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Assessment Of Aspiration Risk In Stroke Patients With Quantification Of Voluntary Cough

C.A. Smith Hammond, L.B. Goldstein, D.J. Zajac, L. Gray, P.W. Davenport, D.C. Bolser
Published 2001 · Medicine

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Background: Dysphagia and subsequent aspiration are serious complications of acute stroke that may be related to an impaired cough reflex. It was hypothesized that aspirating stroke patients would have impaired objective measures of voluntary cough as compared with both nonstroke control subjects and nonaspirating stroke patients. Methods: Swallowing was evaluated by standard radiologic or endoscopic methods, and stroke patients were grouped by aspiration severity (severe, n = 11; mild, n = 17; no aspiration, n = 15). Airflow patterns and sound pressure level (SPL) of voluntary cough were measured in stroke patients and in a group of normal control subjects (n = 18). Initial stroke severity was determined retrospectively with the Canadian Neurological Scale. Results: All cough measures were altered in stroke patients as a group relative to nonstroke control subjects. Univariate analysis showed that peak flow of the inspiration phase (770.6 ± 80.6 versus 1,120.1 ± 148.4 mL/s), SPL (90.0 ± 3.1 versus 100.2 ± 1.6 dB), peak flow of the expulsive phase (875.1 ± 122.7 versus 1,884.1 ± 221.6 mL/s), expulsive phase rise time (0.34 ± 0.1 versus 0.09 ± 0.01 s), and cough volume acceleration (5.5 ± 1.3 versus 27.8 ± 3.9 mL/s/s) were significantly impaired in severe aspirators as compared with nonaspirators. Aspirating patients had more severe strokes than nonaspirators (mean Canadian Neurological Scale score 7.7 ± 0.7 versus 9.8 ± 0.3). Multivariate logistic regression found only expulsive phase rise time values during cough correlated with aspiration status. Conclusion: Objective analysis of cough may provide a noninvasive way to identify the aspiration risk of stroke patients.
This paper references
Pneumonia in Stroke Patients: A Retrospective Study
Ruiying Ding (2000)
Dysphagia following brain-stem stroke. Clinical correlates and outcome.
J. Horner (1991)
Aspiration following stroke
J. Homer (1988)
Aerodynamic and laryngographic assessment of pediatric vocal function
D. Zajac (1993)
von LEDEN (1965)
Cough. In: Handbook of physiology: the respiratory system, vol III, pt 1. Bethesda: American Physiological Society, 1990:315–336
DE Leith (1990)
Contribution of airway collapse to supramaximal expiratory flows.
R. Knudson (1974)
Silent aspiration following stroke
J. Horner (1988)
Assessing the laryngeal cough reflex and the risk of developing pneumonia after stroke: an interhospital comparison.
W. Addington (1999)
Retrospective assessment of initial stroke severity with the Canadian Neurological Scale.
L. Goldstein (1997)
Aspiration following stroke: clinical correlates and outcome
J Horner (1988)
Aspiration in acute stroke: a clinical study with videofluoroscopy.
D. Kidd (1993)
An investigation of factors affecting progress of patients on a stroke unit.
N. Lincoln (1989)
Evaluation and treatment of swallowing disorders
J. Shapiro (1992)
Lesion localization in acute stroke patients with risk of aspiration.
S. Daniels (1999)
Physical dynamics of the cough mechanism.
B. B. Ross (1955)
Contribution of airway collapse to supramaximal airway flow
RJ Knudson (1974)
Swallowing and cough reflexes after onset of stroke.
H. Kobayashi (1994)

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Cough in children with congenital central hypoventilation syndrome.
G. Fontana (2004)
Open Mouth-Maximal Isometric Press: Development and Norms for Clinical Swallowing Evaluations and Treatment.
James A. Curtis (2019)
Cough reflex attenuation and swallowing dysfunction in sub‐acute post‐stroke patients: prevalence, risk factors, and clinical outcome
N. Vilardell (2017)
A Novel Cough Strength Evaluation Method via Cough Sounds
Yasutaka Umayahara (2019)
The effect of titrated fentanyl on suppressed cough reflex in healthy adult volunteers
H. E. Kelly (2016)
Differences in the peak cough flow among stroke patients with and without dysphagia.
Y. Kimura (2013)
Function in Parkinson Disease Training on Voluntary Cough and Swallow Impact of Expiratory Muscle Strength
S. Okun (2009)
Risk factors for aspiration.
N. Metheny (2002)
Ability to cough can be evaluated through cough sounds: An experimental investigation of effects of microphone type on accuracy
Yasutaka Umayahara (2017)
Codeine and cough: an ineffective gold standard
D. Bolser (2007)
The influence of auditory, visual and audiovisual modalities in the interpretation of cough reflex
Hui Teng How (2012)
Expiratory muscle strength training in persons with multiple sclerosis having mild to moderate disability: effect on maximal expiratory pressure, pulmonary function, and maximal voluntary cough.
T. Chiara (2006)
Gastric residual volume and aspiration in critically ill patients receiving gastric feedings.
N. Metheny (2008)
Effect of respiratory rehabilitation for frail older patients with musculoskeletal disorders: a randomized controlled trial.
N. Maki (2018)
The diagnosis and management of chronic cough
A. Morice (2004)
Gastric Feedings Gastric Residual Volume and Aspiration in Critically Ill Patients Receiving
Norma A. Metheny (2010)
Management of Dysphagia in Acquired and Progressive Neurologic Conditions.
M. Ciucci (2019)
Inspiratory and expiratory muscle training in subacute stroke
M. Messaggi-Sartor (2015)
Predicting aspiration in patients with ischemic stroke: comparison of clinical signs and aerodynamic measures of voluntary cough.
C. Smith Hammond (2009)
Reflex Cough and Disease Duration as Predictors of Swallowing Dysfunction in Parkinson’s Disease
M. Troche (2016)
Strategies for the Integration of Cough and Swallow to Maintain Airway Protection in Humans
Alyssa D. Huff (2018)
Cough Reflex Testing in Acute Dysphagia Management: Validity, Reliability and Clinical Application
Anna Miles (2013)
Cortical Gating of Oropharyngeal Sensory Stimuli
K. Wheeler-Hegland (2011)
Cough and Aspiration of Food and Liquids Due to Oral Pharyngeal Dysphagia
C. Hammond (2007)
Cough and aspiration of food and liquids due to oral-pharyngeal dysphagia: ACCP evidence-based clinical practice guidelines.
C. S. Hammond (2006)
Global physiology and pathophysiology of cough: Part 1. Cough phenomenology: CHEST Guideline and Expert Panel report.
Kai K Lee (2020)
Outcomes of an intensive exercise-based swallowing program for persons with Parkinson's disease: A single-case experiment
Jocelyn Jenks (2019)
Cough : causes, mechanisms, and therapy
K. Chung (2003)
Biomechanical Models of Human Upper and Tracheal Airway Functionality
D. N. Kuruppumullage (2018)
Poor cough flow in acute stroke patients is associated with reduced functional residual capacity and low cough inspired volume
K. Ward (2017)
In vivo trial results of a novel ultrasonic cough stimulator.
J. Nitz (2012)
Airway Protective Mechanisms
T. Pitts (2013)
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