ORCID Profile
0000-0002-5329-1222
Current Organisation
University of Sydney
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Publisher: Springer Science and Business Media LLC
Date: 06-05-2019
Publisher: European Respiratory Society (ERS)
Date: 06-05-2021
DOI: 10.1183/23120541.00192-2021
Abstract: Swallowing disorders occur in COPD, but little is known about tongue strength and mastication. This is the first assessment in COPD of tongue strength and a test of mastication and swallowing solids (TOMASS). Anterior tongue strength measures were obtained in 18 people with COPD, aged 73±11 years (mean± sd ), and 19 healthy age-matched controls, aged 72±6 years. Swallowing dynamics were assessed using an eating assessment tool (EAT-10), timed water swallow test (TWST), and TOMASS. Swallowing measures were compared to an inhibitory reflex (IR) in the inspiratory muscles to airway occlusion (recorded previously in the same participants). Tongue strength was similar between COPD and controls (p=0.715). Self-assessed scores of dysphagia EAT-10 were higher (p=0.024) and swallowing times were prolonged for liquids (p=0.022) and solids (p=0.003) in the COPD group. During TWST, ∼30% of COPD group showed clinical signs of airway invasion (cough and wet voice), but none in the control group. For solids, the COPD group had ∼40% greater number of chews (p=0.004), and twofold-higher number of swallows (p=0.0496). Respiratory rate was 50% higher in COPD group than controls (p .001). The presence of an IR was not related to better swallowing outcomes, but signs of airway invasion were associated with a delayed IR. Dysphagia in stable COPD is not due to impaired anterior tongue strength, but rather swallowing–breathing discoordination. To address dysphagia, aspiration and acute exacerbations in COPD, therapeutic targets to improve swallowing dynamics could be investigated further.
Publisher: Springer Science and Business Media LLC
Date: 29-09-2021
DOI: 10.1007/S11325-021-02481-2
Abstract: Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder characterised by repeated narrowing and closure of the upper airway during sleep. Despite growing evidence that dysphagia is a frequent sequela of OSA, the role of speech-language pathologists (SLPs) in managing OSA remains unclear. The aim of this international study was to evaluate SLPs knowledge, attitudes, and experience of OSA. A validated questionnaire, OSA Knowledge and Attitudes (OSAKA), was distributed to SLPs internationally via an online survey. Additional information on demographics, educational history, and clinical practices was ascertained. From a total of 1647 respondents, 822 clinicians from twenty-four countries were included in the final analysis. Knowledge of OSA among SLPs was limited the mean (SD) rate of correct answers was 55% (22%). Over half of SLPs reported patients with OSA on their caseload, with the majority of patients referred for dysphagia services. Yet, only half of SLPs reported confidence in their ability to assess or manage dysphagia in patients with OSA. SLPs' experience of OSA had an effect on their knowledge and attitudes [F (2, 817) = 17.279, p < 0.001]. SLPs are involved in the management of patients with OSA but are practising with limited knowledge and confidence. The findings highlight the need to increase OSA education and training for SLPs. In addition, there is a need for targeted research to increase the evidence base for development of clinical practice guidelines for dysphagia management in patients with OSA.
Publisher: Informa UK Limited
Date: 14-07-2020
Publisher: American Speech Language Hearing Association
Date: 04-08-2020
DOI: 10.1044/2020_AJSLP-19-00180
Abstract: This study evaluated the safety and efficacy of a sensory stimulation protocol that was designed to modulate citric acid cough thresholds as a potential treatment for silent aspiration. Healthy adults ( n = 24) were randomly assigned to one of three sensory stimulation groups: (a) high-intensity ultrasonically nebulized distilled water (UNDW) inhalations (1.6 ml/min) (b) low-intensity UNDW inhalations (0.5 ml/min) and (3) control, 0.9% saline inhalations (1.6 ml/min). Sensory stimulation was delivered once a day, for 4 consecutive days. Citric acid cough thresholds were determined at baseline, Day 3, and Day 5 to evaluate changes in cough sensitivity. Spirometry was undertaken before, during, and after each sensory stimulation session to monitor for bronchoconstriction. No participant showed evidence of bronchoconstriction during the sensory stimulation protocol. There was an interaction effect between day and group on suppressed cough thresholds, χ 2 (4) = 11.32, p = .02. When compared to the control group, there was a decrease in citric acid cough thresholds across Days 1–5 in the high-intensity (−1.8 doubling concentrations, 95% confidence interval [−2.88, −0.72], p = .01) and low-intensity (−1.3 doubling concentrations, 95% confidence interval [−2.4, −0.2], p = .03) UNDW inhalation groups, representing a sensitization effect of UNDW inhalations on cough sensitivity. The UNDW sensory stimulation protocol was safe in healthy adults. The findings provide preliminary evidence that UNDW inhalations sensitize laryngeal afferents related to citric acid–induced cough induction. The therapeutic potential of the UNDW sensory stimulation protocol will be explored in patients with reduced cough sensitivity who are at risk of silent aspiration and aspiration pneumonia. This study explored the safety and efficacy of a sensory stimulation protocol that was designed to modulate cough sensitivity as a potential treatment for silent aspiration. The study revealed that inhalations of nebulized distilled water were safe and increased cough sensitivity, when compared to control saline inhalations.
Publisher: Elsevier BV
Date: 04-2022
DOI: 10.1016/J.SMRV.2022.101589
Abstract: Impaired upper airway sensation may contribute to obstructive sleep apnea (OSA) pathophysiology and could represent a therapeutic target. However, the extent of impaired sensation and its functional role in OSA pathogenesis remains unclear. This study aimed to: 1) evaluate methods of upper airway sensory testing in people with OSA, 2) compare upper airway sensation in people with and without OSA and 3) investigate the potential relationship between upper airway sensation and OSA severity. Major electronic databases were searched for studies that reported methods of upper airway sensory testing in people with OSA (n = 3819). From the selected studies (n = 38), information on the type of sensation, testing methods, validity and test-retest reliability were extracted. Meta-analyses were performed on case-controlled studies and studies that investigated potential relationships between upper airway sensation and OSA severity. Seven categories of sensory tests were reported: olfactory, gustatory, chemical, tactile, vibratory, thermal and perioral neuro-sensation. Testing methods varied widely across studies. No tests were validated in OSA. People with OSA had impaired upper airway sensation to airflow (p = 0.0002), chemical (p = 0.0001), gustatory (p = 0.009), olfactory (p = 0.04), tactile (p = 0.0001) and vibratory (p = 0.005) stimuli. Upper airway sensory impairment increased with OSA severity (p < 0.001). These findings suggest that, while variable across testing methods, people with OSA have impaired upper airway sensation, which is related to increased OSA severity. Development of valid and reliable upper airway sensory testing methods that relate to upper airway function in people with OSA are required to inform future clinical and research practices and identify potential therapeutic targets.
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.PUPT.2019.101827
Abstract: This systematic review summarises and appraises methods of citric acid cough reflex testing (CRT) documented in published literature. Electronic databases, MEDLINE, EMBASE, CINAHL, PsychINFO, Scopus were searched up to and including 11th February 2018. Studies reporting a method of citric acid CRT, published in peer-reviewed journals in English or Spanish, were assessed for the inclusion criteria. Of the selected studies, information on the instrumentation and CRT protocol was extracted. A total of 129 studies were included. Instrumentation and protocols differed widely across studies. Reporting of methods of citric acid CRT was sub-standard, with many crucial methodological components omitted from published manuscripts, preventing their full replication. Considerable methodological variability exists for citric acid CRT in published literature. The findings suggest that caution is warranted in comparing citric acid cough thresholds across studies. Full replication of previously published methods of citric acid CRT is limited due to crucial elements of the citric acid CRT protocol being omitted from published manuscripts. These findings have implications on the use of citric acid CRT in clinical and pharmaceutical studies to evaluate the effects of antitussive medications and cough therapies.
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.PUPT.2019.101838
Abstract: The citric acid cough reflex test (CRT) is used to quantify cough sensitivity and evaluate the effects of cough therapies and antitussive medications. This study quantifies the test-retest variability of natural and suppressed citric acid cough thresholds and urge to cough ratings in healthy in iduals. Healthy adults (n = 16) inhaled increasing concentrations of citric acid (0.01-3.2 mol/L) on three alternate days (1, 3, 5) until C Natural cough thresholds (NCTs) increased across days 1-3 (0.87 doubling concentrations, 95% CI, 0.28, 1.44, p = 0.004) and 1-5 (0.87 doubling concentrations, 95% CI, 0.33, 1.41, p = 0.004). Suppressed cough thresholds (SCTs) increased across days 1-5 (0.64 doubling concentrations per day, 95% CI, 0.03, 1.22, p = 0.04). After taking the effect of day into account, NCTs and SCTs varied within-participants by 0.75 (95% CI, 0.53, 0.93) and 0.78 (95% CI, 0.55,0.98) doubling concentrations respectively. UTC ratings at NCT, or SCT did not significantly increase across days 1-3 or 1-5. Sub-threshold (0.05 mol/L) UTC ratings increased across days 1-3 (-1.43 ratings per day, 95% CI, -2.31, -0.5, p = 0.005) and 1-5 (-1.71 ratings per day, 95% CI, -2.59, -0.79, p = 0.001). UTC ratings at NCT, SCT, and sub-threshold varied within-participants after taking into account the effect of day by 1.34 (95% CI, 1.03, 1.71), 1.47 (95% CI, 1.10, 1.91) and 1.20 (95% CI, 0.91, 1.50) ratings. Natural and suppressed cough thresholds and UTC ratings are subject to test-retest variability. These data are important for the use of citric acid CRT as an outcome measure in longitudinal cough research, as they facilitate interpretation of whether changes in citric acid cough thresholds across days reflect true changes in cough sensitivity, rather than an artefact of repeating the test.
Publisher: Elsevier BV
Date: 09-2022
No related grants have been discovered for Emma Wallace.