重度获得性脑损伤患者吞咽与语言能力的康复：一项在线国际调查

文献信息

中文摘要

目的： 重度获得性脑损伤伴意识障碍（DoC）患者无法交流，并存在严重吞咽困难。为描述当前实践、识别差距并探索昏迷后康复中的新兴方法，国际脑损伤协会DoC特别兴趣小组开展了一项关于言语-语言治疗（SLT）实践的国际调查。
方法： 一份以七种语言提供的在线问卷被分发给参与DoC患者吞咽和/或语言与交流康复的临床医生。调查涵盖（a）社会人口学与实践环境信息，（b）昏迷后SLT一般实践，（c）吞咽评估与管理，以及（d）语言与交流评估与管理。
结果： 共获得166名临床医生的回复，主要为言语-语言病理学家（74%），工作在急性/亚急性期照护（38%）或长期康复（71%）中。大多数评估（74%）和管理（74%）吞咽障碍，25%创建或改编了自己的评估工具。对于语言与交流，大多数受访者报告评估（82%）和管理（76%）这些能力，并频繁使用增强与替代交流（71%）。家庭投入被认为至关重要，用于识别激励性刺激（96%）和让亲属参与治疗（87%）。29%开发了自己的语言评估工具，而51%开发了自己的干预工具，反映出经过验证的资源有限。
结论： 世界各地的临床医生评估和管理DoC患者的吞咽与交流，但报告缺乏经过验证的工具。实践常依赖个体化方法和临床医生开发的材料，并有家庭参与。这些发现凸显了需要加强培训以及标准化、循证的工具，以在连续照护过程中强化SLT实践。

英文摘要

PURPOSE: Patients with severe acquired brain injury and disorders of consciousness (DoC) are noncommunicative and present with severe dysphagia. To characterize current practices, identify gaps, and explore emerging approaches in postcomatose rehabilitation, the DoC Special Interest Group of the International Brain Injury Association conducted an international survey on speech-language therapy (SLT) practices.
METHOD: An online questionnaire, available in seven languages, was disseminated to clinicians involved in swallowing and/or language and communication rehabilitation of patients with DoC. The survey captured (a) sociodemographic and practice setting information, (b) general postcomatose SLT practices, (c) swallowing assessment and management, and (d) language and communication assessment and management.
RESULTS: Responses were obtained from 166 clinicians, predominantly speech-language pathologists (74%), working in acute/subacute care (38%) or in longer-term rehabilitation (71%). Most assessed (74%) and managed (74%) swallowing disorders, and 25% created or adapted their own assessment tools. For language and communication, most respondents reported assessing (82%) and managing (76%) these abilities, with frequent use of augmentative and alternative communication (71%). Family input was considered central, for identifying motivating stimuli (96%) and involving relatives in therapy (87%). While 29% developed their own language assessment tools, 51% did so for intervention tools, reflecting limited validated resources.
CONCLUSIONS: Clinicians worldwide assess and manage swallowing and communication in patients with DoC but report a lack of validated tools. Practice often relies on individualized approaches and clinician-developed materials, with family involvement. These findings highlight the need for enhanced training and standardized, evidence-based instruments to strengthen SLT practices across the continuum of care.
SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.34741404.