J Head Trauma Rehabil Vol. 24, No. 5, pp. 384–391 Copyright c  2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Feasibility of Instrumental Swallowing Assessments in Patients With Prolonged Disordered Consciousness While Undergoing Inpatient Rehabilitation Susan L. Brady, MS, CCC-SLP, BRS-S; Theresa L.-B. Pape, DrPH, MA, CCC-SLP/L; Meghan Darragh, MS, CCC-SLP ; Nelson G. Escobar, MD ; Noel Rao, MD Objective: To evaluate the feasibility, safety, and potential benefit of instrumental swallowing assessments for pa- tients with prolonged disordered consciousness participating in rehabilitation. Design: Case-control, retrospective. Participants: Thirty-five participants divided into 2 cohorts according to cognitive level at the time of baseline instrumental swallowing assessment. Group 1 (n = 17) participants were at Rancho Los Amigo (RLA) level II/III or RLA level III, while Group 2 (n = 18) participants were rated better than RLA level III. Results: Aspiration and laryngeal penetration rates for both groups were similar (aspiration rate Group 1 = 41%, Group 2 = 39%; laryngeal penetration rate Group 1 = 59%, Group 2 = 61%). Overall, 76% (13/17) of Group 1 and 72% (13/18) of Group 2 were able to receive some type of oral feedings following baseline video fluoroscopic swallow study (VFSS) or endoscopic exam of the swallow (FEES). Conclusion: The majority of participants who underwent an instrumental swallowing examination while still functioning at RLA level II/III or RLA level III were able to return to some form of oral feedings immediately following their baseline examination. Swallowing as a treatment modality can be considered a part of the overall plan to facilitate neurobehavioral recovery for patients with prolonged disor- dered consciousness participating in rehabilitation. Keywords: brain injury, coma, deglutition, disordered consciousness, dysphagia, rehabilitation R EHABILITATION TEAMS have traditionally struggled to provide meaningful treatment for individuals with prolonged disordered consciousness. Swallowing therapy may be overlooked as a plausible intervention because of risk for aspiration. Previously reported evidence indicates that safe therapeutic oral feedings, based on findings from instrumental swal- Author Affiliations: Voice & Swallowing Center, Department of Speech-Language Pathology (Dr Brady), Brain Injury Program (Ms Darragh and Dr Escobar), Marianjoy Rehabilitation Hospital (Drs Pape and Rao), Wheaton, Illinois; Department of Veterans Affairs, Office of Research and Development, Rehabilitation Research and Development Service, Hines, Illinois (Dr Pape); and Department of Physical Medicine and Rehabilitation and Institute for Health Care Studies, Northwestern University Feinberg School of Medicine (Dr Pape). The Dr Ralph and Marian Falk Medical Research Foundation supported this work. This article was accepted for a poster presentation at the American Speech- Language-Hearing Association Annual Convention, Boston, Massachusetts, November 2007. Corresponding Author: Susan L. Brady, MS, CCC-SLP, BRS-S, 26 W 171 Roosevelt Rd, Wheaton, IL 60187 (sbrady@marianjoy.org). lowing examinations, are possible and safe and do not increase cost for patients with prolonged disordered consciousness during inpatient (IP) rehabilitation. 1 This article presents complementary evidence regarding the feasibility, safety, and potential benefit of conducting an instrumental assessment of the swallow during IP rehabilitation for patients with prolonged disordered consciousness. Dysphagia following a severe brain injury is attributed to physiological impairments affecting the swallowing mechanism and impaired cognition. 2–4 Persons who re- cover consciousness within 4 weeks of a severe brain injury have been shown to demonstrate improved swal- lowing function during the recovery trajectory, 5,6 but limited information is available regarding swallowing function and recovery for those persons who remain in a prolonged state of disordered consciousness. 1,7 Dis- orders of consciousness have been characterized in the literature as coma, vegetative, and minimally conscious states. 8 384