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Event educates experts on swallowing disorders by Cindy Abole Public Relations People do it about 2,000 to 3,000 times a day, including eating and drinking. At rest, a person does it an average of twice a minute or even more. The process is swallowing.  Of all human functions, swallowing is a normal and necessary process that is performed by everyone, young and old. Yet it is a complicated voluntary and involuntary  action, involving more than 40 muscles of the face, neck and chest.  Dr. Bonnie Martin-Harris uses state-of-the-art biofeedback equipment on a patient. But when something goes wrong, the effect can have scary and sometimes serious consequences.  Beginning today, national experts and practitioners from various disciplines will converge in the Lowcountry to attend the first Charleston Swallowing Conference.  The three-day event will be an opportunity for specialists to focus on the progress of clinical and scientific research work studying the field of dysphagia, or swallowing disorders. The event is sponsored by the MUSC Department of Otolaryngology-Head and Neck Surgery; MUSC Evelyn Trammell Institute for Voice and Swallowing; the College of Health Professions Communication Sciences and Disorders program; and in cooperation with the St. Joseph’s Hospital of Atlanta Evelyn Trammell Voice and Swallowing Center. “Physicians and specialists are demanding more information about how to test for and treat swallowing disorders based on the increased incidence and sometimes life-threatening consequences of the problem,” said Bonnie Martin-Harris, Ph.D., associate professor, Department of Otolaryngology-Head and Neck Surgery and director of the MUSC Evelyn Trammell Institute for Voice and Swallowing.  “Swallowing disorders often lead not only to devastating medical conse-quences but also to social isolation and depression if a patient is unable to eat and drink,” she said. “This conference is an opportunity for scientists to relay past and ongoing treatments, evaluation techniques, and outcome measurement tools that may potentially become requirements for standardized practices in the future.” It is estimated that more than 15 million Americans suffer from swallowing disorders. Experts believe actual numbers for dysphagia may be higher because it is not a reportable disease. Rather, it is a condition that results from many types of medical disorders. Yet the condition does not discriminate and can affect anyone, from small infants to the elderly. Since the early 1980s, the medical community has shifted its focus to swallowing problems thanks to the advances of promising research, more effective tests for evaluation, and new treatment options. More important are its effects on various patient populations, including people who suffer from stroke or head injuries, head and neck cancers, cervical spinal injuries neurological diseases (Parkinson's, Multiple Sclerosis or Muscular Dystrophy),  tissue-connective diseases (scleroderma, severe arthritis) or unknown causes that interfere with the coordination of swallowing muscles.  “Physicians are usually and should be the front-line practitioners involved in identifying swallowing problems,” Martin-Harris said. “They will refer the patient  to trained speech pathologists and other specialists who assist them in the evaluation and treatment. It’s a total team approach to a patient’s care.” The conference will assemble an estimated 400 national and international researchers, physicians, nurses and clinicians involved in gastroenterology, otolaryngology, neurology, pulmono-logy, pediatrics, radiology, internal medicine, speech pathology, and allied health (occupational and physical therapies). Most are involved in the multidisciplinary care and treatment of dysphagia patients.  According to Martin-Harris, today's specialists are concerned about two primary issues when it comes to swallowing disorders.  First, there is the questions about the patient's ability to maintain adequate nutrition and hydration. A patient's diet texture must be evaluated and possibly altered, depending upon their condition, Martin-Harris said.  Second is a patient assessment for aspiration risk.  People, especially the elderly, have trouble inhaling fluid or stomach contents into the upper airway and lungs during swallowing attempts because of weakened or restricted muscles. Aspiration can lead to pneumonia, a leading cause of death in the elderly. More often, symptoms of coughing during meals, wet sounding voices, low-grade temperatures, prolonged meals and weight loss are overlooked but left untreated, can lead to dire consequences.  Both issues can be treated and studied using a motion evaluation tool called video fluoroscopy. It can capture computer-digitalized images of a person's swallowing process and can be used as an assessment tool to treat problems that occur in the muscles or surrounding structures as food or liquid moves down the mouth, throat and stomach. The clinicians are able to view the benefit of swallowing rehabilitation maneuvers and altered food/liquid textures during the examination. The conference will be a forum for scientists and clinicians to discuss advances in the imaging field, treatment methods, clinical research findings, the latest news and applications for muscle re-education, strengthening and neuromuscular stimulation techniques, and quality-of-life issues.  Collaboration emphasizes need for standardization Bonnie Martin-Harris, like many of her colleagues, has been active in research work. A speech pathologist with more than 20 years experience, Martin-Harris has collaborated with many specialists and colleagues on swallowing disorders. She just completed an NIH study that researched how people breathe and swallow. She successfully mapped the entire sequence of swallowing and breathing of people of all ages, creating a template to study and recognize abnormal swallowing patterns in patients. Her latest research studies the need for more standardized methods in the case of interpreting X-rays or other diagnostic tests used by specialists to view the upper air digestive tract and other structures. “It’s a big issue for everyone in the field,” Martin-Harris said. “The problem lies in how we evaluate patients using techniques that are not standardized measurement tools. We’re attempting to develop a set of standardized measures that relate to outcomes. We need to look at the things that have the greatest impact on patients.” For this, she is collaborating with campuswide clinicians and scientists including nursing biostatistician Yvonne Michel, Ph.D., College of Nursing; Donald Castell, M.D., director of the Esophageal Motility Laboratory in MUSC's Digestive Disease Center; Boyd Gillespie, M.D., assistant professor and Terry Day, M.D., director of head and neck oncology, Department of Otolaryngolgoy-Head and Neck Surgery; Lucinda Halstead, M.D., medical director of the Voice and Swallowing Institute and Martin Brodsky, M.S., clinical instructor, Department of Otolaryngolgoy-Head and Neck Surgery. The study will involve 350 patients for the next two years at the MUSC and St. Joseph's Evelyn Trammell Institutes for Voice and Swallowing in Charleston and Atlanta. A day prior to the conference, Martin-Harris has scheduled a closed-validation meeting with conference faculty to establish a consensus regarding the development of a standardized metric for the measure-ment of  swallowing disorders.      Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.