{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T04:48:11Z","timestamp":1771303691996,"version":"3.50.1"},"reference-count":41,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2022,9,5]],"date-time":"2022-09-05T00:00:00Z","timestamp":1662336000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Voluntary cough testing (VCT) may be useful for determining aspiration risk in neurogenic dysphagia; however, has yet to be investigated in traumatic cervical spinal cord injury (tCSCI). The study explored if VCT may elucidate swallowing safety and kinematics related to airway protection in tCSCI survivors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Ten inpatients, 13\u201373\u2009days post\u2010tCSCI (7 incomplete injuries), completed VCT and a modified barium swallowing study that was analyzed via the Penetration Aspiration Scale (PAS) and norm\u2010referenced measures of swallowing events related to airway protection. Spearman rho correlations explored relations among cough airflow, median PAS, and airway protection. Mann\u2013Whitney <jats:italic>U<\/jats:italic> tests explored group differences based on clinical airway invasion (PAS\u2009&gt;\u20092) and receiver operating characteristic statistics probed the sensitivity\/specificity of VCT measures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Safe (PAS\u2009&gt;\u20092) and unsafe swallowers differed by cough volume acceleration (CVA) for the total sample and by inspiratory duration for incomplete injuries (<jats:italic>p<\/jats:italic>\u00a0=\u20090.03, <jats:italic>r<\/jats:italic>\u00a0&gt;\u20090.7). A cut\u2010off value of 24.8\u2009L\/s for CVA predicted airway invasion (AUC\u00a0=\u20090.917, <jats:italic>p<\/jats:italic>\u00a0=\u20090.03) with sensitivity\u00a0=\u00a0100%\/specificity\u00a0=\u00a075%. CVA correlated with delayed laryngeal vestibule closure during swallowing for both the total sample and for incomplete injuries (<jats:italic>r<\/jats:italic><jats:sub>s<\/jats:sub>\u00a0&gt;\u20090.6, <jats:italic>p<\/jats:italic>\u00a0&lt;\u20090.05). Blunted peak flow and prolonged cough phases were associated with disordered laryngeal kinematics and prolonged bolus transit during swallowing (<jats:italic>p<\/jats:italic>\u00a0&lt;\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Reduced CVA, blunted peak flow, and prolonged cough phases reflected PAS and disrupted mechanisms of airway protection in tCSCI survivors, demonstrating promise for VCT as a clinical assessment for post\u2010tCSCI dysphagia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>3 <jats:italic>Laryngoscope<\/jats:italic>, 133:1434\u20131441, 2023<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.30369","type":"journal-article","created":{"date-parts":[[2022,9,5]],"date-time":"2022-09-05T12:24:39Z","timestamp":1662380679000},"page":"1434-1441","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Voluntary Cough Testing as a Clinical Indicator of Airway Protection in Cervical Spinal Cord Injury"],"prefix":"10.1002","volume":"133","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2380-4709","authenticated-orcid":false,"given":"Laura","family":"Pitts","sequence":"first","affiliation":[{"name":"Think+Speak Lab Shirley Ryan AbilityLab  Chicago Illinois U.S.A."},{"name":"Department of Physical Medicine and Rehabilitation Feinberg School of Medicine Northwestern University  Chicago Illinois U.S.A."},{"name":"Department of Communication Sciences and Disorders University of Northern Iowa  Cedar Falls Iowa U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5749-2956","authenticated-orcid":false,"given":"Valerie K.","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Think+Speak Lab Shirley Ryan AbilityLab  Chicago Illinois U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7767-2038","authenticated-orcid":false,"given":"Erin A.","family":"Walaszek","sequence":"additional","affiliation":[{"name":"Strength and Endurance Lab, Spinal Cord Injury Program Shirley Ryan AbilityLab  Chicago Illinois U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5624-7307","authenticated-orcid":false,"given":"Stephanie","family":"Watts","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery, Morsani College of Medicine University of South Florida  Tampa Florida U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3754-4450","authenticated-orcid":false,"given":"Leora R.","family":"Cherney","sequence":"additional","affiliation":[{"name":"Think+Speak Lab Shirley Ryan AbilityLab  Chicago Illinois U.S.A."},{"name":"Department of Physical Medicine and Rehabilitation Feinberg School of Medicine Northwestern University  Chicago Illinois U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,9,5]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/sc.2010.39"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/sc.2017.71"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1590\/1678-775720140132"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2013.08.009"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1152\/jn.00469.2021"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00408-014-9584-7"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-007-9144-x"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.10-0342"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-015-9687-1"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.56.4.502"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.08-1122"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.5535\/arm.21161"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41393-018-0170-3"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1080\/10790268.2019.1665613"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1080\/10790268.2020.1762828"},{"key":"e_1_2_7_17_1","first-page":"15","article-title":"Dysphagia: age is no barrier","volume":"13","author":"Boczko F","year":"2005","journal-title":"Clin Geriatr"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0b013e3182746bc1"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.3340\/jkns.2012.52.3.264"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1038\/sc.2011.34"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/pl00009513"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1177\/0003489415570938"},{"key":"e_1_2_7_23_1","first-page":"853","article-title":"Respiratory dysfunction and management in spinal cord injury","volume":"51","author":"Brown R","year":"2006","journal-title":"Respir Care"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41393-018-0091-1"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.sc.3101440"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-022-10407-7"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1179\/204577211x13207446293695"},{"key":"e_1_2_7_28_1","volume-title":"MASA: The Mann Assessment of Swallowing Ability","author":"Mann G","year":"2002"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2004.11.049"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00417897"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-017-9809-z"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.physbeh.2017.03.018"},{"key":"e_1_2_7_33_1","volume-title":"Dysphagia Assessment and Treatment Planning: A Team Approach","author":"Leonard R","year":"2019"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-018-9928-1"},{"key":"e_1_2_7_35_1","first-page":"973","article-title":"Aspiration pneumonia in stroke","volume":"74","author":"Johnson ER","year":"1993","journal-title":"Arch Phys Med Rehabil"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348940611501207"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-003-0500-1"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26653"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1007\/s004550010004"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.1007\/s004550010017"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.3349\/ymj.2010.51.3.392"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/123.9.1863"}],"container-title":["The Laryngoscope"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.30369","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/lary.30369","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.30369","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T15:05:28Z","timestamp":1692630328000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lary.30369"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,5]]},"references-count":41,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2023,6]]}},"alternative-id":["10.1002\/lary.30369"],"URL":"https:\/\/doi.org\/10.1002\/lary.30369","archive":["Portico"],"relation":{},"ISSN":["0023-852X","1531-4995"],"issn-type":[{"value":"0023-852X","type":"print"},{"value":"1531-4995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,5]]},"assertion":[{"value":"2022-03-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-08-09","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-09-05","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}