Impaired swallowing, or dysphagia, is a frequent consequence of neurological or anatomical impairment that can lead to serious health complications such as aspiration pneumonia, malnutrition, dehydration and choking. Individuals of all ages can be affected by dysphagia. Related health care cost and utilisation pose a significant burden on the Australian Health Care System. In addition, dysphagia severely impacts on the quality of life of patients and their loved ones, reducing safety, self-worth and social participation. Research in the Swallowing Neurorehabilitation Research Lab employs state-of-the-art non-invasive brain stimulation and skill training techniques with the aim of increasing our understanding of healthy and impaired swallowing neurophysiology and developing new and effective rehabilitation strategies.
Researchers at the Swallowing Neurorehabilitation Research Lab are currently working on three key research areas to assist with understanding and managing dysphagia.
Free Water Protocols
As an alternative to nil by mouth or thickened fluids for clients with dysphagia, free water protocols (FWP) allow a client to drink water under controlled conditions. Although the client may aspirate the water, the premise is that aspirating small quantities of water, as a pH neutral substance, will not harm the lungs. In a series of research projects, we are evaluating the safety, benefits and harms, and feasibility of implementing free water protocols across various settings including acute hospitals. The aim is to provide evidence to assist clinicians with their decision making about for whom, in which setting and in which timeframe free water protocols a viable management option.
Pharyngeal High-Resolution Manometry
The advancement of pressure sensor technologies has allowed an unprecedented level of resolution and detail in the recording and analysis of contraction and distension pressures in the throat during swallowing. Using novel high-resolution manometry and impedance approaches, we can now better understand the interaction between pressures generated during the sequential contraction of muscles in the throat and their effects of the movement of food and liquid during swallowing. Together with our collaborator Prof Taher Omari at Flinders University, we employ this technology to develop a better understanding of how impairments and interventions affect swallowing biomechanics.
Skill training in human motor control
Motor skill training has received increasing interest in swallowing rehabilitation research in recent years. This research is based on the notion that swallowing-related muscle contraction not only requires sufficient strength, but also needs to occur in a precisely timed sequence of events. A series of projects in our lab investigates the effects of novel motor skill interventions on behavioural and neurophysiological outcome measures of swallowing.
Clinical reasoning in swallowing bedside assessment
Every day, speech pathologists lead the management of impaired swallowing in a variety of clinical and community settings across the globe. Swallowing bedside assessment is a core component of quality care and the management process as it provides information on swallowing function, additional assessments required and suitable management strategies. In a series of research projects, we aim to identify the clinical reasoning and decision making processes that speech pathologists employ when they assess swallowing function at the bedside, and how these processes lead to clinically informed management decisions.
Non-invasive brain stimulation in swallowing rehabilitation
Non-invasive brain stimulation techniques promoting the brain’s ability to reorganise its neural connections have been shown to hold a promising potential to aid the recovery of impaired motor function. In a series of research projects, we employ transcranial magnetic or direct current stimulation to investigate the role of cortical swallowing motor networks in healthy and impaired swallowing. This research aims to develop novel and effective swallowing rehabilitation interventions that are based on the scientific principles of neuroplastic reorganisation.