A cough evaluation on a patient with T3 ASIA A SCI produced no airway clearance; how should this cough be graded?

A cough evaluation on a patient with T3 ASIA A SCI produced no airway clearance; how should this cough be graded?

• A. Functional
• B. Nonfunctional
• C. Zero
• D. Weak functional

Answer: (B)

When we assess cough effectiveness in SCI, the goal is to judge how well a cough can clear airway secretions. A high-thoracic injury like T3 with ASIA A means the abdominal and intercostal muscles are weak, so generating a strong expulsive cough is difficult. If the evaluation shows no airway clearance despite attempting to cough, the cough is not able to clear secretions and is considered nonfunctional. This differs from a zero grade, which would imply no cough effort at all, whereas nonfunctional reflects an attempt that fails to achieve clearance. Recognizing a nonfunctional cough highlights the need for airway clearance support (such as assisted coughing or mechanical devices) to reduce the risk of secretion retention and pneumonia.

When we assess cough effectiveness in SCI, the goal is to judge how well a cough can clear airway secretions. A high-thoracic injury like T3 with ASIA A means the abdominal and intercostal muscles are weak, so generating a strong expulsive cough is difficult. If the evaluation shows no airway clearance despite attempting to cough, the cough is not able to clear secretions and is considered nonfunctional. This differs from a zero grade, which would imply no cough effort at all, whereas nonfunctional reflects an attempt that fails to achieve clearance. Recognizing a nonfunctional cough highlights the need for airway clearance support (such as assisted coughing or mechanical devices) to reduce the risk of secretion retention and pneumonia.