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Swallowing and Laryngeal Injury After Critical Illness and Surgery
Martin B. Brodsky, Ph.D., Sc.M., F-ASHA, is an associate professor and clinical researcher in the Department of Physical Medicine and Rehabilitation. Employing a team science approach, he works closely with colleagues throughout the School of Medicine, School of Public Health, School of Nursing and School of Engineering, focusing his research on swallowing disorders and laryngeal injury after critical illness and surgery.
Associate Professor of Physical Medicine and Rehabilitation
Research Interests: Larynx, Pharynx, Respiration, Dysphagia after oral intubation, Impact of critical care medicine on swallowing, Swallowing disorders (dysphagia), Swallowing, Dysphagia
Utility of the Yale Swallow Protocol as a Screening in the Outpatient Setting
Amanda Cole,1 Meaghan Isaacs,1 Shauna Berube,1 Amanda Gallagher, 1 Martin B. Brodsky2
1 Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD
2 Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD
Purpose: The aim of this study is to determine the sensitivity and specificity of the Yale Swallow Protocol (YSP) in the outpatient rehabilitation setting.
Background: The YSP is used to screen individuals for aspiration risk, a proxy for and one result of dysphagia (i.e. physiologic swallowing disorder). The YSP has a 96.5% sensitivity and 48.7% specificity in an acute care, referred patient population and is safe and feasible. There is no research for use of the YSP in the outpatient, referred patient population.
Methods: This is a cohort study of patients referred to the outpatient speech-language pathology (SLP) service for objective swallow evaluation via videofluoroscopic swallow study (VFSS) enrolled serially. Data were obtained via the electronic medical record, patient/proxy interview, oral motor exam, YSP, and VFSS. The YSP was completed prior to the VFSS. Criteria for a failed YSP was consistent with that used in previous research, i.e., an inability to finish the water, a change in post-swallow vocal quality, and/or an immediate or delayed airway response (e.g., coughing, throat clearing). The VFSS was used as the reference test to determine sensitivity and specificity of the YSP.
Results: Fifty-five patients enrolled in this study with 53% (n=29) male. The median age of patients was 62 (interquartile range: 49, 69) years. Patients had a variety of medical diagnoses, with the primary (49%, n=27) cause of dysphagia being central nervous system disorders. Sensitivity was 86% and specificity was 48% for the YSP in our outpatient clinic. As a secondary outcome, we found that only 13% (n=7) of patients in our outpatient clinic aspirated thin liquids. As an exploratory aim we determined that the sensitivity and specificity for screening dysphagia was 55% and 38%, respectively.
Conclusion: The results suggest that the YSP could be used as an aspiration screening by referring clinicians in the outpatient setting, but with 87% of patients not aspirating thin liquids, the utility of the YSP appears to be limited. The majority of patients and their providers appeared to have swallowing concerns other than aspiration. The YSP, a screening for aspiration, is not a sufficient screening tool for dysphagia. If the YSP were implemented as a screening for outpatient dysphagia referrals, it is likely that many patients who could benefit from SLP services would be missed.
This research is being presented at the Annual Johns Hopkins PM&R Research and Clinical Expo.
Understanding and Improving Dysphagia After Mechanical Ventilation (K23 DC013569)
May 1, 2014 to April 30, 2019
Goals: To investigate tongue weakness and other pathophysiological aspects of dysphagia and to evaluate a novel, multimodal, sensorimotor intervention during intubation to reduce dysphagia after extubation as a phase II clinical trial.
Role: Principal Investigator
Understanding Swallowing Impairments and Laryngeal Injury After Oral Endotracheal Intubation
The central question in Dr. Brodsky’s research in the critical care population is: “What changed that affected the patient’s ability to use his/her voice and swallow?” Some of this research is conducted in coordination with the Outcomes After Critical Illness and Surgery (OACIS) group.
Dr. Brodsky’s research found an 80 percent increased risk for clinically important symptoms of swallowing impairment for each day of intubation for up to six days, after which, risk plateaus in patients with acute lung injury. Another study followed research patients for five years to determine factors associated with recovery from dysphagia. Diversity of clinical practice and patient recovery patterns were the focus of the third study.
- Coordination of Pharyngeal and Laryngeal Swallowing Events During Single Liquid Swallows After Oral Endotracheal Intubation for Patients with Acute Respiratory Distress Syndrome (2018)
- Recovery from Dysphagia Symptoms after Oral Endotracheal Intubation in Acute Respiratory Distress Syndrome Survivors. A 5-Year Longitudinal Study (2017)
- Duration of Oral Endotracheal Intubation Is Associated with Dysphagia Symptoms in Acute Lung Injury Patients (2014)
- Factors Associated with Swallowing Assessment After Oral Endotracheal Intubation and Mechanical Ventilation for Acute Lung Injury (2014)
- Improving Long-term Outcomes After Discharge from Intensive Care Unit: Report from a Stakeholders’ Conference (2012)
Advancing Understanding of Swallowing Physiology, Formal Assessment and Bedside Screening
Dr. Brodsky’s research interest in swallowing physiology started with the temporal analysis of swallowing mechanics and the coordination of breathing and swallowing in healthy and patient populations. He has also studied quality of life and swallowing physiology in patients with head and neck cancer, and worked on validating physiologic aspects of normal swallowing. Dr. Brodsky’s most recent work in swallowing physiology focused on synthesizing the growing clinical research literature to evaluate bedside screening for swallowing impairments and recommend the best evidence-based screening approach.
Collectively, this research has broad clinical implications for distinguishing normal from disordered swallowing and led to a clinical trial of a novel therapy for patients with critical illness.
- Screening Accuracy for Aspiration Using Bedside Water Swallow Tests: A Systematic Review and Meta-analysis (2016)
- Significance of Nonrespiratory Airflow During Swallowing (2012)
- Respiratory-swallow Phase Patterns and Their Relationship to Swallowing Impairment in Patients Treated for Oropharyngeal Cancer (2010)
- MBS Measurement Tool for Swallow Impairment — MBSImp: Establishing a Standard (2008)
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