Assessment of Dystussia in Traumatic Brain Injury

Recovery of people with mild, moderate, or severe swallowing, speech, hearing, and cognitive-communication impairments is best facilitated by a team of multidisciplinary specialists. Symptoms associated with traumatic brain injury (TBI) include disordered swallowing (dysphagia), ataxia and, frequently, but not inevitably, dysarthria or disorder of speech. Airway compromise also exists in the form of impaired cough, or dystussia. In view of the frequency of oral intake problems in individuals with TBI and the presence of weakened cough, or absence of cough, along with the added challenge of the cognitive-communicative problems, further studies are needed to increase our understanding of the degree of disordered airway protection. From this work appropriate intervention strategies can be designed along with an understanding of the compensations that may be used to assist with improving swallow and airway safety, oral intake and management.

Informed Consent Process:

Investigators working with subjects with TBI, and who are also aware of this study, will have the ability to provide potential participants with a business card containing only the name of the study coordinator (Dr. Erin Silverman) as well as her email and telephone numbers. The individual participants will be responsible for contacting Dr. Silverman if they wish to participate. Additional participants will be recruited via face to face methods and by the previously IRB-approved study flyer at local brain injury support groups and Shands Rehabilitation Hospital.The staff member consenting (Dr. Silverman) has completed University of Florida training on HIPAA and privacy issues. Subjects do not have to give an immediate response about enrolling and may freely discuss the study with people of their choice before making a decision. Capacity to consent will be decided by the consenting staff member (Dr. Silverman). The study will be explained to the subject, any questions answered, and a written and signed consent completed along with a HIPAA authorization. Written consent will be obtained prior to collection of any health history or study data. Once written informed consent is obtained, Dr. Silverman will conduct an extensive interview in order to insure the subject meets all required inclusionary/exclusionary criteria.

Neuropsychological Testing: The MOCA (Montreal Cognitive Assessment) will be administered by Dr. Silverman, on each participant, upon entry into the study.

Measures of TBI severity: Multiple studies have correlated severity of TBI upon initial admission related to the TBI with swallowing function. The Glasgow Coma Scale (GCS) and Rancho Los Amigos Scale (RLAS) are commonly administered upon admission of TBI patients. When available (availability may vary depending on the hospital at initial admission) we will record the GCS and/or RLAS scores from admission. As well, the investigators will administer the RLAS upon enrollment in the study. These measures will be incorporated into our statistical model to better understand the heterogeneity of cognitive impairment on swallow and cough function.