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Videofluoroscopic Profiles of Swallowing and Airway Protection Post-traumatic Cervical Spinal Cord Injury

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Abstract

Videofluoroscopic analyses of swallowing in survivors of traumatic cervical spinal cord injury (tCSCI) have been largely limited to case reports/series and qualitative observations. To elucidate the disrupted physiology specifically underlying dysphagia post-tCSCI, this prospective observational study analyzed videofluoroscopic swallow studies (recorded at 30 frames per second) across 20 tCSCI survivors. Norm-referenced measures of swallow timing or displacement, and calibrated area measures of laryngeal vestibule closure (LVC) were explored in relation to the severity of aspiration or pharyngeal residue. Videofluoroscopic performance was compared by injury level, surgical intervention, tracheostomy status, and in relation to clinical bedside assessments. Reduced pharyngeal constriction, delayed hyoid elevation, and impaired LVC characterized post-tCSCI dysphagia. Reduced extent of hyoid excursion and of pharyngoesophageal segment (PES) opening were not as prominent, only present in approximately half or less of the sample. Ten participants aspirated and 94% of aspiration events were silent. Severity of aspiration significantly correlated with pharyngeal constriction and prolonged pharyngeal transit times. Post-swallow residue correlated with delayed PES distention/closure and prolonged pharyngeal transit. Clinical inference regarding the integrity of the pharyngeal phase at bedside was limited; however, EAT-10 scores demonstrated promise as an adjuvant clinical marker of post-tCSCI dysphagia. This exploratory study further describes the pathophysiology underlying post-tCSCI dysphagia to promote deficit-specific rehabilitation and functional recovery.

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Acknowledgements

This project was supported by Rehabilitation Institute of Chicago (RIC)/Shirley Ryan AbilityLab (SRALab)-Craig H. Neilsen Foundation Infrastructure Grants (2017 & 2019, PIs: Hamilton & Walaszek). We also gratefully acknowledge the time and efforts of the participants and their families as well as our research and clinical colleagues: Ms. Jill Hahlen, Dr. Chih-hung Chang, Dr. Alan Anschel, Ms. Mallory Adams, Ms. Tayler Van Berkum, Ms. Aisha Miller, Ms. Lauren Galvin, and Ms. Erin Fineran for their contributions to project management and completion.

Funding

This study was funded by the Craig H. Neilsen Foundation Infrastructure Grant 2017–2018 (to V.H.) and 2019–2020 (to E.W. and V.H.).

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Authors and Affiliations

  1. Think+Speak Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, Chicago, IL, 60611, USA

    Valerie K. Hamilton, Laura L. Pitts & Leora R. Cherney

  2. Department of Communication Sciences and Disorders, University of Northern Iowa, 245 CAC University of Northern Iowa, Cedar Falls, IA, 50614, USA

    Laura L. Pitts

  3. Strength and Endurance Lab, Spinal Cord Injury Program, Shirley Ryan AbilityLab, 355 E. Erie Street, Chicago, IL, 60611, USA

    Erin A. Walaszek

  4. Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 400 E. Superior Street, Chicago, IL, 60611, USA

    Laura L. Pitts & Leora R. Cherney

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  1. Valerie K. Hamilton
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Correspondence to Laura L. Pitts.

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The authors have no relevant financial or non-financial interests to disclose. Research was completed at the Shirley Ryan AbilityLab.

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Hamilton, V.K., Pitts, L.L., Walaszek, E.A. et al. Videofluoroscopic Profiles of Swallowing and Airway Protection Post-traumatic Cervical Spinal Cord Injury. Dysphagia 37, 1599–1611 (2022). https://doi.org/10.1007/s00455-022-10407-7

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