{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T05:46:14Z","timestamp":1782279974955,"version":"3.54.5"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"\n Background<\/jats:title>\n Vocal fold motion impairment (VFMI) is a common but frequently overlooked complication in patients with brain injury and can significantly compromise multiple airway protective functions\u2014including glottic closure during swallowing, cough reflex, and cough effectiveness\u2014leading to increased risks of aspiration, pneumonia, and poor clinical outcomes. Although swallowing dysfunction and VFMI often coexist in patients with brain injury, the specific characteristics and underlying mechanisms of their association have not been systematically investigated.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This single-center cross-sectional study consecutively enrolled 280 patients with brain injury from June 2024 to May 2025. All patients underwent fiberoptic endoscopic evaluation of swallowing (FEES) to simultaneously assess 18 swallowing indicators covering 5 dimensions and vocal fold motor function. VFMI was defined as complete fixation or hypomotility of the vocal folds under endoscopy. Multivariable logistic regression analysis identified swallowing indicators that significantly co-occurred with VFMI after adjusting for potential confounders. To address the extreme collinearity between bilateral pyriform sinus secretion variables (Spearman\n r<\/jats:italic>\n =\u202f0.974), a composite maximum-score variable [PS_MAX\u202f=\u202fmax(left, right)] was constructed.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 280 patients, 220 (78.6%) had VFMI. After adjusting for confounders, restricted pharyngeal wall movement (OR\u202f=\u202f2.16, 95% CI: 1.06\u20134.38,\n p<\/jats:italic>\n =\u202f0.034) and pyriform sinus secretion pooling (PS_MAX: OR\u202f=\u202f2.165, 95% CI: 1.067\u20134.396,\n p<\/jats:italic>\n =\u202f0.032) consistently co-manifested with VFMI, suggesting their co-occurrence as expressions of shared pharyngolaryngeal neural substrate impairment.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Restricted pharyngeal wall movement and pyriform sinus secretion pooling co-manifest with VFMI as integrated expressions of a shared neural injury substrate\u2014specifically, the overlapping brainstem circuits including the nucleus ambiguus and related pathways that co-regulate pharyngeal constrictor function and vocal cord motor control\u2014rather than as independently co-occurring phenomena. VFMI should be regarded as part of the broader swallowing and airway-protective dysfunction spectrum\u2014encompassing both degglutitive impairment and compromised airway-protective functions including cough reflex and cough effectiveness\u2014caused by brainstem network impairment, rather than an isolated laryngeal disorder. These findings have direct clinical implications in settings where vocal fold status is not simultaneously available, supporting more integrated evaluation and rehabilitation planning that addresses swallowing, cough, and airway-protective function.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fneur.2026.1790412","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T04:46:18Z","timestamp":1782276378000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Co-manifestation of swallowing dysfunction indicators and vocal fold motion impairment within a shared neural substrate in patients with brain injury: a cross-sectional study"],"prefix":"10.3389","volume":"17","author":[{"given":"Shujuan","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Therapy, Guangdong Sanjiu Brain Hospital","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lirong","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Therapy, Guangdong Sanjiu Brain Hospital","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiming","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Guangdong Work Injury Rehabilitation Hospital","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunlong","family":"Liu","sequence":"additional","affiliation":[{"name":"Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Si","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Therapy, Guangdong Sanjiu Brain Hospital","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanji","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Therapy, Guangdong Sanjiu Brain Hospital","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Churong","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Therapy, Guangdong Sanjiu Brain Hospital","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanbo","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Therapy, Guangdong Sanjiu Brain Hospital","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1016\/S1474-4422(19)30411-9","article-title":"The global burden of neurological 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