Introduction
Dysphagia is a relatively common secondary complication in people with cervical spinal cord injuries (CSCI). Dysphagia after CSCI can increase the risk of aspiration pneumonia, which can lead to increased morbidity and mortality. Several previous studies reported risk factors for dysphagia in people with CSCI: age, tracheostomy, severe paralysis, voice quality, and anterior cervical surgery. In addition, inefficient residue clearance in the vallecular and pyriform sinuses may lead to an increased risk of tracheal penetration or laryngeal aspiration and following pulmonary infection.
Respiratory and coughing function is known to be a useful predictor of dysphagia in patients with ischemic stroke. However, few studies have shown that respiratory functions are physiologically associated with swallowing function in people with CSCI. The aim of the present study was to investigate how the respiratory function affects dysphagia and to determine whether the pulmonary function test and peak cough flow (PCF) can be a positive predictor of dysphagia in individuals with CSCI.
Methods
We retrospectively reviewed the medical records of 78 individuals with CSCI who underwent video fluoroscopic swallowing study (VFSS), pulmonary function test (PFT), and PCF. Dysphagia was assessed by evaluating penetration-aspiration scale (PAS) and pharyngeal residue grade (PRG). Parameters of PFT including the tidal volume (TV), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) were measured. The correlation between dysphagia and pulmonary functions was analyzed using Pearson’s correlation analysis.
Results
Of all participants, 40 (51%) were diagnosed with dysphagia and 25 (32%) showed tracheal aspiration. The demographics data showed significantly older age in the penetration-aspiration (PA) group and pharyngeal residue group. Age and PCF showed significant results in logistic regression analysis of penetration or aspiration risk factors. The odds ratio of age and PCF was 1.067 (95% CI=1.022-1.113, p=0.003) and 0.989 (95% CI=0.978-1.000, p=0.032), respectively (Table 1). In analysis for pharyngeal residue, age and FEV1 showed significant results. The odds ratio of age and FEV1 was 1.072 (95% CI=1.025-1.122, p=0.003) and 0.171 (95% CI=0.033-0.898, p=0.037), respectively (Table 2). In addition, FEV1 and PCF showed the strongest correlation with PAS scores or PRG. According to the receiver operating curve analysis of PCF and FEV1 in PAS, each cutoff value was 140 L/min and 1.135 L, respectively.
Conclusion
Pulmonary functions, PCF and FEV1, can be considered as risk factors for predicting dysphagia after CSCI. Therefore, assessing the pulmonary functions in people with CSCI might be useful in early detection of dysphagia and help prevent complications including aspiration pneumonia.
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Comparison between penetraion-aspiration group and non-penetration-aspiration group on demographics, clinical features, injury and parameters of pulmonary function test multivariate logistic regression analysis of pharyngeal residue risk factors
Comparison between pharyngeal residue group and non-pharyngeal residue group on demographics, clinical features, injury and parameters of pulmonary function test and multivariate logistic regression analysis of pharyngeal residue risk factors
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