Current Research Projects
Prevalence and Care Partner Burden of Swallowing Impairments in Alzheimer's Disease (Funded by an Alzheimer's Association New to Field Grant 5/2025-4/2028)
Changes to swallowing are known to occur with aging and may be exacerbated by clinical disease states. As the aging population in the United States grows, Alzheimer's Disease (AD) is one etiology of dysphagia that may intersect with changes due to natural aging. Dysphagia is highly prevalent in people with moderate-severe AD (84%) and is associated with morbidity, mortality, and reduced quality of life. Despite the known negative consequences of dysphagia in people with AD, few research studies have used instrumental imaging or validated rating scales to determine the true prevalence of dysphagia across disease severity in this patient population. Therefore, this cross-sectional cohort study will: 1) compare dysphagia prevalence in 80 people with AD to dysphagia prevalence in 80 age and sex-matched community-dwelling adults using flexible endoscopic evaluation of swallowing (FEES), 2) evaluate concordance and accuracy between patient and care partner-perceived swallow function and objective findings on FEES, and 3) examine dysphagia-related care partner burden and risk factors in 80 care partners of people with AD.
Impact of Preoperative Respiratory Strength Training on Postoperative Health Outcomes for Heart Transplant Candidates (Funded by an American Heart Association Career Development Award, 4/2024-3/2027)
Although heart transplantation (HT) is a life-saving intervention for individuals with end-stage heart failure, swallowing impairment (dysphagia) is a recognized postoperative complication occurring in 71% of HT recipients that is associated with morbidity, mortality, and reduced quality of life. Similarly, data from 182 cardiac surgical (CS) patients revealed swallowing safety impairments in 94% of individuals. Closer examination of this data revealed that aspirators with an effective cough had reduced rates of pneumonia, reintubation, and death compared to aspirators with an ineffective cough. This highlighted that having an effective cough response to tracheal aspirate may improve health outcomes in CS patients, illuminating that treatment focused on improving cough effectiveness may be beneficial. Respiratory strength training (RST) is an exercise-based treatment that has yielded improvements in respiratory capacity, cough effectiveness, and swallowing safety in dysphagic patient populations. Furthermore, pilot data from a prospective cohort study I conducted in 25 CS patients revealed that preoperative RST was safe, feasible, and improved respiratory physiologic capacity. The current study will advance prior research by conducting a randomized, sham-controlled trial in 90 HT recipients with the following specific aims: 1) Determine the impact of a preoperative RST program on pulmonary function, airway clearance, physiological functional reserve, and treatment burden in HT recipients; and 2) Identify the impact of a preoperative RST program on postoperative swallowing safety, physiology, and health outcomes in HT recipients. Maximum expiratory and inspiratory pressure (MEP, MIP) forced vital capacity (FVC), voluntary cough peak expiratory flow (PEF), cough spirometry, clinical frailty scale (CFS) scores, and exercise therapy burden (ETBQ) questionnaire scores will be obtained before and after the RST program. HT recipients will complete the swallowing and eating related fatigue (SERF) questionnaire and undergo standardized fiberoptic endoscopic evaluation of swallowing (FEES) before and after transplant. Trained raters will perform duplicate, blinded ratings of swallowing safety using the penetration-aspiration scale and swallowing physiology using validated FEES timing measures. Core health outcomes (time to oral diet, hospital length of stay, pneumonia, reintubation, 30-day readmission, 90-day mortality, discharge status) will be tracked via the electronic medical record (EMR). This study will provide insight into the efficacy of targeted, preventative treatments to improve postoperative outcomes in HT recipients and will also yield preliminary data regarding implementation of preoperative RST to support future large scale pragmatic clinical trials in HT recipients.
The Prevalence and Characteristics of Oropharyngeal Dysphagia in Critically ill Patients During the Acute and Post-Acute Recovery Phase
The negative sequelae of critical illness are well-known and consist of changes in physical, cognitive, and psychosocial health. Collectively, these changes are referred to as post intensive care syndrome (PICS). Dysphagia, or swallowing difficulty, may result from PICS. Therefore, we conducted a systematic review to examine the prevalence and characteristics of oropharyngeal dysphagia in critically ill adults (e.g., COVID-19, PICS, sepsis) during the acute and post-acute recovery phase. We further sought to understand risk factors for dysphagia development and to determine negative sequelae associated with dysphagia in critically ill adults.
Recently Completed Research Projects
American Speech-Language-Hearing Foundation Mentored Clinical Research Grant ($50,000)
Donohue (PI)
11/01/2021-10/31/2023
Safety, feasibility, and impact of preoperative respiratory strength training in cardiac surgical patients.
American Heart Association Postdoctoral Fellowship ($137,604)
Donohue (PI)
01/01/2022-12/31/2023
Improving postoperative extubation and health outcomes in cardiac surgical patients.