Introduction
Patients with severe levels of cognitive decline and minimally conscious state (MCS) rarely show oral feeding. It has been found that the degree of cognitive function is related to swallowing function, especially in the case of impairment of location related to performance or planning. However, there have been few studies that specifically evaluated factors affecting oral feeding in patients with MCS due to severe brain injury.
This study is to investigate the difference between oral feeding and non-oral feeding groups and factors affecting oral feeding in MCS patients.
Methods
Between October 2016 and May 2020, among the brain injury patients under 10 points of mini-mental state examination (MMSE) or MCS hospitalized in a tertiary hospital were retrospectively screened. The patients were divided according to swallowing function; (1) available for oral feeding; (2) not available for oral feeding. Subjects were matched between-groups on age, sex, brain lesion etiology, MMSE or coma recovery scale (CRS) and disease duration (Table 1).
To determine factors affecting oral feeding, we evaluated associated factors; brain lesion, motor of upper extremities, functional independence measure (FIM), tracheostomy, dysarthria, neglect syndrome, as well as swallowing procedure using videofluoroscopic swallowing study (VFSS) and videofluoroscopic dysphagia scale (VDS). The Medical Research Council (MRC) was used to check the manual muscle strength in upper 3 muscle groups.
Results
1. Oral feeding group vs. non-oral feeding group: independent t-test
Subjects were classified into an oral feeding group (n=50) or a non-oral feeding group (n=50). The brain lesion divided into supratentorial and infratentorial lesion differed significantly between-groups. In addition, the total score and each parameter of VDS showed a significant difference, respectively (Table 2). Although upper dressing and eating score of FIM did not differ significantly, MRC sum score of upper extremities was significantly higher, compared to non-oral feeding group. The coughing reflex was significantly more preserved in the oral feeding group. Dysarthria and neglect syndrome have no significant differences.
2 Factors affecting oral feeding for associated factors: binary logistic regression
A binary logistic regression analysis to find factors affecting oral feeding showed that there was no significant relation of odds ratio.
Conclusion
Although the factors affecting oral feeding in patients with MCS due to severe brain injury have not been identified, MCS patients who have a supratentorial brain lesion, relatively preseverved motor of upper extremities and coughing reflex are more likely to attempt oral feeding. The VDS score, even each parameter, is a significant difference between-groups. Further studies should identify which brain location specifically contribute to diminished swallowing function, and which other associated factors affect oral feeding among MCS patients. |
