[Swallowing in disorders of consciousness]. / Déglutition et états de conscience altérée.

INTRODUCTION: Interest in studying swallowing disorders in patients with altered consciousness has increased over the past decade. Swallowing deficit is frequently encountered in severe brain-injured patients. STATE OF ART: Results of studies have highlighted different factors such as the delay between the injury and the treatment and the level of consciousness of these patients, as well as the presence or not of tracheotomy, which will determine the feasibility of resuming oral feeding. Nowadays, very few valid and sensitive scales can be used to assess swallowing deficit in patients with disorders of consciousness. The Facial Oral Tract Therapy (FOTT) scale is an inter-professional multidisciplinary approach offering a structured way to evaluate and treat patients with swallowing disorders. In contrast with other scales, patients do not have to follow verbal instructions for the FOTT. PERSPECTIVES: This paper presents a review of existing literature on the assessment and management of swallowing disorders in patients with altered state of consciousness, and a description of the FOTT method. CONCLUSION: The FOTT seems to be an interesting assessment and rehabilitation tool for patients with disorders of consciousness. However, clinical studies are needed to confirm the validity and sensitivity of this technique.

[Swallowing disorders in the elderly]. / Troubles de la déglutition chez les sujets âgés.

Swallowing disorders in the elderly. Swallowing disorders are a common problem in the elderly with severe consequences in multiple cases. At the current time these disorders are poorly understood and under-diagnosed. Although physiological aging is accompanied by changes in the process of swallowing resulting in an increase of the occurrence of aspiration, these changes are not responsible for a swallowing disorder. There are multiple aetiologies specific for the elderly and, in some cases, may be treatable when systematic screening is imposed. This one is based on medical history and a physical examination. Then the diagnosis can be confirmed with the videofluoroscopy, the gold standard for swallowing disorders. The management of these disorders is based on preventive measures, education of the patient, his family and of health care professionals and rehabilitation.

Troubles de la déglutition chez les sujets âgés. Les troubles de la déglutition, problème fréquent dans la population âgée aux conséquences sévères, sont actuellement mal connus et sous-diagnostiqués. Le vieillissement physiologique s'accompagne de modifications de la déglutition favorisant la survenue de fausses routes. Les causes spécifiques au sujet âgé sont diverses et peuvent parfois être traitées, imposant leur dépistage systématique. Celui-ci repose sur l'interrogatoire associé à l'examen clinique. Le diagnostic des troubles de la déglutition peut être étayé par la vidéofluoroscopie, examen de référence. La prise en charge de ces troubles repose sur des mesures préventives, l'éducation du patient, de sa famille et des intervenants professionnels, et la rééducation.