[Dysphagia] spontaneous vs volitional cough

[eripley at yahoo.com (Irene Campbell-Taylor)]

Sandi Lancaster <swlslp@yahoo.com> wrote:


Can pts without a volitional cough 

*** There is no point in trying until he can voluntarily hold his breath. When he can, it is useful to work closely with the physiotherapist or respiratory technician to assist in avoiding techniques that will tend to produce possible reflux and aspiration .Directed Cough is a deliberate maneuver that is taught, supervised, and monitored. Forced expiratory technique (FET, or huff cough) and manually assisted cough are examples of directed cough.Directed cough seeks to mimic the attributes of an effective spontaneous cough (or series of coughs), to help to provide voluntary control over reflex, and to compensate for physical limitations (eg, by increasing glottic control, inspiratory and expiratory muscle strength, coordination, and airway stability). Directed cough is rarely contraindicated. The contraindications listed must be weighed against potential benefit in deciding to eliminate cough from the care of the patient : 

Presence of an elevated intracranial pressure or known intracranial aneurysm.

Presence of aortic aneurysm.

Presence of reduced coronary artery perfusion, such as in acute myocardial infarction

Acute unstable head, neck, or spine injury 

Manually assisted directed cough with pressure to the epigastrium may be contraindicated in presence of increased potential for regurgitation/aspiration (eg, unconscious patient with unprotected airway, patient with enteral feeding tube, patient known to reflux significantly ) acute abdominal pathology, abdominal aortic aneurysm, hiatal hernia, or pregnancy, a bleeding diathesis, untreated pneumothorax..

Manually assisted directed cough with pressure to the thoracic cage may be contraindicated in presence of osteoporosis, flail chest.

Consult with an experienced PT or RT.

Irene.



Dr I Campbell-Taylor
Clinical Neuroscientist
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