{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T18:44:10Z","timestamp":1769885050301,"version":"3.49.0"},"reference-count":30,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T00:00:00Z","timestamp":1766016000000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001804","name":"Canada Research Chairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001804","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000196","name":"Canada Foundation for Innovation","doi-asserted-by":"publisher","award":["42113"],"award-info":[{"award-number":["42113"]}],"id":[{"id":"10.13039\/501100000196","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R01AG077481"],"award-info":[{"award-number":["R01AG077481"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Laryngoscope Investig Oto"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective (s).<\/jats:title>\n                    <jats:p>The C2\u2013C7 Cobb angle is used to measure cervical spine curvature, an anatomical parameter that may be associated with swallowing difficulties in some patients. Challenges in visualizing lower cervical vertebrae on videofluoroscopic swallow study images led to the proposal of the C2\u2013C4 modified Cobb angle (MCA) for use in swallowing research. Despite its initial promise, less than optimal reliability and validity suggested a need for improvement and further research. In this study, we aimed to explore the measurement properties of the MCA and a C2\u2013C4 revised\u2010MCA across key timepoints in healthy swallowing of thin liquid boluses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This exploratory analysis examined inter\u2010 and intra\u2010rater reliability, as well as criterion validity of the C2\u2013C4 MCA and C2\u2013C4 revised\u2010MCA in comparison to other measures of cervical spine curvature and head extension (C0\u2013C2, C2\u2013C6, and C2\u2013C7 Cobb angles). Videofluoroscopic images from 35 healthy participants were analyzed using frames from still positioning, bolus passing the mandible, maximum pharyngeal constriction, and swallow rest. Data were analyzed using intraclass correlation coefficients (ICCs), Pearson correlations, and mixed model analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The C2\u2013C4 revised\u2010MCA showed superior intra\u2010 and inter\u2010rater reliability and moderate positive correlation with the C2\u2013C6 Cobb angle, demonstrating criterion validity. No differences in C2\u2013C4 revised\u2010MCA were found across swallowing frames, or as a function of participant age, sex, or head extension.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The findings suggest that the C2\u2013C4 revised\u2010MCA has stronger psychometric properties than the MCA, confirming its utility as a cervical spine curvature measurement during swallowing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>4.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lio2.70333","type":"journal-article","created":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T12:33:58Z","timestamp":1766061238000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Introducing the Modified Cobb Angle for Measuring Cervical Spine Curvature During Swallowing"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4294-6561","authenticated-orcid":false,"given":"Catriona M.","family":"Steele","sequence":"first","affiliation":[{"name":"KITE Research Institute \u2013 University Health Network  Toronto Canada"},{"name":"Department of Speech\u2010Language Pathology, Rehabilitation Sciences Institute, Temerty Faculty of Medicine University of Toronto  Toronto Canada"},{"name":"Canada Research Chair in Swallowing and Food Oral Processing  Ottawa Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Makaya O'","family":"Grady","sequence":"additional","affiliation":[{"name":"School of Rehabilitation Science McMaster University  Hamilton Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7535-1129","authenticated-orcid":false,"given":"Sima","family":"Farpour","sequence":"additional","affiliation":[{"name":"School of Rehabilitation Science McMaster University  Hamilton Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7395-3027","authenticated-orcid":false,"given":"Melanie","family":"Peladeau\u2010Pigeon","sequence":"additional","affiliation":[{"name":"KITE Research Institute \u2013 University Health Network  Toronto Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0699-0610","authenticated-orcid":false,"given":"Sophia Werden","family":"Abrams","sequence":"additional","affiliation":[{"name":"School of Rehabilitation Science McMaster University  Hamilton Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maureen","family":"Folsom","sequence":"additional","affiliation":[{"name":"Aerodigestive Research Core The Ohio State University  Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0198-4297","authenticated-orcid":false,"given":"Emily K.","family":"Plowman","sequence":"additional","affiliation":[{"name":"Aerodigestive Research Core The Ohio State University  Columbus Ohio USA"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery The Ohio State University  Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9473-8844","authenticated-orcid":false,"given":"Ashwini M.","family":"Namasivayam\u2010MacDonald","sequence":"additional","affiliation":[{"name":"School of Rehabilitation Science McMaster University  Hamilton 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