Study: C-Collar and Dysphagia

According to the National Cervical Spinal Cord Injury Statistical Center, 12,000 patients
experience acute spinal cord injury (SCI) in the United States annually. It is reported that
16% to 55% of patients with a cervical spinal cord injury (SCI) present with dysphagia which
compromises their ability to eat and drink safely as well as their quality of life. Based on
previous research, Dysphagia can also result in respiratory complications, particularly
pneumonia, which is the most common cause of death in cervical SCI patients. The contribution
of swallowing impairment, and associated aspiration risks, to respiratory illnesses and
mortality in patients with SCI are unknown. As a first step, the investigators will identify
the nature (type of swallowing impairment such as swallow delay, pharyngeal residue,
penetration or aspiration) and frequency of occurrence of swallowing impairments in elderly
patients with injury to the cervical spinal region. Further, the investigators will determine
the effects of standard medical care, specifically, surgical bracing, on swallow function in
patients post-cervical SCI.

Patients with SCI present with a range of impairments in the oral and pharyngeal phases of
the swallow. These result both from the effects of trauma and medical/surgical management of
injury on anatomy and physiology of the swallow mechanism. Earlier studies postulate that
Acute SCI can result in reduced base of tongue movement, delayed pharyngeal swallow response,
decreased hyolaryngeal excursion with subsequent decrease in cricopharyngeal opening, and
pharyngeal wall dysfunction. These swallowing impairments are particularly devastating in
older patients who lack the functional reserve to overcome these neuroanatomical insults.
Consequently, there is an increased prevalence of dysphagia in the elderly patients with SCI.

Medical and surgical management of SCI can also negatively impact swallow function. Many
patients will require neck immobilization following injury. Neck extension, chin or head
retraction secondary to cervical bracing may increase the risk or severity of dysphagia by
changing the mechanics of swallowing. In addition, fixation at a ninety-degree angle limits
the natural flexion or range of movement a patient employs during deglutition. Studies have
found that cervical orthoses impacts swallowing physiology in healthy adults. An earlier
study reported changes in point of initiation of the swallow, laryngeal penetration,
pharyngeal residue and hyoid bone movement. One would expect changes to be more significant
in patients with dysphagia, and likely more remarkable in the elderly population who
unfortunately, have the highest incidence of cervical SCI. Given the risk factors for
dysphagia and pulmonary complications in this population, it is imperative that thorough
evaluation of oral-pharyngeal swallow function be completed. However, there is little
research addressing the impact of cervical bracing on patients with dysphagia at any age. The
study team here aims to determine if cervical bracing contributes to severity of dysphagia.

Inclusion Criteria:

1. Inpatients receiving treatment for a spine injury

2. Treating physician's approval that cervical cervical spinal column injury is stable

3. Approval for collar removal by treating physician during VFSS

4. Adults 60 and over.

5. All races.

6. Males and females.

7. Glasgow coma scale of 13 or greater.

Exclusion Criteria:

1. History of oral-pharyngeal dysphagia.

2. Neurologic disorders associated with dysphagia including dementia, Parkinson's
disease, multiple sclerosis, stroke, and ALS.

3. Pharyngeal/laryngeal surgery or head/neck radiation treatment.

4. Glasgow coma scale of less than 13 at time of evaluation.

5. Patient's with a tracheotomy.

6. Barium intolerance.

7. Patients who lack the capacity to consent on their own behalf