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: 10045900
• 负责人: Nicole M Rogus-Pulia
• 金额: $ 24.27万
• 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/10045900
• 关键词: Address; African American; 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; Effectiveness; 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; Preventive Intervention; 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 Groups; Universities; Viscosity; Wisconsin; Work; career development; caregiving; clinical care; cohort; common treatment; cultural competence; design; dysphagia rehabilitation; effective therapy; 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; 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.

项目总结/摘要 这个职业发展建议的目的是提供妮可Rogus-Pulia，博士，CCC-SLP，演讲- 威斯康星州大学的语言病理学家和吞咽困难（吞咽功能障碍）专家- 医学和公共卫生的麦迪逊学校与成功所需的培训作为一个独立的，临床医生- 研究干预措施以改善阿尔茨海默病患者吞咽困难护理的科学家， 相关痴呆症（ADRD）。ADRD患者经常出现吞咽困难，并导致严重的健康问题 后果，包括照顾者负担增加、营养不良、肺炎、生活质量下降，以及 mortality. ADRD患者吞咽困难的常见治疗采用代偿性方法， 推注流量以避免吸入（食物或液体进入气道）。这些方法不会导致 吞咽生理学的持续改善，并经常对生活质量产生负面影响。目前有 没有可实际应用或具有持久效果的ADRD患者吞咽困难的有效治疗方法 关于燕子的生理学Rogus-Pulia博士提出的研究目标是开发有效的 对有不良健康后果风险的ADRD患者进行吞咽困难康复干预。 渐进阻力舌加强和唾液替代品是两种干预措施，已被证明 在初步研究中，对老年人的吞咽功能产生积极影响。该提案将包括 一项小型的前瞻性随机临床试验，旨在确定两种新型干预措施对吞咽的影响- 轻中度ADRD患者的相关结局，并确定最有可能获益的患者亚组 这些干预措施。患者-护理人员配对将随机分配至舌强化、唾液替代品 使用，两者的结合，或者只是通常的护理。唾液和吞咽相关结局将在 基线和8周干预期后。作为第三个目标，对非裔美国人进行定性访谈， 将对ADRD患者及其护理人员进行分析，以探索研究方案的文化适应性，或 干预材料，以改善这一代表性不足的群体未来的试验参与。这些数据将 支持一项大型、多中心R 01资助的研究，以确定吞咽困难干预预防的有效性 不良健康结果的一个不同队列的ADRD患者。作为一个机构的初级教员 拥有广泛的基础设施，以支持早期阶段的研究人员，博士Rogus-Pulia是在一个理想的环境， 完成拟议的研究并接受高级培训。她的职业发展计划包括 课程和指导培训领域的1）临床试验设计和分析，2）ADRD临床护理和 3）先进的统计技术，4）定性方法，5）文化能力。确保 成功，她已经确定了这些学科的承诺，专家导师，并为此获得了保护时间 工作该奖项解决了ADRD研究中的重大临床困境和严重差距，同时提供了 教育和指导对于Rogus-Pulia博士领导独立的吞咽困难研究计划至关重要。