The swallow, a target to follow the restauration of consciousness in acquired brain injury
DOI:
https://doi.org/10.2340/jrm.v57.42692Keywords:
Dysphagia, swallowing disorders, consciousness, disorders of consciousness, acquired brain injuriesAbstract
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.
Downloads
References
Brown CV, Hejl K, Mandaville AD, Chaney PE, Stevenson G, Smith C. Swallowing dysfunction after mechanical ventilation in trauma patients. J Crit Care 2011; 26: 108 e9–13. DOI: https://doi.org/10.1016/j.jcrc.2010.05.036
Leder SB. Fiberoptic endoscopic evaluation of swallowing in patients with acute traumatic brain injury. J Head Trauma Rehabil 1999; 14: 448–453. DOI: https://doi.org/10.1097/00001199-199910000-00005
Takizawa C, Gemmell E, Kenworthy J, Speyer R. A systematic review of the prevalence of oropharyngeal dysphagia in stroke, Parkinson’s disease, Alzheimer’s disease, head injury, and pneumonia. Dysphagia 2016; 31: 434–441. DOI: https://doi.org/10.1007/s00455-016-9695-9
Veis SL, Logemann JA. Swallowing disorders in persons with cerebrovascular accident. Arch Phys Med Rehabil 1985; 66: 372–375.
Melotte E, Belorgeot M, Herr R, Simon J, Kaux JF, Laureys S, et al. The development and validation of the SWADOC: a study protocol for a multicenter prospective cohort study. Front Neurol 2021; 12: 662634. DOI: https://doi.org/10.3389/fneur.2021.662634
Jean A. Brain stem control of swallowing: neuronal network and cellular mechanisms. Physiol Rev 2001; 81: 929–969. DOI: https://doi.org/10.1152/physrev.2001.81.2.929
Giacino JT, Ashwal S, Childs N, Cranford R, Jennett B, Katz DI, et al. The minimally conscious state: definition and diagnostic criteria. Neurology 2002; 58: 349–353. DOI: https://doi.org/10.1212/WNL.58.3.349
Lucca LF, Lofaro D, Pignolo L, Leto E, Ursino M, Cortese MD, et al. Outcome prediction in disorders of consciousness: the role of coma recovery scale revised. BMC Neurol 2019; 19: 68. DOI: https://doi.org/10.1186/s12883-019-1293-7
Shiel A, Horn SA, Wilson BA, Watson MJ, Campbell MJ, McLellan DL. The Wessex Head Injury Matrix (WHIM) main scale: a preliminary report on a scale to assess and monitor patient recovery after severe head injury. Clin Rehabil 2000; 14: 408–416. DOI: https://doi.org/10.1191/0269215500cr326oa
Schnakers C, Majerus S, Giacino J, Vanhaudenhuyse A, Bruno MA, Boly M, et al. A French validation study of the Coma Recovery Scale-Revised (CRS-R). Brain Inj 2008; 22: 786–792. DOI: https://doi.org/10.1080/02699050802403557
Herr R, Regnier A, Belorgeot M, Melotte E, Simon J, Sanz LRD, et al. Swallowing assessment in post-comatose patients: a feasibility study on the SWADOC Tool. J Clin Med 2024; 13: 3268. DOI: https://doi.org/10.3390/jcm13113268
Melotte E, Maudoux A, Panda R, Kaux JF, Lagier A, Herr R, et al. Links between swallowing and consciousness: a narrative review. Dysphagia 2023; 38: 42–64. DOI: https://doi.org/10.1007/s00455-022-10452-2
Hamdy S, Aziz Q, Rothwell JC, Crone R, Hughes D, Tallis RC, et al. Explaining oropharyngeal dysphagia after unilateral hemispheric stroke. Lancet 1997; 350: 686–692. DOI: https://doi.org/10.1016/S0140-6736(97)02068-0
Gow D, Rothwell J, Hobson A, Thompson D, Hamdy S. Induction of long-term plasticity in human swallowing motor cortex following repetitive cortical stimulation. Clin Neurophysiol 2004; 115: 1044–1051. DOI: https://doi.org/10.1016/j.clinph.2003.12.001
Hamdy S, Aziz Q, Rothwell JC, Hobson A, Barlow J, Thompson DG. Cranial nerve modulation of human cortical swallowing motor pathways. Am J Physiol 1997; 272: G802–808. DOI: https://doi.org/10.1152/ajpgi.1997.272.4.G802
Cheng I, Takahashi K, Miller A, Hamdy S. Cerebral control of swallowing: an update on neurobehavioral evidence. J Neurol Sci 2022; 442: 120434. DOI: https://doi.org/10.1016/j.jns.2022.120434
Michel A, Verin E, Hansen K, Chassagne P, Roca F. Buccofacial apraxia, oropharyngeal dysphagia, and dementia severity in community-dwelling elderly patients. J Geriatr Psychiatry Neurol 2021; 34: 150–155. DOI: https://doi.org/10.1177/0891988720915519
Wannez S, Heine L, Thonnard M, Gosseries O, Laureys S; Coma Science Group collaborators. The repetition of behavioral assessments in diagnosis of disorders of consciousness. Ann Neurol 2017; 81: 883–889. DOI: https://doi.org/10.1002/ana.24962
Published
How to Cite
License
Copyright (c) 2025 Anne Charlotte Lerick, Eleonore Sequeira, Jean Glenisson; Nikki Sabourin; Virgil Rolland, Gregoire Prum, Eric Verin

This work is licensed under a Creative Commons Attribution 4.0 International License.
All digitalized JRM contents is available freely online. The Foundation for Rehabilitation Medicine owns the copyright for all material published until volume 40 (2008), as from volume 41 (2009) authors retain copyright to their work and as from volume 49 (2017) the journal has been published Open Access, under CC-BY-NC licences (unless otherwise specified). The CC-BY-NC licenses allow third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
From 2024, articles are published under the CC-BY licence. This license permits sharing, adapting, and using the material for any purpose, including commercial use, with the condition of providing full attribution to the original publication.