Rehabilitation of Swallowing and Language Ability in Patients With Severe Acquired Brain Injury: An Online International Survey

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