Impact of Novel Rehabilitative Approaches FOR Dysphagia in Patients with Alzheimer's Disease and Related Dementias

新型康复方法对阿尔茨海默病和相关痴呆症患者吞咽困难的影响

• 批准号: 10468142
• 负责人: Nicole M Rogus-Pulia
• 金额: $ 23.58万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10468142
• 关键词: Address; African American; African American population; Aging; Alzheimer' s disease related dementia; Area; Aspiration Pneumonia; Award; Biomechanics; Biometry; Bolus Infusion; Caregiver Burden; Caregivers; Caring; Clinical; Clinical Trials; Clinical Trials Design; Cognition; Data; Deglutition; Deglutition Disorders; Development; Development Plans; Diagnosis; Diet Modification; Discipline; Disease Progression; Doctor of Philosophy; Education; Elderly; Ensure; Environment; Faculty; Food; Functional disorder; Funding; Future; Goals; Health; Hospitalization; Impaired cognition; Impairment; Infrastructure; Institution; Intake; Intervention; Interview; Language; Lead; Least-Squares Analysis; Liquid substance; Logistic Regressions; Malnutrition; Measures; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Modeling; Oral; Oropharyngeal; Outcome; Participant; Pathologist; Patients; Personal Satisfaction; Physiological; Physiology; Pneumonia; Production; Protocols documentation; Public Health; Qualitative Methods; Qualitative Research; Quality of life; Randomized; Randomized Clinical Trials; Rehabilitation therapy; Research; Research Personnel; Resistance; Risk; Safety; Saliva; Salivary; Scientist; Secure; Site; Speech; Subgroup; Techniques; Testing; Time; Tongue; Training; Underrepresented Populations; Universities; Viscosity; Wisconsin; Work; career development; caregiving; clinical care; cohort; common treatment; cultural competence; design; dysphagia rehabilitation; effective therapy; effectiveness evaluation; evidence base; experience; health care delivery; improved; medical schools; member; mortality; multi-site trial; negative affect; novel; novel therapeutics; patient subsets; post intervention; pressure; prevent; preventive intervention; primary outcome; programs; prospective; recruit; saliva secretion; skills; success; therapy development; treatment as usual; treatment response

PROJECT SUMMARY/ABSTRACT This career development proposal is designed to provide Nicole Rogus-Pulia, PhD, CCC-SLP, a Speech- Language Pathologist and an expert in dysphagia (swallowing dysfunction) at the University of Wisconsin- Madison School of Medicine and Public Health with the training required for success as an independent, clinician- scientist researching interventions to improve the care of dysphagia in patients with Alzheimer’s Disease and Related Dementias (ADRD). Dysphagia frequently develops in patients with ADRD and leads to serious health consequences, including increased caregiver burden, malnutrition, pneumonia, decreased quality of life, and mortality. Common treatments for dysphagia in patients with ADRD employ compensatory approaches that alter bolus flow to avoid aspiration (entrance of food or liquid into the airway). These approaches do not result in sustained improvements in swallowing physiology and often negatively affect quality of life. There are currently no effective treatments for dysphagia in patients with ADRD that can be practically applied or have lasting effects on the physiology of the swallow. The goal of Dr. Rogus-Pulia’s proposed research is to develop effective dysphagia rehabilitative interventions for patients with ADRD at risk for adverse health consequences. Progressive-resistance lingual strengthening and saliva substitute are two interventions that have been shown in preliminary studies to positively influence swallowing function in older adults. This proposal will consist of a small, prospective randomized clinical trial to determine the impact of two novel interventions on swallowing- related outcomes in patients with mild-moderate ADRD and identify subgroups of patients most likely to benefit from these interventions. Patient-caregiver dyads will be randomized to lingual strengthening, saliva substitute use, a combination of the two, or only usual care. Saliva and swallowing-related outcomes will be collected at baseline and following the 8 week intervention period. As a third aim, qualitative interviews with African American patients with ADRD and their caregivers will be analyzed to explore cultural adaptations to the study protocol or intervention materials to improve future trial participation among this underrepresented group. These data will support a large, multi-site R01 funded study to determine effectiveness of dysphagia interventions for prevention of adverse health outcomes in a diverse cohort of patients with ADRD. As a junior faculty member at an institution with extensive infrastructure to support early stage investigators, Dr. Rogus-Pulia is in an ideal environment to complete the proposed research and pursue advanced training. Her career development plan includes both coursework and mentored training in the areas of 1) clinical trials design and analysis, 2) ADRD clinical care and caregiving, 3) advanced statistical techniques, 4) qualitative methods, and 5) cultural competence. To ensure success, she has identified committed, expert mentors in these disciplines and secured protected time for this work. This award addresses a significant clinical dilemma and serious gap in ADRD research while affording the education and mentorship critical for Dr. Rogus-Pulia to lead an independent dysphagia research program.

项目摘要/摘要 该职业发展建议旨在为Nicole Rogus-Pulia，博士，CCC-SLP提供演讲 - 威斯康星大学的语言病理学家和吞咽困难（吞咽功能障碍）的专家 - 麦迪逊医学和公共卫生学院，并获得成功的培训，作为独立的临床 - 科学家研究干预措施，以改善阿尔茨海默氏病和 相关痴呆症（ADRD）。 ADRD患者经常出现吞咽困难，并导致严重健康 后果，包括增加护理人员烧伤，营养不良，肺炎，生活质量降低以及 死亡。 ADRD员工补偿方法改变的患者的吞咽困难的常见治疗方法 推注以避免抽吸（将食物或液体进入气道进入）。这些方法不会导致 吞咽生理学的持续改善，通常会对生活质量产生负面影响。目前有 在ADRD患者中没有有效的吞咽困难治疗方法，可以实际应用或具有持久作用 关于燕子的生理学。 Rogus-Pulia博士提议的研究的目的是发展有效 针对患有不良健康后果风险的ADRD患者的吞咽困难康复干预措施。 进行性抗性舌增强和唾液替代品是两种干预措施 在初步研究中，以积极影响老年人的吞咽功能。该建议将包括 小的，前瞻性的随机临床试验，以确定两种新干预措施对吞咽的影响 轻度中度ADRD患者的相关结果，并确定最有可能受益的患者亚组 从这些干预措施中。患者保养者的二元组将随机分为舌增强，唾液替代品 使用，两者的组合或仅通常的护理。将收集唾液和吞咽相关的结果 基线和8周干预期之后。第三目的是对非裔美国人的定性采访 将分析ADRD及其护理人员的患者，以探讨研究方案的文化适应或 干预材料以改善该代表性不足的群体中未来的试验参与。这些数据将 支持大型多站点R01资助的研究，以确定吞咽困难干预措施的有效性 ADRD患者的潜水员队列中的健康状况不良。作为一家机构的初级教师 Rogus-Pulia博士在支持早期研究人员的广泛基础设施中，处于理想的环境中 完成拟议的研究和购买高级培训。她的职业发展计划包括 1）临床试验设计和分析的课程和修补培训，2）ADRD临床护理和 护理，3）高级统计技术，4）定性方法和5）文化能力。确保 成功，她已经确定了这些学科的专家指导者的认可，并为此确保了受保护的时间 工作。该奖项解决了ADRD研究的重大临床困境和严重的差距 Rogus-Pulia博士领导独立吞咽困难研究计划至关重要的教育和心态。