Feasibility and Safety of Fiberoptic Endoscopic Evaluation of Swallowing in People with Disorder of Consciousness: A Systematic Review

Objective: This systematic review analysed the evidence for the effect of head-up tilt (passive-standing) on consciousness among persons in prolonged disorders of consciousness. Data sources: Articles were identified through primary database searching (Medline, CINAHL, AMED, The Cochrane Library) and post-citation searching (Scopus). Review methods: This review followed the PRISMA statement. The search strategy was created to find articles that combined any conceivable passive standing device, any measure of consciousness and disorders of consciousness of any origin. Inclusion criteria were any papers that evaluated the use of head-up tilt in adults in defined disorders of consciousness. Exclusion criteria included active stand studies, paediatric studies and animal studies. The search was completed independently by two researchers. Data collection and risk of bias assessment was completed using the Downs and Black tool. Results: 6867 titles were retrieved (last search completed 21/6/20). Ten papers met the inclusion criteria: five examined the effects of a single head-up tilt treatment, and five the effects of head-up tilt regimes. Eighty-seven participants were randomised in three randomised controlled trials. In the remaining preliminary studies or case series, 233 participants were analysed. Quality was low, with only two high-quality studies available. Four studies were suitable for effect size analysis, where medium to large effect sizes were found. The two high-quality studies found head-up tilt had a large effect on consciousness. Conclusion: Overall there is some evidence that repeated passive standing on a tilt-table can improve consciousness, but the relevant studies provoke further questions.

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Sleep Treatments in Disorders of Consciousness: A Systematic Review

Diagnostics ◽

10.3390/diagnostics12010088 ◽

2021 ◽

Vol 12 (1) ◽

pp. 88

Author(s):

Martina Cacciatore ◽

Francesca G. Magnani ◽

Matilde Leonardi ◽

Davide Rossi Sebastiano ◽

Davide Sattin

Keyword(s):

Systematic Review ◽

Sleep Disorders ◽

Bright Light ◽

Intrathecal Baclofen ◽

Disorder Of Consciousness ◽

Sleep Related Breathing Disorders ◽

Appropriate Treatment ◽

Effective Therapeutic Strategy ◽

Deep Brain

Sleep disorders are among the main comorbidities in patients with a Disorder of Consciousness (DOC). Given the key role of sleep in neural and cognitive functioning, detecting and treating sleep disorders in DOCs might be an effective therapeutic strategy to boost consciousness recovery and levels of awareness. To date, no systematic reviews have been conducted that explore the effect of sleep treatments in DOCs; thus, we systematically reviewed the existing studies on both pharmacological and non-pharmacological treatments for sleep disorders in DOCs. Among 2267 assessed articles, only 7 were included in the systematic review. The studies focused on two sleep disorder categories (sleep-related breathing disorders and circadian rhythm dysregulation) treated with both pharmacological (Modafinil and Intrathecal Baclofen) and non-pharmacological (positive airway pressure, bright light stimulation, and central thalamic deep brain stimulation) interventions. Although the limited number of studies and their heterogeneity do not allow generalized conclusions, all the studies highlighted the effectiveness of treatments on both sleep disorders and levels of awareness. For this reason, clinical and diagnostic evaluations able to detect sleep disorders in DOC patients should be adopted in the clinical routine for the purpose of intervening promptly with the most appropriate treatment.

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Effectiveness of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in Patients with Swallowing Disorders -A Systematic Review-

Brain & Neurorehabilitation ◽

10.12786/bn.2013.6.1.9 ◽

2013 ◽

Vol 6 (1) ◽

pp. 9 ◽

Cited By ~ 2

Author(s):

Worl-Sook Lee ◽

Seon-Heui Lee ◽

Young Hak Park ◽

Jae Whan Lee ◽

Kee Hwan Kwon ◽

...

Keyword(s):

Systematic Review ◽

Swallowing Disorders ◽

Endoscopic Evaluation

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Protocols and assessment procedures in fiberoptic endoscopic evaluation of swallowing: an updated systematic review

Brazilian Journal of Otorhinolaryngology ◽

10.1016/j.bjorl.2021.03.002 ◽

2021 ◽

Author(s):

Aline Prikladnicki ◽

Márcia Grassi Santana ◽

Maria Cristina Cardoso

Keyword(s):

Systematic Review ◽

Endoscopic Evaluation ◽

Assessment Procedures

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The Neurophysiological Processing of Music in Children: A Systematic Review With Narrative Synthesis and Considerations for Clinical Practice in Music Therapy

Frontiers in Psychology ◽

10.3389/fpsyg.2021.615209 ◽

2021 ◽

Vol 12 ◽

Author(s):

Janeen Bower ◽

Wendy L. Magee ◽

Cathy Catroppa ◽

Felicity Anne Baker

Keyword(s):

Systematic Review ◽

Brain Injury ◽

Music Therapy ◽

Brain Imaging ◽

Acquired Brain Injury ◽

Narrative Synthesis ◽

Imaging Data ◽

Disorder Of Consciousness ◽

Process Music ◽

Brain Imaging Data

Introduction: Evidence supporting the use of music interventions to maximize arousal and awareness in adults presenting with a disorder of consciousness continues to grow. However, the brain of a child is not simply a small adult brain, and therefore adult theories are not directly translatable to the pediatric population. The present study aims to synthesize brain imaging data about the neural processing of music in children aged 0-18 years, to form a theoretical basis for music interventions with children presenting with a disorder of consciousness following acquired brain injury.Methods: We conducted a systematic review with narrative synthesis utilizing an adaptation of the methodology developed by Popay and colleagues. Following the development of the narrative that answered the central question “what does brain imaging data reveal about the receptive processing of music in children?”, discussion was centered around the clinical implications of music therapy with children following acquired brain injury.Results: The narrative synthesis included 46 studies that utilized EEG, MEG, fMRI, and fNIRS scanning techniques in children aged 0-18 years. From birth, musical stimuli elicit distinct but immature electrical responses, with components of the auditory evoked response having longer latencies and variable amplitudes compared to their adult counterparts. Hemodynamic responses are observed throughout cortical and subcortical structures however cortical immaturity impacts musical processing and the localization of function in infants and young children. The processing of complex musical stimuli continues to mature into late adolescence.Conclusion: While the ability to process fundamental musical elements is present from birth, infants and children process music more slowly and utilize different cortical areas compared to adults. Brain injury in childhood occurs in a period of rapid development and the ability to process music following brain injury will likely depend on pre-morbid musical processing. Further, a significant brain injury may disrupt the developmental trajectory of complex music processing. However, complex music processing may emerge earlier than comparative language processing, and occur throughout a more global circuitry.

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Acupuncture to Promote Recovery of Disorder of Consciousness after Traumatic Brain Injury: A Systematic Review and Meta-Analysis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2019/5190515 ◽

2019 ◽

Vol 2019 ◽

pp. 1-14 ◽

Cited By ~ 3

Author(s):

Li Tan ◽

Liling Zeng ◽

Ning Wang ◽

Meijun Deng ◽

Yinshi Chen ◽

...

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Meta Analysis ◽

Poor Quality ◽

Binary Outcomes ◽

Control Group ◽

Efficacy Rate ◽

Disorder Of Consciousness ◽

Social Burden

Traumatic brain injury (TBI) has become an economic and social burden for patients and their families. While acupuncture is an effective tool for promoting recovery of disorder of consciousness (DOC) following TBI, there have been no comprehensive meta-analyses and/or systematic reviews addressing this topic. The present systematic review and meta-analysis aimed to assess the therapeutic efficacy of acupuncture for DOC after TBI. All randomized controlled trials (RCTs) incorporating acupuncture, or acupuncture combined with other interventions for DOC after TBI, were included and assessed by two independent investigators. Six outcome indicators were assessed: Glasgow Coma Scale (GCS); Glasgow Outcome Scale (GOS); mortality; efficacy rate; activities of daily living (ADL); and functional comprehensive assessment. Direct comparisons were performed using RevMan 5.3.0 software, with results presented as mean difference (MD) for continuous outcomes and relative risk (RR) for binary outcomes. A total of 3511 patients from 49 trials were included. Pooled analyses indicated that acupuncture may have a superior effect on GCS score (MD=2.03, 95% CI :1.92 2.43, Z=16.54, and P<0.00001); GOS score (RR=1.23, 95%CI: 1.18 1.35, Z=6.65, and P<0.00001); efficacy rate (RR=1.48, 95%CI: 1.40 1.56, Z=13.49, and P<0.00001); ADL (MD=9.20, 95% CI:8.19 10.21, Z=17.84, and P<0.00001); and mortality (RR=0.50, 95% CI:0.38 0.67, Z=4.70, and P<0.00001). The results demonstrated that the acupuncture group fared better than the control group in the treatment of DOC after TBI. However, studies were generally of poor quality, and publication bias favoring positive studies was obvious. Therefore, rigorous evaluation standards and well-designed studies are necessary in future studies.

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