Objective analysis of cough may provide a noninvasive way to identify the aspiration risk of stroke patients.

Background Clinical signs often fail to identify stroke patients who are at increased risk of aspiration. We hypothesized that objective measure of voluntary cough would improve the accuracy of the clinical evaluation of swallow to predict those patients who are at risk. Methods A comprehensive diagnostic evaluation was completed for 96 consecutive stroke patients that included cognitive testing, a bedside clinical swallow examination, aerodynamic and sound pressure level measures of voluntary cough, and “gold standard” instrumental swallowing studies (ie, videofluoroscopic evaluation of swallow [VSE] or fiberoptic endoscopic evaluation of swallow [FEES]). Stroke severity was assessed retrospectively using the Canadian neurologic scale. Results Based on the findings of VSE/FEES, 33 patients (34%) were at high risk of aspiration and (66%) were nonaspirators. Clinical signs (eg, absent swallow, difficulty handling secretions, or reflexive cough after water bolus) had an overall accuracy of 74% with a sensitivity of 58% and a specificity of 83% for the detection of aspiration. Three objective measures of voluntary cough (expulsive phase rise time, volume acceleration, and expulsive phase peak flow) were each associated with an aspiration risk category (areas under the curves were 0.93, 0.92, and 0.86, respectively). Expulsive phase rise time > 55 m/s, volume acceleration < 50 L/s/s, and expulsive phase peak flow < 2.9 L/s had sensitivities of 91%, 91%, and 82%, respectively; and specificities of 81%, 92%, and 83%, respectively for the identification of aspirators. Conclusion Objective measures of voluntary cough can identify stroke patients who are at risk for aspiration and may be useful as an adjunct to the standard bedside clinical assessment.

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The obesity epidemic affects all populations but is of particular concern when risk is high due to multiple co‐morbidities. We noted unexpectedly high rates of overweight (BMI >;25 <30 kg/m2; OW) and obesity (BMI >;30 kg/m2; OB) in post‐combat MSM and Veterans who self‐reported exposure to blast and/or blunt head trauma. A consecutive cohort of MSM and Veterans participating in a second level screening for traumatic brain injury (TBI) (n=301; mean age 34.5 ± 9.4 years, 94% male, 56% Caucasian) was assessed for BMI, upper/lower body disability, PTSD, and self‐reported Neurobehavioral Symptom Inventory (NSI) via medical record review. Rates of OW/OB were 34 and 50%, respectively; only 17% were of normal weight. Those OW/OB were older (28.3 vs 34.8 yrs; p<0.0001), more likely (p<0.05) to have upper and/or lower body disability, and had higher NSI scores, indicating more severe symptoms (38.8 vs 43.9; p<0.05). Rates of PTSD and depression for normal and OW/OB were 88 and 62% and 90 and 66% respectively. Our findings reveal the challenges faced by these MSM and Veterans, with the combination of mental health problems, orthopedic injury, and possible exposure to TBI (all likely barriers to weight loss interventions) and highlight the need for innovative interventions to prevent and manage OW/OB in this high risk population. Supported in part by NIA AG000029.