclose its potential influence on the clinical history of patients with DoC.
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Affiliation(s)
- Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | | | - Emilio Portaccio
- SOC Neurologia, Ospedale San Giovanni di Dio, Firenze, AUSL Toscana Centro, Florence, Italy
| | | | | | | | - Maenia Scarpino
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, SODc Neurofisiopatologia, AOU Careggi, Florence, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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6
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Mélotte E, Maudoux A, Delhalle S, Lagier A, Thibaut A, Aubinet C, Kaux JF, Vanhaudenhuyse A, Ledoux D, Laureys S, Gosseries O. Swallowing in individuals with disorders of consciousness: A cohort study. Ann Phys Rehabil Med 2020; 64:101403. [PMID: 32535170 DOI: 10.1016/j.rehab.2020.04.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/15/2020] [Accepted: 04/18/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND After a period of coma, a proportion of individuals with severe brain injury remain in an altered state of consciousness before regaining partial or complete recovery. Individuals with disorders of consciousness (DOC) classically receive hydration and nutrition through an enteral-feeding tube. However, the real impact of the level of consciousness on an individual's swallowing ability remains poorly investigated. OBJECTIVE We aimed to document the incidence and characteristics of dysphagia in DOC individuals and to evaluate the link between different components of swallowing and the level of consciousness. METHODS We analyzed clinical data on the respiratory status, oral feeding and otolaryngologic examination of swallowing in DOC individuals. We analyzed the association of components of swallowing and participant groups (i.e., unresponsive wakefulness syndrome [UWS] and minimally conscious state [MCS]). RESULTS We included 92 individuals with DOC (26 UWS and 66 MCS). Overall, 99% of the participants showed deficits in the oral and/or pharyngeal phase of swallowing. As compared with the MCS group, the UWS group more frequently had a tracheostomy (69% vs 24%), with diminished cough reflex (27% vs 54%) and no effective oral phase (0% vs 21%). CONCLUSION Almost all DOC participants had severe dysphagia. Some components of swallowing (i.e., tracheostomy, cough reflex and efficacy of the oral phase of swallowing) were related to consciousness. In particular, no UWS participant had an efficient oral phase, which suggests that its presence may be a sign of consciousness. In addition, no UWS participant could be fed entirely orally, whereas no MCS participant orally received ordinary food. Our study also confirms that objective swallowing assessment can be successfully completed in DOC individuals and that specific care is needed to treat severe dysphagia in DOC.
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Affiliation(s)
- Evelyne Mélotte
- Physical and Rehabilitation Medicine Department, University Hospital of Liege, Liege, Belgium; Coma Science Group, GIGA-Consciousness, University of Liege, Liege, Belgium; Centre du Cerveau(2), University Hospital of Liege, Liège, Belgium.
| | - Audrey Maudoux
- Sensation and Perception Research Group GIGA, University of Liege, Liege, Belgium; Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Liege, Liege, Belgium
| | - Sabrina Delhalle
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Liege, Liege, Belgium
| | - Aude Lagier
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Liege, Liege, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA-Consciousness, University of Liege, Liege, Belgium; Centre du Cerveau(2), University Hospital of Liege, Liège, Belgium
| | - Charlène Aubinet
- Coma Science Group, GIGA-Consciousness, University of Liege, Liege, Belgium; Centre du Cerveau(2), University Hospital of Liege, Liège, Belgium
| | - Jean-François Kaux
- Physical and Rehabilitation Medicine Department, University Hospital of Liege, Liege, Belgium
| | - Audrey Vanhaudenhuyse
- Sensation and Perception Research Group GIGA, University of Liege, Liege, Belgium; Algology Department, University Hospital of Liege, Liege, Belgium
| | - Didier Ledoux
- Intensive Care Unit Department, University Hospital of Liege, Liege, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liege, Liege, Belgium; Centre du Cerveau(2), University Hospital of Liege, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liege, Liege, Belgium; Centre du Cerveau(2), University Hospital of Liege, Liège, Belgium
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7
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Ramírez-Orozco RE, García-Ruiz R, Morales P, Villalón CM, Villafán-Bernal JR, Marichal-Cancino BA. Potential metabolic and behavioural roles of the putative endocannabinoid receptors GPR18, GPR55 and GPR119 in feeding. Curr Neuropharmacol 2020; 17:947-960. [PMID: 31146657 PMCID: PMC7052828 DOI: 10.2174/1570159x17666190118143014] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/26/2018] [Accepted: 11/20/2018] [Indexed: 01/28/2023] Open
Abstract
Endocannabinoids are ancient biomolecules involved in several cellular (e.g., metabolism) and physiological (e.g., eating behaviour) functions. Indeed, eating behaviour alterations in marijuana users have led to investigate the orexigen-ic/anorexigenic effects of cannabinoids in animal/human models. This increasing body of research suggests that the endo-cannabinoid system plays an important role in feeding control. Accordingly, within the endocannabinoid system, canna-binoid receptors, enzymes and genes represent potential therapeutic targets for dealing with multiple metabolic and behav-ioural dysfunctions (e.g., obesity, anorexia, etc.). Paradoxically, our understanding on the endocannabinoid system as a cel-lular mediator is yet limited. For example: (i) only two cannabinoid receptors have been classified, but they are not enough to explain the pharmacological profile of several experimental effects induced by cannabinoids; and (ii) several orphan G pro-tein-coupled receptors (GPCRs) interact with cannabinoids and we do not know how to classify them (e.g., GPR18, GPR55 and GPR119; amongst others). On this basis, the present review attempts to summarize the lines of evidence supporting the potential role of GPR18, GPR55 and GPR119 in metabolism and feeding control that may explain some of the divergent effects and puzzling data re-lated to cannabinoid research. Moreover, their therapeutic potential in feeding behaviour alterations will be considered.
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Affiliation(s)
- Ricardo E Ramírez-Orozco
- Departamento de Nutricion y Cultura Fisica, Centro de Ciencias de la Salud, Universidad Autonoma de Aguascalientes, Ciudad Universitaria, 20131 Aguascalientes, Ags, Mexico
| | - Ricardo García-Ruiz
- Departamento de Fisiologia, Facultad de Medicina. Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Mexico
| | - Paula Morales
- Instituto de Quimica Fisica Rocasolano, Consejo Superior de Investigaciones Científicas, 28006 Madrid, Spain
| | - Carlos M Villalón
- Departamento de Farmacobiologia, Cinvestav- Coapa, Czda. Tenorios 235, Col. Granjas-Coapa, Deleg. Tlalpan, 14330 Ciudad de Mexico, Mexico
| | - J Rafael Villafán-Bernal
- Departamento de Cirugia, Centro de Ciencias de la Salud, Universidad Autonoma de Aguascalientes, CP 20131 Aguascalientes, Ags, Mexico
| | - Bruno A Marichal-Cancino
- Departamento de Fisiologia y Farmacologia, Centro de Ciencias Basicas, Universidad Autonoma de Aguascalientes, Ciudad Universitaria, 20131 Aguascalientes, Ags, Mexico
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8
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Algethamy H. Baseline Predictors of Survival, Neurological Recovery, Cognitive Function, Neuropsychiatric Outcomes, and Return to Work in Patients after a Severe Traumatic Brain Injury: an Updated Review. Mater Sociomed 2020; 32:148-157. [PMID: 32843865 PMCID: PMC7428895 DOI: 10.5455/msm.2020.32.148-157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Introduction Severe traumatic brain injury (sTBI) is a common cause of death and disability worldwide, with long-term squeal among survivors that include cognitive deficits, psychosocial and neuropsychiatric dysfunction, failure to return to pre-injury levels of work, school and inter-personal relationships, and overall reduced quality of and satisfaction with life. Aim The aim of this work is to review the current literature on baseline predictors of outcomes in adults post sTBI. Method Most of available literature on baseline predictors of outcomes in adults post sTBI were reviewed and summarized in this work. Results Currently, a sizeable number of composite predictors of mortality and overall function exists; however, these instruments tend to over-estimate poor outcomes and fail to address issues like cognition, psychosocial/ neuropsychiatric dysfunction, and return to work or school. Conclusion This article reviews currently-identified predictors of all these outcomes.
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Affiliation(s)
- Haifa Algethamy
- Department of Anaesthesia and Critical Care, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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9
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Mélotte E, Maudoux A, Delhalle S, Martial C, Antonopoulos G, Larroque SK, Wannez S, Faymonville ME, Kaux JF, Laureys S, Gosseries O, Vanhaudenhuyse A. Is oral feeding compatible with an unresponsive wakefulness syndrome? J Neurol 2018; 265:954-961. [PMID: 29464377 DOI: 10.1007/s00415-018-8794-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 12/23/2017] [Accepted: 02/10/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of the study is to explore the possibility of oral feeding in unresponsive wakefulness syndrome/vegetative state (UWS/VS) patients. METHOD We reviewed the clinical information of 68 UWS/VS patients (mean age 45 ± 11; range 16-79 years) searching for mention of oral feeding. UWS/VS diagnosis was made after repeated behavioural assessments using the Coma Recovery Scale-Revised. Patients also had complementary neuroimaging evaluations (positron emission tomography, functional magnetic resonance imaging and electroencephalography and diffusion tensor imaging). RESULTS Out of the 68 UWS/VS patients, only two could resume oral feeding (3%). The first patient had oral feeding (only liquid and semi liquid) in addition to gastrostomy feeding and the second one could achieve full oral feeding (liquid and mixed solid food). Clinical assessments concluded that they fulfilled the criteria for a diagnosis of UWS/VS. Results from neuroimaging and neurophysiology were typical for the first patient with regard to the diagnosis of UWS/VS but atypical for the second patient. CONCLUSION Oral feeding that implies a full and complex oral phase could probably be considered as a sign of consciousness. However, we actually do not know which components are necessary to consider the swallowing conscious as compared to reflex. We also discussed the importance of swallowing assessment and management in all patients with altered state of consciousness.
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Affiliation(s)
- Evelyne Mélotte
- Physical and Rehabilitation Medicine Department, University Hospital of Liege, Liège, Belgium. .,GIGA Consciousness, Coma Science Group and Neurology Department, University and University Hospital of Liege, Liège, Belgium.
| | - Audrey Maudoux
- GIGA Consciousness, Coma Science Group and Neurology Department, University and University Hospital of Liege, Liège, Belgium.,Otorhinolaryngology Head and Neck Surgery Department, University and University Hospital of Liege, Liège, Belgium
| | - Sabrina Delhalle
- Otorhinolaryngology Head and Neck Surgery Department, University and University Hospital of Liege, Liège, Belgium
| | - Charlotte Martial
- GIGA Consciousness, Coma Science Group and Neurology Department, University and University Hospital of Liege, Liège, Belgium
| | - Georgios Antonopoulos
- GIGA Consciousness, Coma Science Group and Neurology Department, University and University Hospital of Liege, Liège, Belgium
| | - Stephen Karl Larroque
- GIGA Consciousness, Coma Science Group and Neurology Department, University and University Hospital of Liege, Liège, Belgium
| | - Sarah Wannez
- GIGA Consciousness, Coma Science Group and Neurology Department, University and University Hospital of Liege, Liège, Belgium
| | - Marie-Elisabeth Faymonville
- Hypnosis and Pain GIGA Center and Algology and Palliative Care Department, University and University Hospital of Liege, Liège, Belgium
| | - Jean-François Kaux
- Physical and Rehabilitation Medicine Department, University Hospital of Liege, Liège, Belgium
| | - Steven Laureys
- GIGA Consciousness, Coma Science Group and Neurology Department, University and University Hospital of Liege, Liège, Belgium
| | - Olivia Gosseries
- GIGA Consciousness, Coma Science Group and Neurology Department, University and University Hospital of Liege, Liège, Belgium
| | - Audrey Vanhaudenhuyse
- GIGA Consciousness, Coma Science Group and Neurology Department, University and University Hospital of Liege, Liège, Belgium.,Hypnosis and Pain GIGA Center and Algology and Palliative Care Department, University and University Hospital of Liege, Liège, Belgium
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10
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Falletta Caravasso C, de Pasquale F, Ciurli P, Catani S, Formisano R, Sabatini U. The Default Mode Network Connectivity Predicts Cognitive Recovery in Severe Acquired Brain Injured Patients: A Longitudinal Study. J Neurotrauma 2016; 33:1247-62. [PMID: 26559732 DOI: 10.1089/neu.2015.4003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
To study the functional connectivity in patients with severe acquired brain injury is very challenging for their high level of disability because of a prolonged period of coma, extended lesions, and several cognitive and behavioral disorders. In this article, we investigated in these patients the default mode network and somatomotor connectivity changes at rest longitudinally, in the subacute and late phase after brain injury. The aim of the study is to characterize such connectivity patterns and relate the observed changes to clinical and neuropsychological outcomes of these patients after a period of intensive neurorehabilitation. Our findings show within the default mode network a disruption of connectivity of medial pre-frontal regions and a significant change of amplitude of internal connections. Notably, strongest changes in functional connectivity significantly correlated to consistent clinical and cognitive recovery. This evidence seems to indicate that the reorganization of the Default Mode Network may represent a valid biomarker for the cognitive recovery in patients with severe acquired brain injury.
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Affiliation(s)
| | - Francesco de Pasquale
- 1 Department of Radiology, IRCCS Santa Lucia Foundation , Rome, Italy
- 2 Faculty of Veterinary Medicine, University of Teramo, Teramo, Italy
| | - Paola Ciurli
- 3 Post-Coma Unit, IRCCS Santa Lucia Foundation , Rome, Italy
| | - Sheila Catani
- 3 Post-Coma Unit, IRCCS Santa Lucia Foundation , Rome, Italy
| | - Rita Formisano
- 3 Post-Coma Unit, IRCCS Santa Lucia Foundation , Rome, Italy
| | - Umberto Sabatini
- 1 Department of Radiology, IRCCS Santa Lucia Foundation , Rome, Italy
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11
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Young GB, Owen AM. Evaluating the Potential for Recovery of Consciousness in the Intensive Care Unit. Continuum (Minneap Minn) 2015; 21:1397-410. [DOI: 10.1212/con.0000000000000234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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12
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Kjaersgaard A, Nielsen LH, Sjölund BH. Factors affecting return to oral intake in inpatient rehabilitation after acquired brain injury. Brain Inj 2015; 29:1094-104. [DOI: 10.3109/02699052.2015.1022883] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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13
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Bicego A, Lejoly K, Maudoux A, Lefebvre P, Laureys S, Schweizer V, Diserens K, Faymonville ME, Vanhaudenhuyse A. [Swallowing in disorders of consciousness]. Rev Neurol (Paris) 2014; 170:630-41. [PMID: 24952924 DOI: 10.1016/j.neurol.2014.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 03/31/2014] [Accepted: 04/11/2014] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Interest in studying swallowing disorders in patients with altered consciousness has increased over the past decade. Swallowing deficit is frequently encountered in severe brain-injured patients. STATE OF ART Results of studies have highlighted different factors such as the delay between the injury and the treatment and the level of consciousness of these patients, as well as the presence or not of tracheotomy, which will determine the feasibility of resuming oral feeding. Nowadays, very few valid and sensitive scales can be used to assess swallowing deficit in patients with disorders of consciousness. The Facial Oral Tract Therapy (FOTT) scale is an inter-professional multidisciplinary approach offering a structured way to evaluate and treat patients with swallowing disorders. In contrast with other scales, patients do not have to follow verbal instructions for the FOTT. PERSPECTIVES This paper presents a review of existing literature on the assessment and management of swallowing disorders in patients with altered state of consciousness, and a description of the FOTT method. CONCLUSION The FOTT seems to be an interesting assessment and rehabilitation tool for patients with disorders of consciousness. However, clinical studies are needed to confirm the validity and sensitivity of this technique.
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Affiliation(s)
- A Bicego
- Coma Science Group, centre de recherches du cyclotron, université de Liège, allée du 6-Août, Sart Tilman B30, 4000 Liège, Belgique
| | - K Lejoly
- Coma Science Group, centre de recherches du cyclotron, université de Liège, allée du 6-Août, Sart Tilman B30, 4000 Liège, Belgique
| | - A Maudoux
- Coma Science Group, centre de recherches du cyclotron, université de Liège, allée du 6-Août, Sart Tilman B30, 4000 Liège, Belgique; Service d'oto-rhino-laryngologie, hôpital universitaire de Liège, université de Liège, 13, avenue de l'Hôpital, 4000 Liège, Belgique
| | - P Lefebvre
- Service d'oto-rhino-laryngologie, hôpital universitaire de Liège, université de Liège, 13, avenue de l'Hôpital, 4000 Liège, Belgique
| | - S Laureys
- Coma Science Group, centre de recherches du cyclotron, université de Liège, allée du 6-Août, Sart Tilman B30, 4000 Liège, Belgique; Service de neurologie, hôpital universitaire de Liège, université de Liège, 13, avenue de l'Hôpital, 4000 Liège, Belgique
| | - V Schweizer
- Unité de phoniatrie, service d'oto-rhino-laryngologie, hôpital universitaire de Lausanne, 31, avenue Beaumont, 1011 Lausanne, Suisse
| | - K Diserens
- Unité de neurorééducation aiguë, département des neurosciences cliniques, hôpital universitaire de Lausanne, 46, rue du Bugnon, 1011 Lausanne, Suisse
| | - M-E Faymonville
- Service d'algologie-soins palliatifs, hôpital universitaire de Liège, université de Liège, CHU Sart Tilman, B35, 4000 Liège, Belgique
| | - A Vanhaudenhuyse
- Service d'algologie-soins palliatifs, hôpital universitaire de Liège, université de Liège, CHU Sart Tilman, B35, 4000 Liège, Belgique.
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Shaklai S, Peretz R, Spasser R, Simantov M, Groswasser Z. Long-term functional outcome after moderate-to-severe paediatric traumatic brain injury. Brain Inj 2014; 28:915-21. [DOI: 10.3109/02699052.2013.862739] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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15
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Péran P, Catani S, Falletta Caravasso C, Nemmi F, Sabatini U, Formisano R. Supplementary Motor Area Activation Is Impaired in Severe Traumatic Brain Injury Parkinsonism. J Neurotrauma 2014; 31:642-8. [DOI: 10.1089/neu.2013.3103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Patrice Péran
- INSERM, Imagerie Cérébrale et Handicaps Neurologiques, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Université de Toulouse III, UPS, Imagerie Cérébrale et Handicaps Neurologiques, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | | | | | - Federico Nemmi
- INSERM, Imagerie Cérébrale et Handicaps Neurologiques, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Université de Toulouse III, UPS, Imagerie Cérébrale et Handicaps Neurologiques, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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16
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Urologic dysfunction and neurologic outcome in coma survivors after severe traumatic brain injury in the postacute and chronic phase. Arch Phys Med Rehabil 2011; 92:1134-8. [PMID: 21704794 DOI: 10.1016/j.apmr.2011.02.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 02/17/2011] [Accepted: 02/18/2011] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To investigate voiding dysfunction and upper urinary tract status in survivors of coma resulting from traumatic brain injury (TBI), and to compare clinical and urodynamic results with neurologic and psychological features as well as functional outcomes. DESIGN Observational study focused on urologic dysfunction and neurologic outcome in coma survivors after traumatic brain injury in the postacute and chronic phase. SETTING A postcoma unit in a rehabilitation hospital. PARTICIPANTS Consecutive patients (N=57) who recovered from coma of traumatic etiology and who were admitted during a 1-year period to a postcoma unit of a rehabilitation hospital. INTERVENTIONS Patients underwent clinical urologic assessment, urodynamics with the assessment of the Schafer nomogram and the projected isovolumetric detrusor pressure to evaluate detrusor contractility, ultrasound assessment of the lower and upper urinary tract and voiding cystourethrography, routinely performed, according to the International Continence Society Standards. Neurologic variables assessed were brain injury and disability severity, and neuropsychological status. Neuroimaging identified the site of cerebral lesions. MAIN OUTCOME MEASURES Urinary symptoms, disability by means of the Glasgow Outcome Scale (GOS), and neuropsychological status by means of the Neurobehavioral Rating Scale (NBRS), and the relationships among them. RESULTS Of the 57 patients studied, 30 had overactive bladder (urge incontinence) symptoms, 28 had detrusor overactivity, and 18 had detrusor underactivity with associated pseudodyssynergia in 15 of these patients. Eleven patients had hypertrophic bladder; 3, bilateral pyelectasia; and 2, vesicoureteral reflux. Disability measured by GOS was severe in 8 patients and moderate in 27, while recovery was good in 22 patients. The mean NBRS total score indicated a mild cognitive impairment. Neuroimaging showed diffuse brain injury in all patients. Statistically significant relationships were found between urge incontinence, detrusor overactivity, and poor neurologic functional outcome, between detrusor overactivity and right hemisphere damage (P=.0001), and between impaired detrusor contractility and left hemisphere injuries (P=.0001). CONCLUSIONS Most patients who recovered from coma resulting from TBI have symptoms of overactive bladder syndrome and voiding difficulties. These urinary problems correlate with cerebral involvement and neurologic functional outcome.
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Lee JS, Jwa CS, Yi HJ, Chun HJ. Impact of early enteral nutrition on in-hospital mortality in patients with hypertensive intracerebral hemorrhage. J Korean Neurosurg Soc 2010; 48:99-104. [PMID: 20856655 DOI: 10.3340/jkns.2010.48.2.99] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Revised: 07/08/2010] [Accepted: 08/03/2010] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE We conducted this study to evaluate the clinical impact of early enteral nutrition (EN) on in-hospital mortality and outcome in patients with critical hypertensive intracerebral hemorrhage (ICH). METHODS We retrospectively analyzed 123 ICH patients with Glasgow Coma Scale (GCS) score of 3-12. We divided the subjects into two groups : early EN group (< 48 hours, n = 89) and delayed EN group (≥ 48 hours, n = 34). Body weight, total intake and output, serum albumin, C-reactive protein, infectious complications, morbidity at discharge and in-hospital mortality were compared with statistical analysis. RESULTS The incidence of nosocomial pneumonia and length of intensive care unit stay were significantly lower in the early EN group than in the delayed EN group (p < 0.05). In-hospital mortality was less in the early EN group than in the delayed EN group (10.1% vs. 35.3%, respectively; p = 0.001). By multivariate analysis, early EN [odds ratio (OR) 0.229, 95% CI : 0.066-0.793], nosocomial pneumonia (OR = 5.381, 95% CI : 1.621-17.865) and initial GCS score (OR = 1.482 95% CI : 1.160-1.893) were independent predictors of in-hospital mortality in patients with critical hypertensive ICH. CONCLUSION These findings indicate that early EN is an important predictor of outcome in patients with critical hypertensive ICH.
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Affiliation(s)
- Jeong-Shik Lee
- Department of Neurosurgery, National Medical Center, Seoul, Korea
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18
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Cook AM, Peppard A, Magnuson B. Nutrition Considerations in Traumatic Brain Injury. Nutr Clin Pract 2008; 23:608-20. [DOI: 10.1177/0884533608326060] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Aaron M. Cook
- From the University of Kentucky Healthcare, Lexington
| | - Amy Peppard
- From the University of Kentucky Healthcare, Lexington
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Formisano R, Barba C, Buzzi MG, Newcomb-Fernandez J, Menniti-Ippolito F, Zafonte R, Vinicola V, Spanedda F. The impact of prophylactic treatment on post-traumatic epilepsy after severe traumatic brain injury. Brain Inj 2008; 21:499-504. [PMID: 17522989 DOI: 10.1080/02699050701310994] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM To assess the incidence of late post-traumatic epilepsy (PTE) in patients with very severe traumatic brain injury (TBI) who either received or did not receive anti-epileptic prophylactic treatment. METHODS Two populations were studied: 55 patients retrospectively and 82 subjects prospectively. RESULTS Ten patients (18%) in the first population showed late PTE. Although the incidence was lower in patients who did not receive prophylactic treatment, the difference between the treated and the non-treated group was not statistically significant. Sixty-nine patients in the second group (84%) had prophylactic treatment. Twenty-seven patients (39%) suffered from late PTE during the 2-year follow-up period and 17 of them (63%) showed EEG epileptic abnormalities. No patient who did not receive preventive therapy suffered from late PTE during the observation period. CONCLUSIONS Due to the negative cognitive effects of anti-epileptic drugs, the preliminary results are of considerable interest for the rehabilitation of patients with very severe TBI.
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Affiliation(s)
- R Formisano
- Rehabilitation Hospital, I.R.C.C.S Santa Lucia Foundation, Rome, Italy.
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Brady SL, Darragh M, Escobar NG, O'Neil K, Pape TLB, Rao N. Persons with disorders of consciousness: are oral feedings safe/effective? Brain Inj 2007; 20:1329-34. [PMID: 17378224 DOI: 10.1080/02699050601111435] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PRIMARY OBJECTIVE Evaluate the safety and efficacy of providing oral feedings to persons early in coma recovery following a severe brain injury. RESEARCH DESIGN Descriptive, retrospective study. METHODS AND PROCEDURES Medical chart reviews of all patients admitted to a rehabilitation hospital following severe brain injury. MAIN OUTCOMES AND RESULTS Twenty-five patients met the inclusion criteria, 22 had a tracheostomy, and all were NPO. Subjects were divided into two cohorts. Group 1, n=10, mean age 43.5 years, received oral feedings early in coma recovery. Group 2, n=15, mean age 45.2 years, did not. Group 1, 30% returned to an oral diet of three meals daily at discharge from inpatient rehabilitation as compared to 40% in group 2 (chi2 = 0.260, p = 0.610). Average cost of care for group 1 = US$45 759 and group 2 = US$41 056 (p = 0.634). CONCLUSION Safe therapeutic oral feedings, in accordance with findings from instrumental swallowing examinations, are possible for patients with disordered consciousness. The therapeutic oral feedings do not significantly increase the cost of care, but the effectiveness of oral feedings early in coma recovery requires further investigation.
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Affiliation(s)
- Susan L Brady
- Marianjoy Rehabilitation Hospital, 26 W 171 Roosevelt Road, Wheaton, Illinois 60187, USA.
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Krakau K, Hansson A, Karlsson T, de Boussard CN, Tengvar C, Borg J. Nutritional treatment of patients with severe traumatic brain injury during the first six months after injury. Nutrition 2007; 23:308-17. [DOI: 10.1016/j.nut.2007.01.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Revised: 12/12/2006] [Accepted: 01/23/2007] [Indexed: 11/29/2022]
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Formisano R, Bivona U, Penta F, Giustini M, Buzzi MG, Ciurli P, Matteis M, Barba C, Della Vedova C, Vinicola V, Taggi F. Early clinical predictive factors during coma recovery. ACTA NEUROCHIRURGICA. SUPPLEMENT 2005; 93:201-5. [PMID: 15986756 DOI: 10.1007/3-211-27577-0_36] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
In severe brain injury patients few studies have examined the role of early clinical factors emerging before recovery of consciousness. Patients suffering from vegetative state and minimally conscious state in fact may need variable periods of time for recovery of the ability to follow commands. In a previous study we retrospectively examined a population of very severe traumatic brain injury patients with coma duration of at least 15 days (prolonged coma), and we found, as significant predictive factors for the final outcome, the time interval from brain injury to the recovery of the following clinical variables: optical fixation, spontaneous motor activity and first safe oral feeding. Psychomotor agitation and bulimia during coma recovery were also favourable prognostic factors for the final outcome. In a further study, also as for the neuropsychological recovery, the clinical variable with the best significant predictive value was the interval from head trauma to the recovery of safe oral feeding. In the present study the presence of psychomotor agitation diagnosed by means of LCF (score 4 = confused-agitated) at the admission time in rehabilitation predicted a statistically significant better outcome at the discharge time in comparison with patients without agitation.
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Affiliation(s)
- R Formisano
- IRCCS Rehabilitation Hospital, Santa Lucia Foundation, Rome, Italy.
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