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Proactive Dysphagia Management of Patients with Neurodegenerative Diseases: Early Identification and Intervention

Donohue, Cara A. (2021) Proactive Dysphagia Management of Patients with Neurodegenerative Diseases: Early Identification and Intervention. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Abstract

Patients with neurodegenerative diseases (ND) frequently experience concomitant impairments in pulmonary, cough, and swallow function. These impairments can lead to accelerated morbidity and mortality due to adverse events (e.g. aspiration pneumonia, respiratory failure, malnutrition/dehydration). Historically, exercise-based interventions have been avoided in patients with ND due to fear that they may lead to faster disease progression and increased fatigue, yet, emerging evidence has revealed moderate exercise training in patients with ND may prolong function, life, and quality of life. This has led to the proposal of a paradigm shift from reactive to proactive management of these patients. Therefore, there is high demand for noninvasive, portable methods for continuously monitoring pulmonary and swallow function in patients with ND to proactively implement palliative interventions and mitigate adverse events. Yet, few exist. Gold standard assessments (e.g. spirometry, videofluoroscopy) require in-person clinic visits, which can be challenging for patients with ND to attend due to physical mobility impairments, transportation issues, multifactorial health problems, and compromised immune systems (e.g. COVID-19 pandemic). Therefore, this dissertation examined: 1) The safety, tolerability, and impact of exercise-based interventions on function and quality of life in patients with amyotrophic lateral sclerosis (PALS); and 2) The ability of a novel, non-invasive, sensor-based technology (high-resolution cervical auscultation [HRCA]) to characterize swallow function in patients with ND. To examine Aim 1, the first experiment examined the impact of respiratory interventions on pulmonary, cough, and surrogates of swallow function in PALS and the second experiment investigated the impact of exercise-based interventions on function and quality of life in PALS via a systematic review. To investigate Aim 2, the third experiment explored HRCA’s ability to differentiate between swallows from patients with ND and healthy age-matched adults and the fourth experiment compared temporal and spatial swallow kinematic measures between patients with ND and healthy adults and investigated HRCA’s ability to annotate specific swallow kinematic events in patients with ND. Findings revealed: 1) Exercise-based interventions are well-tolerated and may be beneficial for PALS with mild-moderate disease severity, and 2) HRCA has high potential as a noninvasive, accurate method for characterizing swallow function in patients with ND.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Donohue, Cara A.cad191@pitt.educad1910000-0002-5546-6081
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairCoyle, James L.jcoyle@pitt.edujcoyle
Committee MemberHelou, Leah B.lbh7@pitt.edulbh7
Committee MemberSejdic, Ervinesejdic@pitt.eduesejdic
Committee MemberLacomis, Davidlacomisd@upmc.edu
Committee MemberGarand, Kendrea L.garand@southalabama.edu
Date: 11 June 2021
Date Type: Publication
Defense Date: 23 February 2021
Approval Date: 11 June 2021
Submission Date: 5 March 2021
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 190
Institution: University of Pittsburgh
Schools and Programs: School of Health and Rehabilitation Sciences > Communication Science and Disorders
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: dysphagia, neurodegenerative diseases, videofluoroscopy, machine learning, cervical auscultation, swallow screening, deglutition, deglutition disorders
Date Deposited: 11 Jun 2021 20:46
Last Modified: 11 Jun 2021 20:46
URI: http://d-scholarship.pitt.edu/id/eprint/40319

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