James Borders

• PhD CCC-SLP
• Postdoctoral Research Fellow at Columbia University

The primary aim of this study was to describe the development of the Visual Analysis of Swallowing Efficiency and Safety (VASES)—a standardized method to rate pharyngeal residue, penetration, and aspiration during FEES. As a secondary aim, we explored the feasibility of training novices to interpret FEES using VASES. Literature review and consensus...

Background: Pneumonia, a leading cause of death in progressive supranuclear palsy (PSP), results from progressive and pervasive deficits of airway protection, including both cough and swallowing dysfunction. Cough protects the airway by expelling aspirate and may be an important therapeutic target to protect against pneumonia in the presence of dy...

Despite rapid growth in the number of treatments to rehabilitate dysphagia, studies often demonstrate mixed results with non-significant changes to functional outcomes. Given that power analyses are infrequently reported in dysphagia research, it remains unclear whether studies are adequately powered to detect a range of treatment effects. Therefor...

Objective Minimal detectable change (MDC) represents the smallest amount of change required for an outcome to be considered real and not merely due to measurement error or task variability. This study aimed to examine MDC for cough and lingual strength outcomes among individuals with neurodegenerative disease. Methods In a single session, individu...

Purpose Sensorimotor cough skill training (CST) has been shown to improve cough strength, as well as facilitate changes during training (i.e., motor performance) and generalization to untrained tasks (i.e., motor learning). However, there is a gap in our understanding of the effects of voluntary CST (without sensory stimuli) on motor performance an...

Purpose Variations in vocal fold bowing, as measured endoscopically with the bowing index (BI), across neurodegenerative diseases remain unexplored, which may inform interventions to minimize morbidity and mortality secondary to voice and airway protective dysfunction. The study's aim was to compare BI between people with Parkinson's disease, progr...

Purpose: Reproducibility is a core principle of science and access to a study’s data is essential to reproduce its findings. However, data sharing is uncommon in the field of Communication Sciences and Disorders (CSD), often due to concerns related to privacy and disclosure risks. Synthetic data offers a potential solution to this barrier by genera...

Purpose Respiratory–swallow coordination (RSC) frequently changes in people with Parkinson's disease (PwPD). Little is known about how these changes relate to impairments in swallowing safety (penetration and aspiration) and efficiency (pharyngeal residue). Therefore, the aims of this study were to assess the relationships between RSC, pharyngeal r...

Background When re‐learning a motor skill, practicing a variety of treatment targets promotes error processing and the exploration of motor control strategies, which initially disrupts accuracy during training (motor performance), but ultimately enhances generalization, retention, and transfer (motor learning). Cough skill training (CST) is feasibl...

Multiple bolus trials are administered during clinical and research swallowing assessments to comprehensively capture an individual’s swallowing function. Despite valuable information obtained from these boluses, it remains common practice to use a single bolus (e.g., the worst score) to describe the degree of dysfunction. Researchers also often co...

Introduction: Visual Analysis of Swallowing Efficiency and Safety (VASES) and Dynamic Imaging Grade of Swallowing Toxicity for Flexible Endoscopic Evaluation of Swallowing (DIGEST-FEES) are two complimentary methods for assessing swallowing during FEES. Whereas VASES is intended to facilitate trial level ratings of pharyngeal residue, penetration,...

Purpose This study retrospectively examined patient-reported symptoms, quality of life, and swallowing kinematics in individuals with presumed muscle tension dysphagia (MTDg). Method Twenty-six individuals met the inclusion criteria. Data were gathered from patient-reported outcome measures (PROs), symptomology, clinician reports of palpation, and...

Introduction Thickened liquids are commonly recommended to reduce the risk of penetration-aspiration. However, questions persist regarding the impact of bolus consistency on swallowing safety. The common practice of summarizing Penetration-Aspiration Scale (PAS) scores based on worst scores is a bias in prior analyses. The aim of this study was to...

Purpose This systematic review represents an update to previous reviews of the literature addressing behavioral management of respiratory/phonatory dysfunction in individuals with dysarthria due to neurodegenerative disease. Method Multiple electronic database searches and hand searches of prominent speech-language pathology journals were conducte...

Cerebellar ataxias are neurological conditions with a high prevalence of aspiration pneumonia and dysphagia. Recent research shows that sensorimotor cough dysfunction is associated with airway invasion and dysphagia in other neurological conditions and may increase the risk of pneumonia. Therefore, this study aimed to characterize sensorimotor coug...

Purpose Expiratory muscle strength training (EMST) improves maximal expiratory pressure (MEP), and several researchers have reported improvements to voluntary cough airflow in people with Parkinson's disease (PD). However, the link between the change in MEP and cough and whether patient-specific factors impact the training response is not well unde...

This study investigated rater confidence when rating airway invasion with the penetration-aspiration scale (PAS) on flexible endoscopic evaluations of swallowing (FEES), raters’ accuracy against a referent-standard, inter-rater reliability, and potential associations between clinician confidence, experience, and accuracy. Thirty-one clinicians who...

Introduction Cough dysfunction is highly prevalent in Parkinson's disease (PD) and associated with pneumonia, a leading cause of death. Although research suggests that cough can be volitionally upregulated, patterns of improvements that occur during cough skill training and potential correlates remain unexamined. Therefore, we sought to characteriz...

Introduction: Auditory-perceptual assessments of cough are commonly used by speech-language pathologists working with people with swallowing disorders with emerging evidence beginning to demonstrate their validity, however their reliability amongst novice clinicians is unknown. Therefore, the primary aim of this study was to characterize the relia...

Purpose The aim of this study was to establish preliminary reference values for the Visual Analysis of Swallowing Efficiency and Safety (VASES)—a standardized rating methodology used to evaluate swallowing safety and efficiency for flexible endoscopic evaluation of swallowing (FEES). Method FEES were completed in nondysphagic, community-dwelling a...

The production of a cough involves three distinct phases: inspiration, compression, and forceful expiration. Various cough and lung volume outcomes can be derived from these phases with spirometry or respiratory inductive plethysmography methodologies, respectively. However, current research best-practice requires the user to laboriously measure ea...

Purpose: Epiglottic inversion, which provides one layer of the requisite protection of the airway during swallowing, is dependent on a number of biomechanical forces. The aim of this study was to examine the association between swallowing mechanics, as visualized during a Modified Barium Swallow (MBS) exam, and the rating of epiglottic inversion a...

Purpose: The aim of this study was to establish preliminary reference values for the Visual Analysis of Swallowing Efficiency and Safety (VASES) – a standardized rating methodology used to evaluate swallowing safety and efficiency for flexible endoscopic evaluations of swallowing (FEES). Method: FEES were completed in non-dysphagic, community-dwell...

Purpose of Review This narrative review introduces key elements of cough neural control, function, dysfunction, and measurement for physicians and speech-language pathologists. Its goal is to guide integrated approaches to the assessment of cough and facilitate differential diagnosis of cough dysfunction among people with dysphagia. Recent Finding...

Dysphagia is a largely inevitable symptom in both progressive supranuclear palsy (PSP) and Parkinson’s disease (PD). To date, comparative studies in these diseases have failed to detect differences in the severity of impairments in swallowing safety or efficiency, potentially due to small sample sizes and outcome measures with low sensitivity. Ther...

The aim of this study was to examine relationships between the presence vs. absence of an aspiration-related airway protective response (i.e., coughing or throat clearing) with aspiration amount, trial volume, disease diagnosis, and disease duration in people with neurologic disease. A secondary analysis was completed of flexible endoscopic evaluat...

Purpose To improve the credibility, reproducibility, and clinical utility of research findings, many scientific fields are implementing transparent and open research practices. Such open science practices include researchers making their data publicly available and preregistering their hypotheses and analyses. A way to enhance the adoption of open...

The purpose of this retrospective study was to determine whether reduced lingual strength was associated with functional swallowing outcomes in individuals with Parkinson’s disease (PD). Participants (N = 42) completed evaluations of maximal lingual isometric pressure (MIP) and mean lingual swallowing pressure (MSP), and flexible endoscopic evaluat...

Purpose Open science is a collection of practices that seek to improve the accessibility, transparency, and replicability of science. Although these practices have garnered interest in related fields, it remains unclear whether open science practices have been adopted in the field of communication sciences and disorders (CSD). This study aimed to s...

Background: Disorders of airway protection (cough and swallowing) are pervasive in Parkinson's disease (PD) resulting in a high incidence of aspiration pneumonia and death. However, there are no randomized controlled trials comparing strength and skill-based approaches to improve airway protection in PD. Objectives: The aim of this study was to...

Purpose Airway protective deficits (swallowing and cough) greatly reduce health and quality of life and are a pervasive consequence of neurodegenerative movement disorders. Expiratory muscle strength training (EMST) and cough skill training (CST) are two treatment approaches to improve airway protection; however, many patients are unable to access...

PURPOSE: To improve the credibility, reproducibility, and clinical utility of research findings, many scientific fields are implementing transparent and open research practices. Such ‘open science’ practices include researchers making their data publicly available and pre-registering their hypotheses and analyses. A way to enhance the adoption of o...

Caring for a family member with dysphagia can negatively impact caregiver wellbeing, although little is known about how dysphagia severity or specific symptoms influence this. The purpose of this study was to examine how objective measures of dysphagia in people with Parkinson’s disease influenced their caregivers’ quality of life. Fifty caregivers...

Progressive supranuclear palsy (PSP) is a neurodegenerative disease characterized by a high prevalence of dysphagia, cough dysfunction, and resultant aspiration pneumonia. Sensorimotor cough function is important for airway clearance in people with dysphagia. Upregulation of cough has been demonstrated in healthy adults and Parkinson’s disease; how...

Purpose: Open science is a collection of practices that seek to improve the accessibility, transparency, and replicability of science. Though these practices have garnered interest in related fields, it remains unclear whether open science practices have been adopted in the field of communication sciences and disorders (CSD). This study aimed to su...

Purpose The primary aim of this study was to examine the criterion-referenced validity of the Visual Analysis of Swallowing Efficiency and Safety (VASES). As a secondary aim, we examined the concurrent validity of using verbal numerical ratings for VASES as a potential substitute for visual analog scale ratings. Method Fifty-seven novice raters we...

Purpose Voluntary cough dysfunction is highly prevalent across multiple patient populations. Voluntary cough has been utilized as a screening tool for swallowing safety deficits and as a target for compensatory and exercise-based dysphagia management. However, it remains unclear whether voluntary cough dysfunction is associated with the ability to...

The primary aim of this study was to assess the reliability of auditory-perceptual cough assessment amongst novices. As a secondary aim, we also examined the effects of standardized training on reliability of auditory-perceptual cough assessments.

Cough is an important airway protective behavior responsible for ejecting material from the airway to prevent pneumonia, a leading cause of death in older adults and individuals with Parkinson's disease (PD). Variability of motor performance for both spinal and bulbar functions has been documented; however, there are no studies examining variabilit...

Purpose The COVID-19 pandemic has drastically increased the use of telehealth. Prior studies of telehealth clinical swallowing evaluations provide positive evidence for telemanagement of swallowing. However, the reliability of these measures in clinical practice, as opposed to well-controlled research conditions, remains unknown. This study aimed t...

The penetration-aspiration scale (PAS) is an 8-point scale used to characterize the depth and response to airway invasion during videofluoroscopy. Though widely used in the field of deglutition, there is a lack of consensus regarding the statistical properties of the scale. In order to better understand the state of the literature and the statistic...

Objectives Progressive supranuclear palsy (PSP) is a neurodegenerative disease which results in cough and swallowing dysfunction and aspiration pneumonia. Relationships among vocal fold atrophy, cough, and swallowing have been identified in related diseases, but remain unknown in PSP. This study examined: 1) the prevalence of vocal fold bowing in P...

Malnutrition and weight loss are highly prevalent in persons with Alzheimer's disease and related dementias. Oral intake is an important interventional target for addressing these nutritional consequences. However, the efficacy of interventions remains poorly understood as prior syntheses have failed to examine the impact of intervention approaches...

Objectives Sensation is an integral component of laryngeal control for breathing, swallowing, and vocalization. Laryngeal sensation is assessed by elicitation of the laryngeal adductor reflex (LAR), a brainstem-mediated adduction of the true vocal folds. During Flexible Endoscopic Evaluations of Swallowing (FEES), the touch method can be used to el...

Dysphagia is common in hospitalized patients post-extubation and associated with poor outcomes. Laryngeal sensation is critical for airway protection and safe swallowing. However, current understanding of the relationship between laryngeal sensation and aspiration in post-extubation populations is limited. Acute respiratory failure patients requiri...

Purpose The high incidence of swallowing and communication disorders following stroke is well documented. However, many of these studies have used retrospective chart reviews to make estimates of incidence and co-occurrence. The current study prospectively examined the incidence and co-occurrence of dysphagia, dysarthria, and aphasia following a 1s...

The purpose of this study was to investigate the reliability of residue ratings on Fiberoptic Endoscopic Evaluation of Swallowing (FEES). We also examined rating differences based on experience to determine if years of experience influenced residue ratings. A group of 44 raters watched 81 FEES videos representing a wide range of residue severities...

This study aimed to determine whether underlying factors such as interpersonal attention and mood contributed to Wilthermuth and Heath’s (2009) finding that that interpersonal motor synchrony increases cooperative behavior. In a hand clapping condition, participants played a hand clapping signaling game that required motor synchrony. In another con...