Current Research Projects
Impact of Preoperative Respiratory Strength Training on Postoperative Health Outcomes for Heart Transplant Candidates (Funded by an American Heart Association Career Development Award, 4/2024-3/2027)
Although heart transplantation (HT) is a life-saving intervention for individuals with end-stage heart failure, swallowing impairment (dysphagia) is a recognized postoperative complication occurring in 71% of HT recipients that is associated with morbidity, mortality, and reduced quality of life. Similarly, data from 182 cardiac surgical (CS) patients revealed swallowing safety impairments in 94% of individuals. Closer examination of this data revealed that aspirators with an effective cough had reduced rates of pneumonia, reintubation, and death compared to aspirators with an ineffective cough. This highlighted that having an effective cough response to tracheal aspirate may improve health outcomes in CS patients, illuminating that treatment focused on improving cough effectiveness may be beneficial. Respiratory strength training (RST) is an exercise-based treatment that has yielded improvements in respiratory capacity, cough effectiveness, and swallowing safety in dysphagic patient populations. Furthermore, pilot data from a prospective cohort study I conducted in 25 CS patients revealed that preoperative RST was safe, feasible, and improved respiratory physiologic capacity. The current study will advance prior research by conducting a randomized, sham-controlled trial in 90 HT recipients with the following specific aims: 1) Determine the impact of a preoperative RST program on pulmonary function, airway clearance, physiological functional reserve, and treatment burden in HT recipients; and 2) Identify the impact of a preoperative RST program on postoperative swallowing safety, physiology, and health outcomes in HT recipients. Maximum expiratory and inspiratory pressure (MEP, MIP) forced vital capacity (FVC), voluntary cough peak expiratory flow (PEF), cough spirometry, clinical frailty scale (CFS) scores, and exercise therapy burden (ETBQ) questionnaire scores will be obtained before and after the RST program. HT recipients will complete the swallowing and eating related fatigue (SERF) questionnaire and undergo standardized fiberoptic endoscopic evaluation of swallowing (FEES) before and after transplant. Trained raters will perform duplicate, blinded ratings of swallowing safety using the penetration-aspiration scale and swallowing physiology using validated FEES timing measures. Core health outcomes (time to oral diet, hospital length of stay, pneumonia, reintubation, 30-day readmission, 90-day mortality, discharge status) will be tracked via the electronic medical record (EMR). This study will provide insight into the efficacy of targeted, preventative treatments to improve postoperative outcomes in HT recipients and will also yield preliminary data regarding implementation of preoperative RST to support future large scale pragmatic clinical trials in HT recipients.
Prevalence, Risk Factors, and Characteristics of Dysphagia in Heart Transplant Patients
Recent data in a heterogenous cohort of cardiac surgical patients revealed that 94% of individuals had swallowing safety impairments and 52% of individuals had swallowing efficiency impairments (Plowman et al., 2021). Additionally, patients who aspirated (had swallowed material enter the trachea) waited 85 hours longer to resume eating and drinking, had a 43% longer hospital stay, a $50,000 increased cost of care and also had higher odds of developing pneumonia, being reintubated, and dying compared to individuals who did not aspirate. These data reveal that individuals who undergo heart transplantation are vulnerable to developing postoperative swallowing difficulties, or dysphagia, which can lead to other adverse health-related outcomes. Yet, no studies to date have examined the prevalence of swallowing difficulties, the characteristics of swallowing impairments, or the risk factors for developing dysphagia in this patient population. Therefore the current study will aim to: 1) Determine the prevalence of swallowing difficulties in postoperative heart transplant patients, 2) Describe the characteristics of postoperative dysphagia in heart transplant patients, and 3) Identify risk factors that contribute to postoperative dysphagia in heart transplant patients via retrospective chart review.
Motor Imagery Practice to Improve Respiratory and Cough Function
This research study is examining something called motor imagery practice. Motor imagery practice is an intervention or exercise technique that involves imagining performing a movement without actually executing it. Benefits of motor imagery practice include improvements in motor skills, improvements in motor learning, and improvements in neural plasticity (the ability for the brain to change). While motor imagery practice has been explored to improve motor function of the arms and legs, only one study to date has explored the ability to improve motor function of muscles important for swallowing. In this previous study, motor imagery practice led to improvements in tongue strength in healthy older adults. The current study will expand upon this work by examining motor imagery practice of cough and respiratory muscle strength training in healthy community dwelling adults between the ages of 18-6 years old.
Determining the Discriminant Ability of the Eating Assessment Tool-10 in Detecting Aspiration in Individuals with Huntington's Disease
The study of dysphagia in Huntington's disease (HD) lags behind in its clinical importance. Recent research by Schindler et al. in 2020 reveals that dysphagia is prevalent in HD, affecting 35% of those in the early stage, 94% in the moderate stage, and 100% in the advanced stage of disease progression. Nevertheless, there is currently no validated, standardized screening tool to accurately identify dysphagia in individuals with HD. The development of a quick, accurate, and easy-to-administer dysphagia screening tool is crucial for triaging individuals with HD at multidisciplinary neurology clinics who may have dysphagia and benefit from further instrumental evaluation of swallowing. Therefore, this research study will 1) determine the discriminant ability of self-reported dysphagia using the validated EAT-10 to detect swallowing safety and efficiency impairments in individuals with HD based on instrumental swallow evaluations (e.g., videofluoroscopy, fiberoptic endoscopic evaluation of swallowing), and 2) determine the relationship between EAT-10 scores, dysphagia based on instrumental swallow evaluations, and demographic and disease characteristics in individuals with HD.
Impact of Productivity Standards for Speech-Language Pathologists on Patient Care and Ethics
Speech-language pathologists (SLPs) face a variety of challenges within clinical practice. Rising productivity demands are one of the main challenges that SLPs face on a consistent basis. Prior research studies in related rehabilitation fields have demonstrated that high productivity standards in medical settings can impact patient care and can impact ethical decision-making (Tammany et al., 2019; Bennett et al., 2019). Therefore, the current study will aim to 1) determine the prevalence and conditions of productivity standards for SLPs across medical settings,
and 2) to examine the impact of productivity standards on patient care and ethical decision-making via a prospective survey of SLPs.
Determining the Impact of the Modified Barium Swallowing Impairment Profile (MBSImP) on Student Knowledge of Swallowing, Confidence and Comfortability Within Clinical Settings, and Interest in Dysphagia
The Modified Barium Swallowing Impairment Profile (MBSImP) is a standardized approach to performing videofluoroscopy swallow studies (VFSSs) and to analyzing VFSS images using 17 physiological components of swallowing to inform dysphagia assessment and treatment. A student version of the online MBSImP training course was developed as an educational tool to be used in dysphagia courses for master's students in speech-language pathology. While the MBSImP training course is frequently utilized in graduate level dysphagia courses, little is known about the impact the MBSImP training course has on student knowledge of dysphagia, student confidence and comfortability within clinical settings, and student interest in the field of dysphagia. Therefore the current study will examine the impact of the MBSImP clinical training course on 1) dysphagia knowledge, 2) confidence and comfortability within clinical settings, and 3) interest in the field of dysphagia by having graduate students complete surveys before and after completing the MBSImP online training course.
Evaluating Speech-Language Pathologist Critical Appraisal Skills of Research Articles
Critical appraisal of research articles is a key part of clinical practice for speech-language pathologists (SLPs). Yet, few clinicians receive comprehensive training during graduate master's SLP programs to identify, critically appraise, and apply evidence from research articles to clinical scenarios (Greenwell & Walsh, 2021; Fulcher-Rood et al., 2020; Hoffman et al., 2013; Thome et al., 2020; Vallino-Napoli & Reilly, 2004). Therefore, the current prospective research study will 1) determine resources clinicians use, how often clinicians seek out resources, and barriers to accessing resources to inform their clinical practice, and 2) evaluate how well clinicians critically appraise methods and results sections of research articles and apply them to clinical scenarios.
The Prevalence and Characteristics of Oropharyngeal Dysphagia in Critically ill Patients During the Acute and Post-Acute Recovery Phase
The negative sequelae of critical illness are well-known and consist of changes in physical, cognitive, and psychosocial health. Collectively, these changes are referred to as post intensive care syndrome (PICS). Dysphagia, or swallowing difficulty, may result from PICS. Therefore, we conducted a systematic review to examine the prevalence and characteristics of oropharyngeal dysphagia in critically ill adults (e.g., COVID-19, PICS, sepsis) during the acute and post-acute recovery phase. We further sought to understand risk factors for dysphagia development and to determine negative sequelae associated with dysphagia in critically ill adults.
Recently Completed Research Projects
American Speech-Language-Hearing Foundation Mentored Clinical Research Grant ($50,000)
Donohue (PI)
11/01/2021-10/31/2023
Safety, feasibility, and impact of preoperative respiratory strength training in cardiac surgical patients.
American Heart Association Postdoctoral Fellowship ($137,604)
Donohue (PI)
01/01/2022-12/31/2023
Improving postoperative extubation and health outcomes in cardiac surgical patients.