Study: C-Collar and Dysphagia

October 1, 2019 updated by: University of Wisconsin, Madison

Effects of Cervical Bracing on Elderly Patients With Dysphagia

The purpose of this study is to characterize oral-pharyngeal swallow function with the guidance of videofluoroscopy under two conditions, with and without cervical bracing, in patients determined to have dysphagia.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

According to the National Cervical Spinal Cord Injury Statistical Center, 12,000 patients experience acute spinal cord injury (SCI) in the United States annually. It is reported that 16% to 55% of patients with a cervical spinal cord injury (SCI) present with dysphagia which compromises their ability to eat and drink safely as well as their quality of life. Based on previous research, Dysphagia can also result in respiratory complications, particularly pneumonia, which is the most common cause of death in cervical SCI patients. The contribution of swallowing impairment, and associated aspiration risks, to respiratory illnesses and mortality in patients with SCI are unknown. As a first step, the investigators will identify the nature (type of swallowing impairment such as swallow delay, pharyngeal residue, penetration or aspiration) and frequency of occurrence of swallowing impairments in elderly patients with injury to the cervical spinal region. Further, the investigators will determine the effects of standard medical care, specifically, surgical bracing, on swallow function in patients post-cervical SCI.

Patients with SCI present with a range of impairments in the oral and pharyngeal phases of the swallow. These result both from the effects of trauma and medical/surgical management of injury on anatomy and physiology of the swallow mechanism. Earlier studies postulate that Acute SCI can result in reduced base of tongue movement, delayed pharyngeal swallow response, decreased hyolaryngeal excursion with subsequent decrease in cricopharyngeal opening, and pharyngeal wall dysfunction. These swallowing impairments are particularly devastating in older patients who lack the functional reserve to overcome these neuroanatomical insults. Consequently, there is an increased prevalence of dysphagia in the elderly patients with SCI.

Medical and surgical management of SCI can also negatively impact swallow function. Many patients will require neck immobilization following injury. Neck extension, chin or head retraction secondary to cervical bracing may increase the risk or severity of dysphagia by changing the mechanics of swallowing. In addition, fixation at a ninety-degree angle limits the natural flexion or range of movement a patient employs during deglutition. Studies have found that cervical orthoses impacts swallowing physiology in healthy adults. An earlier study reported changes in point of initiation of the swallow, laryngeal penetration, pharyngeal residue and hyoid bone movement. One would expect changes to be more significant in patients with dysphagia, and likely more remarkable in the elderly population who unfortunately, have the highest incidence of cervical SCI. Given the risk factors for dysphagia and pulmonary complications in this population, it is imperative that thorough evaluation of oral-pharyngeal swallow function be completed. However, there is little research addressing the impact of cervical bracing on patients with dysphagia at any age. The study team here aims to determine if cervical bracing contributes to severity of dysphagia.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Observational

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
23

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Wisconsin
      • Madison, Wisconsin, United States, 53792
        • University of Wisconsin - Madison

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

60 years and older (ADULT, OLDER_ADULT)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

Inpatients with dysphagia in a cervical brace.

Description

Inclusion Criteria:

  1. Inpatients receiving treatment for a spine injury
  2. Treating physician's approval that cervical cervical spinal column injury is stable
  3. Approval for collar removal by treating physician during VFSS
  4. Adults 60 and over.
  5. All races.
  6. Males and females.
  7. Glasgow coma scale of 13 or greater.

Exclusion Criteria:

  1. History of oral-pharyngeal dysphagia.
  2. Neurologic disorders associated with dysphagia including dementia, Parkinson's disease, multiple sclerosis, stroke, and ALS.
  3. Pharyngeal/laryngeal surgery or head/neck radiation treatment.
  4. Glasgow coma scale of less than 13 at time of evaluation.
  5. Patient's with a tracheotomy.
  6. Barium intolerance.
  7. Patients who lack the capacity to consent on their own behalf

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort

Group / Cohort

A group or subgroup of participants in an observational study that is assessed for biomedical or health outcomes.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Collar On
Individuals who have been referred for videoflouroscopic swallow study (VFSS) as per standard of care, with a stable cervical injury, will have trials of liquids and solids with the Cervical Brace (Collar) on.
Behavioral: Collar On
Collar Off
Individuals who have been referred for videoflouroscopic swallow study (VFSS) as per standard of care, with a stable cervical injury, will have trials of liquids and solids with the Cervical Brace (Collar) off.
Behavioral: Collar Off

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
To identify aspiration between study conditions (with and without a collar).
Time Frame: Comparing aspiration presence between two study conditions (with and without a cervical collar). Data will be reported at the end of study completion, an average of 1 year.
Measures of dysphagia aspiration (Y/N) and will be obtained in subjects both with and without a collar during the swallow evaluation.
Comparing aspiration presence between two study conditions (with and without a cervical collar). Data will be reported at the end of study completion, an average of 1 year.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
University of Wisconsin, Madison

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
September 17, 2013

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
May 17, 2017

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
April 5, 2018

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
October 25, 2017

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
November 17, 2017

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
November 21, 2017

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
October 2, 2019

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
October 1, 2019

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
October 1, 2019

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • 2017-0222
  • A539772 (Other Identifier: UW Madison)
  • SMPH/SURGERY/SURGERY*SP (Other Identifier: UW Madison)

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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