NSSR Clinical Science Lab

Focus

The focus of the NSSR clinical laboratory is to:
  1. Assess and identify speech, swallow and respiratory impairment and progression in individuals with neurodegenerative and neuromuscular disease (ALS, PD, OPMD, DMD, Pompe’s disease).
  2. Investigate the impact of novel therapeutic interventions on physiology, function, quality of life, disease progression and ultimately survival in ALS and PD.
  3. Improve service delivery for speech and swallowing dysfunction in neurodegenerative disease populations.

Facilities

The human clinical laboratory is equipped with state of the art technology for the comprehensive evaluation of swallowing, speech, voice and respiration. Radiographic images of swallowing are captured on a Phillips BV Endura fluoroscopy unit and a Pentax Digital Swallowing Workstation permits data acquisition and analysis of both videofluoroscopy and flexible endoscopic evaluations of swallowing (FEES). ManoScan 360 High-Resolution Esophageal Manometry (HREM) is utilized to measure velopharyngeal, oropharyngeal and esophageal pressures and patterns of contraction when at rest and during swallowing. Voice evaluations are completed using flexible and rigid videostroboscopy and acoustic voice analysis using the Pentax Digital Videostroboscopy System and Visipitch tool. Respiratory function testing is completed with a Care Fusion spirometer (FVC, FEV, PEF) and Micro respiratory pressure meters (MIP, MEP, SNIF). Cough evaluations are performed using an oral pneumotachograph coupled with a powerlab interface and Lab Chart cough analysis system.
  • NSSR Basic Science Lab

Studies

The current research focus of the NSSR clinical laboratory is to increase our understanding of bulbar dysfunction in individuals with ALS and identify ways to maintain and/or improve speech, swallow and respiratory function. Specific research questions being addressed at this time include: 1) Investigating the impact of exercise on airway protection, swallow and respiratory function and disease progression in ALS; 2) Determining the relationship between voluntary cough production and airway protection during swallowing in ALS; and 3) Determining the relationship between patient-perceived speech and swallowing impairment and clinician-rated metrics of dysarthria and dysphagia in ALS. If you are an individual with ALS and are interested in learning more about our current research studies, please contact clinical trials coordinator Lauren Tabor at ltabor@ufl.edu
  • Effects of Strength Training on Bulbar Function in Persons with Amyotrophic Lateral Sclerosis
    Funding Source: National Institute of Child Health Development. Grant Mechanism: 1R21 HDO75327-01 Principle Investigator: Dr. Emily Plowman Bulbar in the form of progressive speech, swallow and respiratory impairment are highly prevalent in Amyotrophic Lateral Sclerosis (ALS) and together account for 95% of disease mortality. Although progressive muscle weakness is the primary sign of ALS, the effects of exercise and strength training in this patient population is controversial. While exercise in persons with ALS has historically been discouraged due to fear that muscle overburden may execrate physical decline, recent animal and human data suggest that moderate intensity exercise, applied early in the disease, may serve a neuroprotective role in ALS. Indeed, exciting preliminary data from our laboratory indicate that a regimen of expiratory muscle strength training (EMST) in persons with mild-moderate ALS has a positive effect on expiratory force generating abilities, airway protection and cough during swallowing, swallow kinematics, self-reported swallow severity and swallow-related quality of life. The central goal of this blinded, randomized sham control clinical trail is to investigate the effects of an eight-week regimen of EMST on bulbar function in persons with mild to moderate ALS. The central hypothesis is that eight-weeks of daily moderate intensity resistance EMST exercise will actively engage the expiratory and submental musculature, deter disuse atrophy and prolong function of breathing, cough and swallowing in persons with ALS.  This study is will specifically determine the effect of EMST on: 1) expiratory force generating ability (maximum expiratory pressure); 2) swallow physiology and airway safety during swallow; 3) cough function; 4) functional oral intake, swallow-related quality of life and self-reported swallow severity in persons with mild to moderate ALS. The results will provide valuable insight into the potential role of muscle strength training for improving bulbar function in persons with ALS and will help guide the future direction of research and treatment for this devastating disorder.  This study represents the first clinical trial investigating the impact of exercise on bulbar dysfunction and is being performed in the NSSR human clinical laboratory.  It is funded by the National Institute of Child Heath Development (NICHD) under the R21 grant mechanism. Interested patients wishing to learn more about this study should contact study coordinator Lauren Tabor on 813 974-3374 or at ltabor@health.usf.edu
  • Reducing Barriers to living at home for the Rural Veteran with Amyotrophic Lateral Sclerosis
    Funding Source: Veterans Affair Office of Rural Health N08-FY14Q4-S0-P01503 Co-investigator: Dr. Emily Plowman The objective of this study is to identify and reduce potential barriers to living at home with ALS for rural Veterans and for Veterans with transportation issues. Dr. Plowman is a co-investigator on this study and her specific roles are to serve as the respiratory, speech and swallowing expert on this grant.
  • Impact of Lingual Resistance Exercise Training on Swallowing Function, Airway Protection and Oral Intake in Neurodegenerative Disease
    Funding Source: University of South Florida College of Medicine Interdisciplinary Seed Grant Principal Investigator: Dr. Emily Plowman The objective of this pilot investigation is to determine the impact of progressive lingual resistance training on the maintenance of tongue strength and endurance, oropharyngeal swallowing pressures, airway protection and functional oral intake in individuals with Parkinson’s disease (PD) and Amyotrophic lateral sclerosis (ALS).

Related Human Clinical Science Lab Publications



Hoy, M., Domer, A., Plowman, E.K., Loch, R., Belafsky, P.C. (2013) Causes and Diagnosis of Dysphagia in a Tertiary Swallow Center. Annals of Otology, Rhinology & Laryngology, 122(5):335-338. Pubmed

Plowman, E.K., Mehdizadeh O., Leder B., Martino R., Belafsky PC. (2012). A Bibliometric Review of Published Abstracts Presented at the Dysphagia Research Society: 2001-2011. Dysphagia, E Pub Ahead of Print. Pubmed

Halum, S., Ting, J., Plowman, E.K., Belafsky, P.C., Postma, G., Pitman, M.J., Moscatello, A., Khosla, S., Maronian, N.C., Sinacori, J.T., Ekbom, D.C. & Merati, A. (2012). A Multi-Institutional Analysis of Tracheotomy Complications. Laryngoscope, 122(1): 38-45.

Plowman, E.K, Domer, A. & Belafsky P.C. (2011). Central, peripheral and comorbid affects of normal and disordered aging on deglutition. Otorinolaringologia, 61: 45-52. PDF

Plowman, E., Hentz, B. and Ellis, C. (2011). Post-Stroke Aphasia Prognosis: A Review of Patient-Related and Stroke-Related Factors. Journal of Evaluation in Clinical Practice, 18(3):689-94. Pubmed

Plowman, E.K. & Okun, M.S. (2011). Antiphospholipid syndrome and other lupus-related movement disorders. Handbook of Clinical Neurology, 100, 237-245. Pubmed

Plowman, E.K. and Kleim, J.A. (2010). Motor Cortex Reorganization Across the Lifespan. Journal of Communication Disorders, 43(4), 286-294. Pubmed

Plowman-Prine E.K, Sapienza, C.M, Okun, M.S., Pollock, S.L, Jacobson, C., Wu, S., Rosenbek, J.C. (2009). The Relationship between Quality of Life and Swallowing in Parkinson’s Disease. Movement Disorders, 24(9),1352-1358. Pubmed

Plowman-Prine, E.K., Okun, M.S., Sapienza, C.M., Shrivastav, R., Fernandez, H.H., Foote, K.D., Elllis, C., Rodriguez, A.D., Burkhead, L.M., & Rosenbek, J.C. (2009). Perceptual characteristics of Parkinsonism speech: A comparison of the pharmacological effects of levodopa across speech and non-speech motor systems. Neurorehabilitation, 24, 1-13. Pubmed

Jones, H. N., Shrivastav, R, Wu, S. S., Plowman-Prine, E. K., & Rosenbek, J. C. (2009). Intensity and fundamental frequency variability before and after two behavioral treatments for aprosodia. Journal of Medical Speech-Language Pathology, 17, 45-53.

Plowman-Prine, E.K., Triggs, W.J., Malcolm, M., & Rosenbek, J.C. (2008). Reliability of Transcranial Magnetic Stimulation for mapping swallowing musculature. Clinical Neurophysiology, 119(10):2298-30. Pubmed

Rosenbek, J.C. & Plowman, E.K. (2002). Update of the neuropathologies of speech and language: Aphasia, dysarthria, apraxia of Speech. Journal of Japanese Aphasiology, 22, 9-16.