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| The Swallowing Centre |
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Patient Population
The Swallowing Centre, established in 1988, was designed to provide
a multi-disiplinary approach to the assessment, diagnosis, and management
of persons with swallowing disorders, with a major academic research
component.
The Centre involves the disciplines of speech-language pathology, gastroenterology,
and nutrition, but also requires constant collaboration within other professional
disciplines such as otolaryngology, neurology, respirology and radiology.
In 1998, Speech Language Pathology serviced 1,344 consultations, with
87 per cent involving a significant swallowing component. Following initial
clinical assessment, approximately 25 per cent require the use of a special
videofluoroscopic swallow study which is conducted jointly by a speech-language
pathologist and radiologist. To date, the speech-language pathologists
at TWH have conducted more than 3,700 procedures in their evaluation and
management of swallowing-disordered patients.
In addition to the inpatient program, the Swallowing Centre has developed
an ambulatory Swallowing Clinic which is dedicated to the evaluation,
treatment and study of a variety of swallowing disorders. About 24 patients
are seen in the Swallowing Clinic per month by Speech-Language Pathology,
an increase of 142% since 1996.
Education
Members of the swallowing team are active in education of medical and
allied health professionals in their own and other disciplines.
Research
Program research has both clinical and basic components and is directed
to both the esophageal and oropharyngeal stages of swallowing.
Research projects include:
- electrical and mechanical activity to differentiate between esophageal
and gastric components;
- localization of esophageal afferent and efferent neurons;
- brainstem electrical recording to establish central mechanisms
for control of esophageal peristalsis;
- assessment of esophageal tone;
- regional and myogenic differences smooth muscle esophagus
with particular attention to oscillator properties, ion
channels, SNARE proteins and constitutive
nitric oxide synthesis;
- investigation and treatment of adverse effects associated
with administration of extracellular hemoglobin (supported
by Hemosol Inc);
- assessment of the esophageal interstitial cells of
Cajal by morphology and tracing techniques
- MRI assessment of swallowing in normals and stroke
patients effect of pharyngeal stimulation on recovery
of dysphagia
in stroke patients
establishing a data base of incidence and course
of dysphagia in stroke patients
- computer programs for analysis and modeling of
gut electrical activity
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