Specialised dysphagia management in patients with Spinal Cord Injury: A retrospective review of speech and language services across three UK Specialist SCI centres.

Published Date: 01st December 2025

Publication Authors: Morgan. S

Conference Abstract

Introduction Speech and language therapists (SLTs) in specialist spinal cord injury centres (SCIC) have expertise in the assessment and management of complex dysphagia in patients with spinal cord injury (SCI). Dysphagia has a reported incidence of 41% in SCI due to mechanical, respiratory and neurological impairments1. For those with high level cervical SCIs, ventilation via tracheostomy is often a requirement. SLTs in UK contribute to laryngeal weaning and decannulation as part of the multidisciplinary team2. Silent aspiration is a key feature due to sensory and motor impairments, making clinical swallow evaluation unreliable as a method of screening, therefore the use of instrumental assessments, such as Flexible Endoscopic Evaluation of Swallowing (FEES) and videofluoroscopy (VFS), are essential diagnostic tools. In the UK, limited bed capacity delays admission to a SCIC and specialist rehabilitation. This review looked at the type and frequency of interventions delivered by SLTs in SCICs for those with cervical SCIs and their impact on clinical outcomes. Material and Methods A retrospective review was undertaken of SCI referrals to SLT services in three UK SCICs over a three-year period (2020-2022). Each site provided workforce details alongside de-identified demographic data alongside time from injury to SLT contact, SLT diagnosis, SLT intervention, frequency of intervention and outcomes. Results There were 152 SCI patients referred to SLT services across the three units (males = 65%; mean age = 59 years). 72% had a traumatic injury, with 82% being at the cervical level and 36% had a complete injury (AIS A). The average time from injury to SLT at SCIC was 123 days (range: 0-1218 days), with only 11 patients being seen within 30 days of injury. 86% of patients were referred for dysphagia, and 28% for dysphonia. SLT interventions for dysphagia were delivered under 3 key themes: Assessment and Advise (47%), Swallowing Interventions (36%), Airway Interventions (13%). Overall, 47% received an instrumental assessment, of which 22% had a FEES, 14% had a videofluoroscopy and 11% had both during their treatment. 35% of patient received intensive therapy 3-5 times a week, such as evidence based therapy that promotes improved hyolaryngeal excursion with SLT-led oral trials, and biofeedback using surface electromyography (SEMG) and FEES. On admission to the SCIC 39% were nil by mouth (NBM). On discharge, only 3% were NBM and all other patients resumed normal (89%) or modified (7%) diet following SLT interventions. Airway interventions supported ventilator weaning and decannulation in the majority of patients through assessment of secretion management, laryngeal weaning, one-way valve trials and identifying laryngeal abnormalities with early use of flexible nasendoscopy/FEES. Discussion/Conclusion SLT services within SCICs demonstrate a high level of expertise and effectiveness in their interventions despite lengthy delays to admission. The majority of caseloads were successfully weaned from ventilators and returned to oral intake at discharge. The use of instrumental assessments is highly beneficial to identify specific impairments and plan and deliver therapy programmes targeting swallowing skill, strength and coordination that rehabilitates chronic dysphagia towards normal function in SCI.

Lopez, B.; Morgan, S.; Et al. (2025). Specialised dysphagia management in patients with Spinal Cord Injury: A retrospective review of speech and language services across three UK Specialist SCI centres. Dysphagia. 40(Supp 2), p. S116. [Online]. Available at: https://dx.doi.org/10.1007/s00455-025-10864-w [Accessed 4 February 2026].