Measuring voluntary and reflexive cough strength in healthy individuals

Mills, Claire; Jones, Richard D.; Huckabee, Maggie‐Lee

doi:10.1016/j.rmed.2017.09.013

Cited by 24 publications

(26 citation statements)

References 57 publications

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“…Suppressed cough has recently been more widely used in dysphagia research using CRT with the hypothesis that cortical inhibition will allow for a true sensory reflex cough, as the individual can no longer voluntarily control their cough response (Mills et al . 2017). This method of testing enables the assessor to determine whether an individual's cortical cough centres have been affected by their stroke; the ability to suppress a cough response indicates that the cortical regions responsible for cough are intact, whereas an inability to suppress coughing may suggest stroke‐related injury to these areas.…”

Section: Discussionmentioning

confidence: 99%

“…A study relating to objective cough strength measures in healthy individuals, which recorded peak airflow during cough (Mills et al . 2017), found that whether a VC was strong or weak, it was still stronger than an RC. A priming or placebo effect relating to instructions given for CRT has been speculated (Monroe 2010), suggesting instructions such as ‘cough if you feel the need to’ (as per the protocol from Miles et al .…”

Section: Discussionmentioning

confidence: 99%

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Cough reflex testing in acute stroke: A survey of current UK service provision and speech and language therapist perceptions

Trimble

Patterson

2020

Intl J Lang & Comm Disor

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Background Silent aspiration (SA)—airway entry of food, drink or other material without a cough response—is common post‐stroke. Clinical swallowing examination misses up to 40% of dysphagic patients with SA. This may put these patients at risk of aspiration pneumonia, prolonged length of hospital stay and increased healthcare costs. After stroke, the laryngeal cough reflex is frequently impaired with significant relationships between pneumonia rates and reduced cough strength and sensitivity. There has been a significant amount of recent interest in cough reflex testing (CRT) as a potential means to improve clinical identification of patients at risk of SA. However, there is a lack of consensus regarding the methodology and protocols for use of CRT with widely varying outcomes reported in the literature. Aims To provide an overview of current practice in the UK with regards to clinical use of CRT by speech and language therapists (SLTs) in acute stroke settings and to explore the perceptions regarding its potential application in clinical dysphagia management and the barriers and facilitators associated with adopting CRT in clinical practice. Methods & Procedures A cross‐sectional web‐based survey was developed, piloted and delivered. The survey targeted all UK‐based SLTs working in acute stroke settings. Outcomes & Results A total of 129 SLTs with varying levels of experience of CRT from all regions of the UK responded. Only four SLT services in the UK were reported to be currently using CRT clinically with acute stroke patients. A total of 29% of respondents who were not using CRT were considering introducing CRT into their service's dysphagia protocol. Variation was reported in the procedures and protocols. Overall, users reported improved confidence in the clinical detection of SA and felt that the introduction of CRT had improved their patient‐related outcomes. Issues included difficulties procuring citric acid, implications for SLT time (including service set‐up and delivery of CRT) and restricted access to instrumental assessments. Conclusions & Implications This survey gives valuable insight into the current practice and perceptions of SLTs in the UK working in acute stroke settings in relation to CRT. It highlights discrepancies between reported approaches and recommendations from existing guidelines and validation studies. The variation in responses indicates a need to develop a consensus statement and further research to guide practice.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cough reflex testing in acute stroke: A survey of current UK service provision and speech and language therapist perceptions

Trimble

Patterson

2020

Intl J Lang & Comm Disor

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“…While the association between aspiration risk and impaired cough function is well-established, the accuracy of perceptual assessment of cough effectiveness is less clear. Acoustic evaluation of cough strength is less reliable than measuring cough characteristics such as peak cough flow (PCF), 24 peak expiratory flow (PEF), 25 or cough sensitivity (e.g., inhalation of citric acid or capsaicin). 26 Inclusion of these methods into swallowing examination in F I G U R E 2 Allocation of diet recommendations by Gugging Swallowing Screen (GUSS) 11 vs. Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS) 13 in 51 participants with idiopathic Parkinson's disease, IDDSI Levels see Table 2 PD patients has been widely suggested [25][26][27] and might increase the validity of the GUSS as a dysphagia screening tool in this patient group.…”

Section: Discussionmentioning

confidence: 99%

Dysphagia Screening in Parkinson's Disease. A diagnostic accuracy cross‐sectional study investigating the applicability of the Gugging Swallowing Screen (GUSS)

Frank

Radtke

Nienstedt

et al. 2020

Neurogastroenterology Motil

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“…Sensitivity can be assessed by the concentration or duration at which the cough can be evoked when exposed to variable concentrations and/or durations of nebulized aerosols of a cough-inducing substance (such as citric acid, L-tartaric acid, or capsaicin). However, there is considerable variability in the methods used in performing the test (4,5,6). To assess the efficiency and strength of the cough, a group of Japanese scientists developed a device to measure cough strength while testing the cough reflex.…”

Section: Introductionmentioning

confidence: 99%

Cough as a neurological sign: Does it worth it?

Al‐Biltagi¹,

Bediwy²,

Saeed³

2021

Preprint

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Cough is one of the most common complaints that lead patients to see a doctor. It is not only a basic respiratory sign but also an important neurological sign. There are 3 main types of cough: reflex cough (type I), voluntary cough (type II), and evoked cough (type III). Reflex cough sensitivity may be increased in many neurological disorders, such as space-occupying lesion of the brainstem, medullary lesions secondary to type I Chiari malformations, tics disorders such as Tourette’s syndrome, somatic cough, neurodegenerative disorders of the cerebellum, and chronic vagal neuropathy due to allergic and nonallergic diseases. On the other hand, cough sensitivity decreases in the cerebral hypoxia, cerebral hemispheric stroke with a brainstem shock, dementia due to Lewy body disease, Parkinson’s disease, amyotrophic lateral sclerosis, multiple sclerosis, and peripheral neuropathy such as hereditary sensory and autonomic neuropathy type IV, diabetic neuropathy, vitamin B12, and folate deficiency. The ear-cough reflex of Arnold’s nerve, syncopal cough, cough headache, opioid associated cough and cough-anal reflex are signs that can help in the diagnosis of underlying neurological disorders. The cough reflex test is a quick, easy, and inexpensive test that can be performed during the cranial nerve exam. In this article, we have discussed cough reflex testing and various neurological disorders that increase or decrease cough sensitivity.

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Measuring voluntary and reflexive cough strength in healthy individuals

Cited by 24 publications

References 57 publications

Cough reflex testing in acute stroke: A survey of current UK service provision and speech and language therapist perceptions

Cough reflex testing in acute stroke: A survey of current UK service provision and speech and language therapist perceptions

Dysphagia Screening in Parkinson's Disease. A diagnostic accuracy cross‐sectional study investigating the applicability of the Gugging Swallowing Screen (GUSS)

Cough as a neurological sign: Does it worth it?

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