Hope for people with swallowing disorders

In her first job as a speech-language pathologist, Giselle Carnaby Mann, Ph.D., M.P.H., was surprised by the large number of patients with swallowing problems at the hospital in Australia where she worked, and frustrated by the lack of treatment information available.

“In those days we were pretty good at saying if you had a swallowing problem or not, but not really good at treating it,” said Mann, an associate professor in the department of behavioral science and community health and co-director of UF’s Swallowing Research Laboratory. “If patients didn’t get better by themselves then there wasn’t a lot more that could be done.”

Today there are promising treatments available, thanks in part to Mann and her colleagues. While traditional swallowing therapies have relied on modifying food or using compensatory measures, Mann uses an exercise-based approach to help patients progressively strengthen the muscles involved in swallowing. In her research she has focused on two patient populations: patients with head and neck cancer, and people who have had a stroke.

Chemotherapy and radiation therapy for head and neck cancer can cause deep tissue fibrosis, a condition in which the tissue surrounding the treatment area becomes hard and inflexible. With funding from the American Cancer Society, Mann recently completed a study that is the first of its kind to demonstrate that swallowing problems can be prevented if patients participate in a swallowing exercise program throughout cancer treatment. The therapy has been so successful that it has been adopted as a standard of care for patients with head and neck cancer treated at the UF Shands Cancer Center.

Swallowing problems occur in up to 65 percent of people who have had a stroke, according to the American Stroke Association. Mann is evaluating the effects of a swallowing rehabilitation program for these patients she describes as a three-week “boot camp for swallowing.” The training is intense — patients swallow 80 to 90 times a session compared to 20 to 30 times in traditional swallowing therapy sessions. Researchers closely monitor the patients’ eating and train participants to keep their airways clear. The program was developed by Mann and Michael Crary, Ph.D., a professor in the department of speech, language and hearing sciences.

Mann believes these therapies could help a wide range of people with swallowing disorders, not just those with head and neck cancer or stroke. Swallowing disorders occur when muscles or nerves involved in swallowing weaken, putting the elderly or people with conditions like Parkinson’s disease or multiple sclerosis at risk. In the United States 10 to 20 million adults experience some sort of swallowing disability, Mann said, and the problem affects a lot more than a person’s nutrition. The inability to swallow can have a devastating effect on a person’s social interactions and quality of life.

“With these therapies we’re keeping the swallowing musculature active and we’re getting benefits, we think, from the development of improved microvascular flow as well as antioxidant protection of muscle structures and nerves that control those muscles. These types of changes could actually translate out to the general community, in particular, the frail elderly,” she said.

Throughout her career Mann has relied on her public health background in epidemiology and biostatistics to help her examine the issue of swallowing disorders from a population perspective.

“I think that the health professions and public health are a perfect alliance,” said Mann, who holds a Ph.D. in speech pathology and advanced degrees in public health. “The addition of public health to what I started with provided me with the expertise to be able to evaluate some of these complex problems in a much more sophisticated manner than I would have ever been able to do without that training.”