This study aimed to identify swallowing difficulties in cervical spinal cord Injury patients due to trauma. A total of 6 patients with traumatic cervical spinal cord injury admitted to the tertiary care hospital and referred to speech language pathology (SLP) service were enrolled in the study. The selected study subjects were in the age range of 25-45 years. Patients referred were initially assessed for bedside swallow assessment to decide the patient’s eligibility for cuff deflation trials and if successful then for speaking valve trials in graded pattern and duration taken to decannulate. These patients were analyzed on time duration taken for start of cuff deflation trials, start of speaking valve trial, duration of speaking valve trial. All 6 subjects underwent bedside swallow assessment (BSE) and Videofluoroscopic evaluation of swallowing (VFSS) to confirm safety of swallowing as well as to rule out aspiration risk. The results showed that the tracheostomy rehabilitation starts 5-7 days post admission/surgical correction of cervical fractures with a referral from the physician. Following referral in 3-4 days cuff deflation trials are attempted with repeated swallowing training for management of own oropharyngeal secretions which facilitates better tolerance of cuff deflation trials. Once patient is tolerating cuff deflation trials graded speaking valve trial is done along with RT. As patient is able to exhibit volitional swallow and bedside swallow assessment is done and if patients fail consecutively the SLP decides for instrumental swallow assessment. This decides the candidacy of oral feeding with modified diet/regular diet. Once patient tolerates full time speaking valve capping trials are initiated either by SLP/RT to decide candidacy of decannulation. In conclusion, the functional swallow safety should be assessed as a routine in patients with cervical spinal cord injury to rule out silent aspiration risk and to minimize secondary health complications. Tracheostomy rehabilitation is a great challenge for speech language pathology to facilitate speech breathing and functional swallow status, which requires specialized skills and competencies for a speech language pathologist