Dysphagia occurs in a significant number of individuals with spinal cord injury (SCI) presenting to acute care and inpatient rehabilitation. This prospective study has found dysphagia in nearly 40% of individuals with tetraplegia. Tracheostomy, mechanical ventilation, nasogastric tube, and age are significant risk factors. The detrimental complications of dysphagia in SCI can cause significant morbidity and delays in rehabilitation. Thus, early and accurate diagnosis of dysphagia is imperative to reduce the risk of developing life-threatening complications. Incidence and risk factors of dysphagia and the use of the bedside swallow evaluation (BSE) and videofluoroscopy swallow study (VFSS) to diagnose dysphagia are presented. The often underappreciated role of respiratory therapists, including assist cough, high tidal volume ventilation, and the use of Passy-Muir valve, in the care of individuals with SCI who have dysphagia is discussed. Improved secretion management and respiratory stabilization enable the individuals with dysphagia to be evaluated sooner and safely by a speech pathologist. Early evaluation and intervention could improve upon morbidity and delayed rehabilitation, thus improving overall clinical outcomes.
Kirshblum S, Johnston MV, Brown J, O’Connor KC, Jarosz P. Predictors of dysphagia after spinal cord injury. Arch Phys Med Rehabil. 1999;80(9):1101-1105.
Predictors of dysphagia after spinal cord injury
, Arch Phys Med Rehabil.
, vol. 80
(pg. 1101
-1105
) Wuermser LA, Ho CH, Chiodo AE, Priebe MM, Kirshblum SC, Scelza WM. Spinal cord injury medicine. 2. Acute care management of traumatic and nontraumatic injury. Arch Phys Med Rehabil. 2007;88(3 Suppl 1):S55-61.
Spinal cord injury medicine. 2. Acute care management of traumatic and nontraumatic injury
, Arch Phys Med Rehabil.
, vol. 88
(pg. S55
-61
) Wolf C, Meiners TH. Dysphagia in patients with acute cervical spinal cord injury. Spinal Cord. 2003;41(6):347-353.
Dysphagia in patients with acute cervical spinal cord injury
, Spinal Cord.
, vol. 41
(pg. 347
-353
) Shem K., Castillo K., Wong S., Chang J. Dysphagia in individuals with tetraplegia: incidence and risk factors. J Spinal Cord Med. 2011;34:85-92
Dysphagia in individuals with tetraplegia: incidence and risk factors
, J Spinal Cord Med.
, vol. 34
(pg. 85
-92
) Consortium for Spinal Cord Medicine. Respiratory management following spinal cord injury: a clinical practice guideline for health-care professionals. J Spinal Cord Med. 2005;28(3):259-293.
Consortium for Spinal Cord Medicine. Respiratory management following spinal cord injury: a clinical practice guideline for health-care professionals
, J Spinal Cord Med.
, vol. 28
(pg. 259
-293
) Carter RE. Respiratory aspects of spinal cord injury management. Paraplegia. 1987;25:262-266.
Respiratory aspects of spinal cord injury management
, Paraplegia.
, vol. 25
(pg. 262
-266
) Devivo MJ, Kartus PL, Stover SL, Phillip RD, Fine R. Cause of death for patients with spinal cord injury. Arch Intern Med. 1989;149:1761-1766.
Cause of death for patients with spinal cord injury
, Arch Intern Med.
, vol. 149
(pg. 1761
-1766
) Jackson AB, Groomers TE. Incidence of respiratory complications following SCI. Arch Phys Med Rehabil. 1994;75:270-275.
Incidence of respiratory complications following SCI
, Arch Phys Med Rehabil.
, vol. 75
(pg. 270
-275
) Lemons VR, Wagner FC Jr. Respiratory complications aftercervicalspinalcordinjury. Spine.1994;19:2315-2320.
Respiratory complications aftercervicalspinalcordinjury
, Spine.
, vol. 19
(pg. 2315
-2320
) Lanig IS, Peterson WP. The respiratory system in spinal cord injury. Phys Med Rehabil Clinics North Am. 2000;11:29-43.
The respiratory system in spinal cord injury
, Phys Med Rehabil Clinics North Am.
, vol. 11
(pg. 29
-43
) Winslow C, Rozovsky J. Effect of spinal cord injury on the respiratory system. Am J Phys Med Rehabil. 2003;82(10):803-814.
Effect of spinal cord injury on the respiratory system
, Am J Phys Med Rehabil.
, vol. 82
(pg. 803
-814
) Winslow C, Bode R, Felton D, Chen D, Meyer PR. Impact of resppiratoy complications on length of stay and hospital costs in acute cervical spine injury. Chest. 2002;121:1548-1554.
Impact of resppiratoy complications on length of stay and hospital costs in acute cervical spine injury
, Chest.
, vol. 121
(pg. 1548
-1554
) Reines HD, Harris RC. Pulmonary complications of acute spinal cord injuries. Neurosurgery. 1987;21:193-196.
Pulmonary complications of acute spinal cord injuries
, Neurosurgery.
, vol. 21
(pg. 193
-196
) Bellamy R, Pitts FW, Stauffer ES. Respiratory complications in traumatic quadriplegia. Analysis of 20 years’ experience. J Neurosurg. 1973;39:596-600.
Respiratory complications in traumatic quadriplegia. Analysis of 20 years’ experience
, J Neurosurg.
, vol. 39
(pg. 596
-600
) Gilbert J. Critical care management of the patient with acute spinal cord injury. Crit Care Clinics. 1987;3:549-567.
Critical care management of the patient with acute spinal cord injury
, Crit Care Clinics.
, vol. 3
(pg. 549
-567
) Clough P, Lindenauer D, Hayes M, Zekany B. Guidelines for routine respiratory care of patients with spinal cord injury. Phys Ther. 1986;66:1395-1402.
Guidelines for routine respiratory care of patients with spinal cord injury
, Phys Ther.
, vol. 66
(pg. 1395
-1402
) Wallbom A, Naran B, Thomas E. Acute ventilator management and weaning in individuals with high tetraplegia. Topics in SCI Rehabil. 2005;10(3):1-7.
Acute ventilator management and weaning in individuals with high tetraplegia
, Topics in SCI Rehabil.
, vol. 10
(pg. 1
-7
) McMichan JC, Michel L, Westbrook PR. Pulmonary dysfunction following traumatic quadriplegia. JAMA. 1980;243:528-531.
,
JAMA.
, vol. 243
(pg. 528
-531
) Cook N. Respiratory care in spinal cord injury with associated traumatic brain injury: bridging the gap in critical care nursing intervention. Intens Crit Care Nurs. 2003;19:143-153.
Respiratory care in spinal cord injury with associated traumatic brain injury: bridging the gap in critical care nursing intervention
, Intens Crit Care Nurs.
, vol. 19
(pg. 143
-153
) Sortor S. Pulmonary issues in quadriplegia. Eur Respir Rev. 1992;2:330-334.
Pulmonary issues in quadriplegia
, Eur Respir Rev.
, vol. 2
(pg. 330
-334
) Stevens RD, Bhardwaj A, Kirsch JR, Mirski MA. Critical care and perioperative management in traumatic spinal cord injury. J Neurosurg Anesthesiol. 2003;15:215-229.
Critical care and perioperative management in traumatic spinal cord injury
, J Neurosurg Anesthesiol.
, vol. 15
(pg. 215
-229
) Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compares with traditional tidal volumes for acute lung injury and the acute respiratory distresss syndrome. New Engl J Med. 2000;342:1301-1308.
,
New Engl J Med.
, vol. 342
(pg. 1301
-1308
) Peterson P, Brooks CA, Mellick D, Whiteneck G. Protocol for ventilator management in high tetraplegia. Top Spinal Cord Inj Rehabil. 1997:2:101-106.
Protocol for ventilator management in high tetraplegia
, Top Spinal Cord Inj Rehabil.
, vol. 2
(pg. 101
-106
) Bhaskar KR, Brown R, O’Sullivan DD, Melia S, Duggan M, Reid L. Bronchial mucus hypersecretion in acute quadriplegia. Macromolecular yields and glycoconjugate composition. Am Rev Respir Dis. 1991;143:640-648.
Bronchial mucus hypersecretion in acute quadriplegia. Macromolecular yields and glycoconjugate composition
, Am Rev Respir Dis.
, vol. 143
(pg. 640
-648
) Slack RS, Shucart W. Respiratory dysfunction associated with traumatic injury to the central nervous system. Clin Chest Med. 1994;15:739-749.
Respiratory dysfunction associated with traumatic injury to the central nervous system
, Clin Chest Med.
, vol. 15
(pg. 739
-749
) Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery. Spine. 2002;27(22):2453–2458.
Incidence of dysphagia after anterior cervical spine surgery
, Spine.
, vol. 27
(pg. 2453
-2458
) Frempong -Boadu A, Houton JK, Osborn B, Opulencia J, Kells L, Guida DD, Le Roux PD. Swallowing and speech dysfunction in patients undergoing anterior cervical discectomy and fusion: a prospective, objective preoperative and postoperative assessment. J Spinal Disord Tech. 2002;15(5):362-368.
Swallowing and speech dysfunction in patients undergoing anterior cervical discectomy and fusion: a prospective, objective preoperative and postoperative assessment
, J Spinal Disord Tech.
, vol. 15
(pg. 362
-368
) Winslow CP, Winslow TJ, Wax MK. Dysphonia and dysphagia following the anterior approach to the cervical spine. Arch Otolaryngol Head Neck Surg. 2001;127(1):51-55.
Dysphonia and dysphagia following the anterior approach to the cervical spine
, Arch Otolaryngol Head Neck Surg.
, vol. 127
(pg. 51
-55
) Stewart M, Johnston RA, Stewart I, Wilson JA. Swallowing performance following anterior cervical spine surgery. Br J Neurosurg. 1995;9(5):605-609.
Swallowing performance following anterior cervical spine surgery
, Br J Neurosurg.
, vol. 9
(pg. 605
-609
) Tolep K, Getch CL, Criner GJ. Swallowing dysfunction in patients receiving prolonged mechanical ventilation. Chest. 1996;109(1):167-172.
Swallowing dysfunction in patients receiving prolonged mechanical ventilation
, Chest.
, vol. 109
(pg. 167
-172
) Shem, K, Castillo K, Naran B. Factors associated with dysphagia in individuals with high tetraplegia. Top Spinal Cord Inj Rehabil. 2005;10(3):8-18.
Factors associated with dysphagia in individuals with high tetraplegia
, Top Spinal Cord Inj Rehabil.
, vol. 10
(pg. 8
-18
) Feldman SA, Deal CW, Uriquhart W. Disturbance of swallowing after tracheostomy. Lancet. 1966;1(7444):954-955.
Disturbance of swallowing after tracheostomy
, Lancet.
, vol. 1
(pg. 954
-955
) Bonanno PC. Swallow dysfunction after tracheostomy. Ann Surg. 1971;174(1):29-33.
Swallow dysfunction after tracheostomy
, Ann Surg.
, vol. 174
(pg. 29
-33
) Eibling DE, Gross RD. Subglottic air pressure: a key component of swallowing efficiency. Ann Otol Rhinol Laryngol. 1996;105(4):253-258.
Subglottic air pressure: a key component of swallowing efficiency
, Ann Otol Rhinol Laryngol.
, vol. 105
(pg. 253
-258
) Gamache FW Jr, Voohies RM. Hypertrophic osteophytes causing dysphagia: a review. J Neurosurg.
Hypertrophic osteophytes causing dysphagia: a review
, J Neurosurg.
Singh G, Triadafilopous G. Gastroesophageal reflux disease in patients with spinal cord injury. J Spinal Cord Inj. 2000;23(1):23-27.
Gastroesophageal reflux disease in patients with spinal cord injury
, J Spinal Cord Inj.
, vol. 23
(pg. 23
-27
) Grabois M, Garrison SJ, Hart KA, Lehmkuhl LK. Physical Medicine and Rehabilitation: The Complete Approach. Malden, MA: Blackwell Science; 2000.
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