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NIH grant 1R01HD121800-01A1: Defining and Predicting Chronic Aspiration After Traumatic Cervical Spinal Cord Injury
Institute: {'code': 'HD', 'abbreviation': 'NICHD', 'name': 'Eunice Kennedy Shriver National Institute of Child Health and Human Development', 'admin_org_id': '12500030', 'admin_funding_url': ''}. PI: Alicia K Vose. Award: $647588.
Start: 2026-09-11T00:00:00.
PROJECT SUMMARY/ABSTRACT
Traumatic cervical spinal cord injury (SCI) is frequently complicated by dysphagia during acute hospitalization;
however, swallowing dysfunction is widely assumed to resolve as perioperative edema and airway-related factors
subside. Respiratory complications remain the leading cause of late mortality in cSCI, yet the contribution
of persistent airway-protection impairment to this long-term burden has not been prospectively defined.
Preliminary data from our laboratory demonstrate that nearly half of adults years after traumatic cSCI exhibit
silent, instrumentally confirmed aspiration despite minimal symptoms. No prospective longitudinal cohort has
characterized the trajectory of airway protection from the acute phase through chronic recovery or identified early
predictors of transition to chronic aspiration.
The long-term goal of this research program is to reduce preventable respiratory morbidity and late mortality
after traumatic cervical spinal cord injury by identifying, stratifying, and ultimately modifying persistent
impairments in airway protection and cough physiology. The overall objective of this R01 is to define the
longitudinal trajectory and physiologic basis of dysphagia following acute traumatic cervical SCI (Aim 1) and
develop and internally validate a multidomain risk stratification model to identify individuals at highest risk for
chronic aspiration (Aim 2). Our central hypothesis is that aspiration persisting beyond 6 months reflects
incomplete recovery of airway-protection timing and sensorimotor coordination and can be predicted using early
post-injury clinical and physiologic characteristics. We will enroll 120 adults with first-time traumatic cervical SCI
(C1–C7; AIS A–D) and follow approximately 100 analyzable participants for 24 months. Participants will undergo
repeated instrumental swallowing and laryngeal sensorimotor assessments, quantitative kinematic analysis of
airway-protection timing, respiratory and cough physiology testing, and measurement of circulating inflammatory
biomarkers at six predefined timepoints spanning acute, subacute, and chronic recovery phases.
Aim 1 will define the natural history of aspiration and identify physiologic mechanisms underlying persistent
airway-protection failure. Aim 2 will integrate early clinical exposures, physiologic metrics, and inflammatory
biomarkers within an internally validated predictive modeling framework to generate a clinically interpretable risk
stratification model for chronic aspiration. This study will establish the first prospective longitudinal cohort
defining airway-protection trajectories after traumatic cervical SCI and will provide a validated framework
for early identification of individuals at highest risk for sustained airway-protection failure. The expected impact
is a shift from symptom-driven evaluation to proactive, physiology-informed surveillance and targeted
intervention in this high-risk population.document fetched 2026-09-20 02:42