Objective: To determine the incidence and type of swallowing disorders that
accompany severe brain injury and to identify factors that affect oral int
ake.
Design: Inception cohort study.
Setting: Level I trauma center.
Patients: Consecutively admitted patients with severe brain injury who achi
eved cognitive levels during admission to assess swallowing and who did not
sustain injuries preventing swallowing assessment (n = 54).
Main Outcome Measures: Type of swallowing abnormalities and presence of asp
iration evident on videofluoroscopic swallow studies (VFSS), days to initia
tion and achievement of oral feeding, ventilation days, presence of a trach
eostomy, and cognitive levels at initiation and achievement of oral feeding
.
Results: Sixty-one percent of subjects exhibited abnormal swallowing. Loss
of bolus control and reduced lingual control occurred most commonly. Aspira
tion rate was 41%. Normal swallowers achieved oral feeding in 19 days versu
s 57 days for abnormal swallowers. Rancho Los Amigos (RLA) Level IV was nee
ded for initiation of oral feeding; Level VI was needed for total oral feed
ing. Risk factors for abnormal swallowing included: lower admission Glasgow
Coma Scale (GCS) and RLA scores, presence of a tracheostomy, and ventilati
on time longer than 2 weeks. Risk factors for aspiration were lower admissi
on GCS and RLA scores.
Conclusions: Swallowing disorders and behavioral/cognitive skills are frequ
ently present in patients with severe brain injury and significantly affect
oral intake of food. Persons who swallow abnormally take significantly lon
ger to start eating and to achieve total oral feeding, and they require non
oral supplementation three to four times longer than those who swallow norm
ally. (C) 1999 by the American Congress of Rehabilitation Medicine and the
American Academy of Physical Medicine and Rehabilitation.