Learn how to perform a perceptual cough assessment, what to listen for, and why it’s useful in clinical decision-making for patients who have dysphagia. The information in this post comes from the work of James A. Curtis, PhD, CCC-SLP, BCS-S.
Free DIRECT download: Auditory-perceptual cough assessment for SLPs – cheat sheet. (Email subscribers get free access to all the resources in the Free Subscription Library.)
Outline
- 4 reasons why SLPs should assess cough.
- Dr. Curtis’s preferred pattern for voluntary cough assessment.
- Auditory-perceptual descriptors for cough assessment.
- Integrate your perceptual cough assessment into the larger clinical picture.
- Learn more about auditory-perceptual assessment of cough.
- Related Eat, Speak, & Think posts.
- References
4 reasons why SLPs should assess cough
Dr. Curtis discussed four reasons why SLPs should assess cough as part of dysphagia screening or evaluation during his interview with Sarah Baar on the Speech Scope podcast (Baar & Curtis, 2026). Here is a short summary:
- Cough assessment can improve dysphagia screening. Impaired cough often co-occurs with impaired swallow function.
- Cough effectiveness affects airway clearance. An effective cough can help clear penetrated or aspirated material from the airway.
- Cough can help inform risk and clinical decision-making. Impaired cough in a person with dysphagia is associated with increased risk of adverse outcomes, such as aspiration pneumonia.
- Impaired cough is a potential treatment target. SLPs can incorporate Voluntary Cough Skill Training (VCST) or cough strength training with dysphagia therapy to help improve the patient’s ability to clear penetration or aspiration when it occurs.
Dr. Curtis’s preferred pattern for voluntary cough assessment
Dr. Curtis’s cough assessment tutorial is detailed and includes both auditory-perceptual cough assessment and instrumental cough assessment (Curtis, n.d.). Both types of voluntary cough assessment follow the same pattern.
- Sequential cough
- Trial 1 – patient is provided with verbal instruction only.
- Trial 2 – patient is provided with verbal instruction + clinician model.
- Single cough
- Trial 1 – patient is provided with verbal instruction only.
- Trial 2 – patient is provided with verbal instruction + clinician model.
Just for completeness, his tutorial also covers reflex cough testing, in case you’re interested in learning about that.
Auditory-perceptual descriptors for cough assessment
Here are Dr. Curtis’s descriptors from his cough tutorial (Curtis, n.d.):
- Perceived strength: WNL, mildly impaired, moderately impaired, severely impaired.
- Perceived crispness: WNL, mildly impaired, moderately impaired, severely impaired.
- Perceived amount of voicing: 0-100%, defined as the percentage of time spent with voicing during the expulsive cough phase.
- Type of expiratory effort: cough, throat clear, huff, vocalization/grunt, other.
- Number of expiratory efforts.
Integrate your perceptual cough assessment into the larger clinical picture
Dr. Curtis discusses how to integrate the results of your cough assessment into the larger clinical picture, which I recommend you listen to (or read the transcript on YouTube; Baar & Curtis, 2026). Such a discussion is beyond the scope of this article.
The main idea is that we should consider our patient’s medical history when deciding how to interpret the results of the cough assessment and how it should affect our recommendations and treatment plan.
For instance, a person’s cough may be strong but uncoordinated. Such a patient may benefit more from Voluntary Cough Skill Training (VCST) than from expiratory muscle strength training (EMST).
Or perhaps the cough is well-coordinated but weak. If the weakness is stemming from impaired respiratory muscle strength, then VCST likely wouldn’t help much, but perhaps EMST or inspiratory muscle strength training might be more appropriate.
Learn more about auditory-perceptual assessment of cough
Here are some good resources to learn more about Dr. James Curtis’s approach to auditory-perceptual cough assessment:
- Episode 29 of the Speech Scope podcast*, available on Medbridge.com, YouTube, and various podcast platforms.
- Cough Assessment tutorial on Dr. Curtis’s webpage (text and videos).
- Dr. Curtis’s free cough assessment training on OSF, including practice listening to and imitating coughs.
*As an affiliate of Medbridge, I may earn a small commission on qualifying new subscriptions. There is no extra charge to you, and it will help keep Eat, Speak, & Think sustainable.
Related Eat, Speak, & Think posts
- Do SLPs know the risks of dysphagia diets?
- Learn how to assess dysphagia risk with the BOLUS framework.
- 10 factors that increase risk of aspiration pneumonia.
References
- Baar, S. (Host), & Curtis, J. (Guest). (2026). Dysphagia management and cough rehab: How can SLPs assess and treat? (No. 29) [Audio podcast episode]. In Speech Scope. Medbridge. https://www.medbridge.com/educate/courses/dysphagia-management-and-cough-rehab-how-can-slps-assess-and-treat-sarah-baar-james-curtis
- Curtis, J. A. (2022). Auditory-perceptual assessment of cough: Reliability [Training materials]. OSF. https://osf.io/kwjcy/files/ahfr4
- Curtis, J. A. (n.d.). Voluntary and reflex cough assessment. https://www.jamescurtisphd.me/tutorials/cough/cough-assessment
Featured image by Vlada Karpovich from Pexels, found on Canva.com.
Free DIRECT download: Auditory-perceptual cough assessment for SLPs – cheat sheet. (Email subscribers get free access to all the resources in the Free Subscription Library.)
Lisa earned her M.A. in Speech-Language Pathology from the University of Maryland, College Park and her M.A. in Linguistics from the University of California, San Diego.
She participated in research studies with the National Institute on Deafness and other Communication Disorders (NIDCD) and the University of Maryland in the areas of aphasia, Parkinson’s Disease, epilepsy, and fluency disorders.
Lisa has been working as a medical speech-language pathologist since 2008. She has a strong passion for evidence-based assessment and therapy, having earned five ASHA Awards for Professional Participation in Continuing Education.
She launched EatSpeakThink.com in June 2018 to help other clinicians be more successful working in home health, as well as to provide strategies and resources to people living with problems eating, speaking, or thinking.
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