Dysphagia in patients with acute cervical spinal cord injury

Abstract

Study design: Longitudinal observational. Objectives: (a) To establish a reliable and feasible method to indicate the presence and severity of dysphagia and (b) to establish a course of treatment in individuals presenting with cervical spinal cord injury (CSCI). Setting: Spinal Cord Injury Center, Werner Wicker Klinik, Bad Wildungen, Germany. Patients and methods: This is a cross-sectional study of 51 patients consecutively admitted to the Intensive Care Unit of the SCI in-patient service. They were subjected to neurological and fiberoptic endoscopic examination of swallowing (FEES). Data concerning artificial respiration, presence of tracheostomy, oral or non-oral feeding were obtained from the medical charts. Statistics were carried out by a calculation of a nonparametric correlation (Spearman). Results: Five levels of dysphagia could be distinguished. At levels 1 and 2, patients presented with a severe impairment of swallowing, in level 3 aspiration was met by a powerful coughing reflex, level 4 comprised a laryngeal edema and/or a mild aspiration of fluids only and at level 5 laryngeal function was not compromised. On admission, 20 patients with CSCI presented with mild (level 4), eight with moderate (level 3) and 13 with severe dysphagia (levels 1 and 2). In 10 no signs of dysphagia could be detected. After treatment, level 1 was no longer detected, one patient showed level 2, two patients showed level 3, all other patients showed only mild or no signs of dysphagia any longer. Conclusions: Dysphagia of various severities was present in the majority of these patients with CSCI together with respiratory insufficiency. FEES allows for the detection and classification of dysphagia as well as for an evaluation of the therapeutic management. Under interdisciplinary treatment the prognosis of dysphagia is good.

Dysphagia in cervical spinal cord injury

“…Age was found to be statistically related to dysphagia by Kirshblum et al, 7 but not by Wolf and Meiners, 2 Abel et al 8 or Seidl et al 9 In the present study, the mean age of patients with aspiration was significantly higher compared with the patients without evidence of aspiration. Even linear by linear association after categorization in different age groups showed higher prevalence of dysphagia with increasing age.…”

“…This correlation was also supported in previous studies. 2,[7][8][9] Although the cause-effect relationship between dysphagia and the need for tracheostomy is unclear, various reports of increased risk of dysphagia through tracheostomy give weight to the possibility that risk of dysphagia increases through the existence of tracheostomy in cervical spinal cord injury patients. This was also evident in the present study, as the incidence of aspiration was significantly related to the presence of tracheostomy by the time of VFSS, but not to the history of tracheostomy.…”

“…In many patients, this problem is transient and tends to recover naturally throughout the rehabilitation process. 1,2 However, the fact that aspiration risk is a major risk factor of hospital-acquired pneumonia, 3 and that in spinal cord injury patients respiratory problems, especially pneumonia, is the most common cause of death, 4 makes precise evaluation of swallowing function in cervical spinal cord injury patients invaluable.…”

Dysphagia in acute tetraplegics: a retrospective study

“…As mechanical alteration of the tissues during an anterior approach has repeatedly been described as the mechanism for dysphagia, a different treatment of the tissues must be the reason for the improved results in our population. Problems during the surgical procedure must be considered in Wolf's study, 5 in which the cause of dysphagia was, in all cases, identified as laryngeal swelling. Such swelling generally arises due to a lack of lymphatic or other drainage as a result of trauma.…”

Dysphagia and Respiratory Care in Individuals with Tetraplegia: Incidence, Associated Factors, and Preventable Complications

“…[1][2][3] The most recent estimate of dysphagia incidence within one month is 40%. 4 The detrimental consequences of dysphagia in SCI include primarily pulmonary with transient hypoxemia, chemical pneumonitis, mechanical obstruction, atelectasis, bronchospasm, and pneumonia.…”