Untitled Document

Research

JoAnne Robbins

Ph.D., Northwestern University
Professor, Department of Medicine
Associate Director, Geriatric Research Education and Clinical Center
Jrobbin2@wisc.edu
http://www2.medicine.wisc.edu/home/people-search/people/staff/1201/ROBBINS_JOANNE/

The Nature, Diagnosis, Treatment and Prevention of Senescent Swallowing

Difficulty swallowing (dysphagia) affects approximately 18,000,000 adults in the U.S. Dysphagia has been associated with specific diseases of aging, most commonly stroke, although we have found that disease-free aging can also affect swallowing. In the University of Wisconsin/VA Swallowing Laboratory, the age-related changes we are documenting and their impact on the flow of food through the gastrointestinal system explain, at least in part, the life-threatening pneumonia, malnutrition, dehydration and reduced quality of life so frequently found in older individuals.

Another major focus is to improve diagnostic methods of radiographic imaging using a swallowed radiopaque barium bolus. We have been custom-designing barium with specific properties of viscosity, adhesiveness and taste in order to maximize diagnostic and treatment information derived from the routine clinical examination. We have patented our technology, and an industry partner is manufacturing the new bariums. Our materials are becoming the clinical and research standard.

I am also conducting two federally funded, multi-site clinical trials that focus on treatment of dysphagia. The trial, funded by the National Institutes of Health, is investigating the effect of a simple chin tuck or thickened liquids on the incidence of liquid aspiration pneumonia in patients with dementia, with or without Parkinson's disease. The other clinical trial, funded by the Department of Veterans Affairs, is evaluating the effect of lingual exercise on aspiration, pneumonia, tongue strength, muscle mass, swallowing physiology, swallowing-specific quality of life and diet in frail elderly patients with dysphagia.

Finally, we are studying esophageal physiology and its effect on bolus flow during swallowing. We hypothesize that clinicians may be confusing gastroesophageal reflux (GER) with intra-esophageal reflux (IER) and intra-esophageal stasis (IES). Unlike GER, with IER food may remain in the esophagus and back up into the throat where it can be inhaled by the lungs and cause respiratory illness, particularly in many older adults. Treatment implications are tremendous and could potentially diminish pneumonia, the third leading cause of death in the geriatric population.

Representative Publications
White, R., Cotton, S.M., Hind, J., Robbins, J., & Perry, A. (2008). A comparison of the reliability and stability of oro-lingual swallowing pressures in patients with head and neck cancer and healthy adults. Dysphagia, 2008, Oct 28. [Epub ahead of print].

Humbert, I.A., Fitzgerald, M.E., McLaren, D.G., Johnson, S., Porcaro, E., Kosmatka, K., Hind, J., & Robbins, J. (2008). Neurophysiology of swallowing: Effects of age and bolus type. Neuroimage, 2008, Oct 28. [Epub ahead of print].

McHorney, C.A., Martin-Harris, B., Robbins, J., & Rosenbek, J. (2008). Clinical validity of the SWAL-QOL and SWAL-CARE outcome tools with respect to bolus flow measures. Dysphagia, 23(4), 461.

Humbert, I.A., & Robbins, J. (2008). Dysphagia in the elderly. Phys. Med. Rehabil. Clin. N. Am., 19(4), 853-66.

Robbins, J., Butler, S.G., Daniels, S.K., Diez Gross, R., Langmore, S., Lazarus, C.L., Martin-Harris, B., McCabe, D., Musson, N., & Rosenbek, J. (2008). Swallowing and dysphagia rehabilitation: translating principles of neural plasticity into clinically oriented evidence. J. Speech Lang. Hear Res., 51(1), S276-300.

Humbert, I.A., & Robbins, J. (2007). Normal swallowing and functional magnetic resonance imaging: a systematic review. Dysphagia, 22(3), 266-75.

Robbins, J., Kays, S.A., Gangnon, R.E., Hind, J.A., Hewitt, A.L., Gentry, L.R., & Taylor, A.J. (2007). The effects of lingual exercise in stroke patients with dysphagia. Arch. Phys. Med. Rehabil., 88(2), 150-8.

Fried, L.F., Biggs, M.L., Shlipak, M.G., Seliger, S., Kestenbaum, B., Stehman-Breen, C., Sarnak, M., Siscovick, D., Harris, T., Cauley, J., Newman, A.B., & Robbins, J. (2007). Association of kidney function with incident hip fracture in older adults. J. Am. Soc. Nephrol., 18(1), 282-6.

Robbins, J., Kays, S., & McCallum, S. (2007). Team management of dysphagia in the institutional setting. J. Nutr. Elder., 26(3-4), 59-104.

Kays, S., & Robbins, J. (2006). Effects of sensorimotor exercise on swallowing outcomes relative to age and age-related disease. Semin. Speech Lang., 27(4), 245-59.

Robbins, J. (2006). New frontiers in dysphagia rehabilitation. Semin. Speech Lang., 27(4), 217-8.

Hind, J.A., Nicosia, M.A., Gangnon, R., & Robbins, J. (2005). The effects of intraoral pressure sensors on normal young and old swallowing patterns. Dysphagia, 20(4), 249-53.

Robbins, J., Gangnon, R.E., Theis, S.M., Kays, S.A., Hewitt, A.L., & Hind, J.A. (2005). The effects of lingual exercise on swallowing in older adults. J. Am. Geriatr. Soc., 53(9), 1483-9.

Robbins, J., Hind, J., & Logemann, J. (2004). An ongoing randomized clinical trial in dysphagia. J. Commun. Disord., 37(5), 425-35.

Robbins, J.A., & Barczi, S.R. (2003). Disorders of swallowing. In W. Hazzard & J. Halter (Eds.), Principles of geriatric medicine (5th ed.). New York: McGraw Hill.

Robbins, J., Langmore, S., Hind, J.A., & Erlichman, M. (2002). Dysphagia research in the 21st century and beyond: proceedings from Dysphagia Experts Meeting, August 21, 2001. J. Rehabil. Res. Dev., 39(4), 543-8.

Robbins, J. (2002). The current state of clinical geriatric dysphagia research. J. Rehabil. Res. Dev., 39(4), vii-ix.

McHorney, C.A., Robbins, J., Lomax, K., Rosenbek, J.C., Chignell, K., Kramer, A.E., & Bricker, D.E. (2002). The SWAL-QOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults: III. Documentation of reliability and validity. Dysphagia, 17(2), 97-114.

Hind, J., Nicosia, M., Carnes, M., Roecker, E., & Robbins, J. (2001). Comparison of effortful and non-effortful swallowing in healthy middle aged and older adults. Archives of Physical Medicine and Rehabilitation, 82, 1661-1665.

Barczi, S., Sullivan, P., & Robbins, J. (2000). How should dysphagia care of older adults differ? Establishing optimal practice patterns. Sem. Speech and Language Path., 21, 347-361.

Kim, H.K., Chung, C.S., Lee, K.H., & Robbins, J.A. (2000). Aspiration subsequent to pure medullary infarction: Lesion sites, clinical variables and outcome. Archives of Neurology, 57, 478-483.

Nicosia, M.A., Hind, J.A., Roecker, E.B., Carnes, M., Doyle, J., Dengel, G.A., & Robbins, J. (2000). Age effects on temporal evolution of isometric and swallowing pressure. Journal of Gerontology, Medical Sciences, 55A, M634-M640.

Robbins, J., Coyle, J., Roecker, E., Rosenbek, J., & Wood, J. (1999). Differentiation of normal and abnormal airway protection during swallowing using the penetration-aspiration scale. Dysphagia, 14(4), 228-232.

Robbins, J. (1999). The evolution of swallowing neuroanatomy and physiology in humans: A practical perspective [Invited Editorial]. Annals of Neurology, 36, 279-280.

Robbins, J. (1999). Old swallowing and dysphagia: Thoughts on intervention and prevention. Nutrition in Clinical Practice, 14(5), S21-S26.

Priefer, B., & Robbins, J. (1997). Eating changes in mild stage Alzheimer's disease: A pilot study. Dysphagia, 12(4), 212-221.

Robbins, J.A., Levine, R.L., Wood, J., Roecker, E., & Luschei, E. (1995). Age effects on lingual pressure generation as a risk factor for dysphagia. Journal of Gerontology, Medical Sciences, 50A(5), M257-M262.

Robbins, J.A., Levine, R.L., Maser, A., Rosenbek, J.C., & Kempster, G.L. (1993). Swallowing after unilateral cerebral stroke. Archives of Physical Medicine and Rehabilitation, 74, 1295-1300.

Robbins, J.A., & Levine, R.L. (1993). Swallowing after lateral medullary stroke syndrome plus. Clinics in Communicative Disorders, 3(4), 45-55.

Robbins, J.A., Hamilton, J.W., Lof, G.L., & Kempster, G. (1992). Oropharyngeal swallowing in normal adults of different ages. Gastroenterology, 103, 823-829.

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