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Department of Communications/
News Bureau
22 Davis Hall, 10 Lippitt Road, Kingston, RI 0288
Phone: 401-874-2116 Fax: 401-874-7872

URI awarded $70,000 grant to assist patients with swallowing disorders

KINGSTON, R.I. -- May 14, 2002 -- Imagine choking every time you tried to eat or drink. This is what happens to many adults suffering from dysphagia—commonly known as swallowing disorders.

To improve the treatment of patients with dysphagia, Dr. Colleen Karow, an assistant professor in the Department of Communicative Disorders at the University of Rhode Island, was recently awarded a $70,000 grant from the State Department of Mental Health, Retardation and Hospitals (MHRH). With the funding, Karow hopes to improve the quality of life for people suffering with swallowing disorders.

"This grant promotes my objective to enhance the quality of dysphagia services provided by speech pathologists statewide," said the Kingston resident.

"By developing partnerships with medical facilities across the state graduate students can gain experiences in real medical settings before graduation," says Karow who came to the University of Rhode Island in 1998 with an extensive clinical background as a medical speech and language pathologist.

The MHRH grant will be used to improve services offered through a relationship between the URI Department of Communicative Disorders and Slater Hospital. The program provides training for speech pathology graduate students using real life situations including helping patients learn to eat more safely. According to Karow, "The University of Rhode Island is the only institution in the state that offers graduate level coursework and field experiences in the treatment of swallowing disorders."

The Eleanor Slater Hospital is a 700 bed-public hospital operated by the MHRH. It treats patients with acute and long-term medical illnesses as well as patients with psychiatric disorders. "Jim Benedict, Chief Operating Officer of Slater Hospital has been great. He wants to provide the highest level of care for his patients and he has been extremely supportive of promoting programs that target patient health and service delivery", says Karow.
Dysphagia can occur in multiple types of medical situations. Swallowing disorders affect between 50 and 70 percent of patients after severe damage to the nervous system. Additionally, dysphagia is common among victims of stroke and can also be seen in cases of Parkinson’s disease, Lou Gehrig’s disease, muscular dystrophy, cerebral palsy, multiple sclerosis, and brain injuries. Negative effects of the disorders result in poor nutrition, dehydration, and the risk of food or liquid entering the airway, which can result in pneumonia or chronic lung disease. But, help is available.

Speech and language pathologists are licensed professionals who can work with patients with dysphagia to improve nutrition, strength, and overall health.

"It’s sad to see a person who has just had a stroke and has swallowing problems. The patient may be choking on food and feeling that they can no longer eat. As a speech pathologist, I am able to walk into that patient’s room and say, ‘I have some techniques that may be able to help you’," explains Karow. "One technique uses a powder that thickens liquids to make them easier to swallow."

In many types of swallowing disorders, thinner fluids tend to slip into the airway, often creating dangerous medical situations. Thicker substances are swallowed slowly and often can be ingested correctly with the proper swallowing techniques. Some swallowing techniques include placing the patient in an upright position, facilitating a pleasant and calm environment, confirming that the patient’s lips are closed during swallowing, and turning the patient’s head.

"Some patients don't even know [when] they are choking. There can be damage to the nerves in their throat or to important areas in the brain and, as a result, they do not realize the food is caught in their airway," Karow says.

Because of intense pressures in the health care system, speech pathologists provide initial diagnoses but are often restricted from conducting extensive follow-up care. "The pathologists do not get to spend enough one-on-one time with the patients. This may limit the quality of service. Through this grant, my goal is to teach the students their role as a speech and language pathologist and as patient advocates so that they can become critical players in patient rehabilitation", says Karow.

Through hands-on work at Slater, Karow hopes graduate students will gain world experience that they will use throughout their careers as medical speech pathologists. Some of the supervised services provided by URI grad students at Slater include: teaching patients swallowing techniques to improve food intake, feeding patients who cannot feed themselves, providing therapy to improve muscle function and movement, improving patients’ oral hygiene, and creating an enhanced dining environment for patients who need encouragement to eat. Additionally, Karow is working to develop educational programs that bring graduate students in training and nursing aides together to work with dysphagic patients in small group settings during mealtimes. Karow reports that these opportunities will give nursing assistants more confidence in working with patients that have choking risks and they will be better prepared to carry over safe feeding techniques learned during the therapeutic mealtimes. At Slater Hospital, Karow has also implemented a Daily Drink Program to improve patient hydration and an Oral Care Program, to improve oral hygiene for dysphagia patients who may be aspirating on material that often gets mixed with saliva. "The benefits to reducing oral bacteria before eating have been shown to reduce a patient’s response to aspiration", says Karow.

Karen Houle, a certified speech and language pathologist at Slater, is affiliated with the graduate student program and works closely with the students by overseeing student-patient interactions. Houle has worked to improve the dysphagia radiology facilities at Slater, which are used to perform modified barium swallow (MBS) studies. X-ray technology helps the pathologist and the radiologist determine if a variety of foods are swallowed correctly.

According to Karow, "Not long ago, dysphagia patients were sent to private hospitals from Slater for their MBS evaluations. With this funding, the hospital has been able to provide state of the art equipment. At Slater Hospital, Karen has obtained top-of-the-line equipment where she can make accurate assessments on the different types of swallowing problems patients can have."

Karow and Houle are also in the process of introducing advanced technology to the state of Rhode Island, including better swallowing assessment procedures and computer equipment. At Slater, students will have the opportunity to observe new tests for patients who are immobile, including a procedure which allows doctors to insert a small camera attached to a tube through the patient’s nose. Pathologists are then able to view patients swallow with different consistencies of foods (for example liquids versus solids) to better assess their medical treatment.

Additionally, at URI, Karow has been using a new computerized video system, "Clark TUT," to view MBS studies. "A Clark TUT computer can be connected to the radiographic equipment at Slater Hospital, and also can be used to view barium swallow studies that have been conducted at other centers for detailed analysis. I can use the pictures for training purposes. Images can be viewed in a series at a slow rate to examine the patient’s swallowing process in each frame. No one else in Rhode Island has this equipment," says Karow.

"The [MHRH] funding has allowed for us to develop programs and bring testing procedures to the hospital that were not available before the partnership," explains Karow. "With this partnership, the hospital is able to provide quality service with the graduate students on hand to help."

For digital images, please contact Nancy Gillespie at 874-2116 or email at ngillespie@advance.uri.edu.
For Information: Dave Lavallee, 401-874-5862, Sarah Emmett, 401-874-2116

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