Swallowing disorders in severe brain injury: Risk factors affecting returnto oral intake

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.