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Top Spinal Cord Inj Rehabil. 2012 Winter;18(1):15-22. doi: 10.1310/sci1801-15.

Dysphagia and respiratory care in individuals with tetraplegia: incidence, associated factors, and preventable complications.

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1
Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center , San Jose , California.

Abstract

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.

KEYWORDS:

aspiration; dysphagia; intubation; mechanical ventilation; pneumonia; spinal cord injury; swallowing; tetraplegia; tracheostomy

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