The recent spread of COVID-19 has led to an international pandemic, with >4 million confirmed cases to date worldwide, of which >1.3 million confirmed cases and >80,000 deaths have been reported in the USA. Infected individuals commonly experience severe respiratory difficulties and pneumonia, leading to hospital admission and the need for intensive care and mechanical ventilation. Emerging evidence suggests that impaired taste and smell may be early markers of the disease, and that in severe cases, there may be neurological damage in in the medulla, an important brainstem control site for both respiration and swallowing. Given the overlapping neuroanatomical regulation of breathing and swallowing, we hypothesize that dysphagia (swallowing impairment) will be common in People recovering from Severe COVID-19 (PrSC-19) and associated with poorer outcomes. Through this grant supplement, we propose to extend our existing work characterizing dysphagia profiles in different clinical populations to study dysphagia and its impact in PrSC- 19. To understand the prevalence and pathophysiology of dysphagia in PrSC-19, we will conduct detailed analyses of videofluoroscopies performed during the standard of care, post-discharge from intensive care to regular medical care units within the acute care setting. Given the current limitations in performing swallowing assessments for inpatients who test positive for COVID-19, we will also establish 3 regional research clinics that will offer comprehensive swallowing assessments to PrSC-19 after discharge from acute care to rehabilitation or the community. These assessments will include the collection of case history information, videofluoroscopy, use of a novel digital stethoscope to measure respiratory-swallow coordination, measures of other risk factors for dysphagia (e.g. bulbar muscle strength) and patient-reported outcomes. Detailed analyses of the videofluoroscopies will identify specific measures of swallowing that fall outside the range of normal variation based on comparison to healthy reference values established through our research program exploring swallowing physiology on liquids of different consistencies.
People recovering from severe COVID-19 infection (PrSC-19) are at very high risk for dysphagia (swallowing impairment), which represents a serious risk for complications, including pneumonia and hospital readmission. We propose to extend our existing work characterizing dysphagia in different clinical populations to study dysphagia and its impact in PrSC-19. Comprehensive swallowing assessments including videofluoroscopy and measures of respiratory-swallow coordination will be compared to reference data in healthy adults to establish an understanding of mechanisms of swallowing impairment in PrSC-19 and identify priorities for targeted swallowing intervention. Project Narrative Thickened liquids have become the most common intervention for dysphagia (swallowing impairment), yet we lack a clear understanding of how this intervention works to achieve clinical benefit. In this project, we will advance our understanding of how thickening influences swallowing by measuring the physiological flow of 5 incremental degrees of liquid thickening. These measures of physiological flow will take into consideration both the physical flow properties of these liquids and the forces applied during swallowing by healthy adults and individuals with swallowing impairment due to stroke, brain injury, oropharyngeal cancer, post cervical spine surgery and neurodegenerative disease.
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