Smartstrokes 2013

An early but landmark study by Splaingard, et al. (1988) documented that clinical swallowing assessment identified only 42% of patients who were consequently found to aspirate on videofluoroscopic swallowing study. More concerning is that of those patients with severe aspiration documented on the radiographic swallowing assessment, 70% were not identified as aspirating at bedside. The findings of this early study have been replicated through numerous subsequent reports. The critical flaw in the clinical swallowing assessment lies in the nature of impairment in many neurologically impaired patients. For patients with neuro-sensory impairment, cough response to aspiration may be absent or impaired. This leaves the clinician with a diagnostic conundrum: Is the patient aspirating but without cough response? Or is the patient not aspirating? Cough reflex testing consists of challenging the sensory integrity of the aerodigestive tract by introduction of a tussive agent. This particular test has been studied in res