Quite an award to swallow
A leading New Zealand communication disorders researcher has been recognised by the University of Canterbury for her work aimed at improving the health of stroke patients and making financial savings for the health care sector.
UC’s Associate Professor Maggie-Lee Huckabee (Communication Disorders) is a world leader in cough-reflex research and, in recognition of her ground-breaking work, has been awarded UC’s Innovation Medal for 2014.
The Innovation Medal is awarded by the University Council for excellence in transforming knowledge or ideas so they are adopted by the wider community in ways that contribute beneficial value.
“It is an honour to receive this award but I see it not so much as an award for me, but for me and all the clinicians and hospitals who I have worked with, including postgraduate students. The research programme was a group effort,” says Huckabee.
The aim of Huckabee’s research is to help prevent pneumonia in post-stroke and post-surgical patients caused by dysphagia, or swallowing impairment. Her work has led to clinicians across New Zealand changing care protocols.
“If you or I have food that goes down the wrong way — towards the lungs — we produce a strong reflexive cough to protect our airways. This is what keeps us from getting pneumonia. In some patients with swallowing impairment, sensation in the throat is reduced so food can go into the lungs but not produce a protective cough. In this case, the food in the lungs is not cleared and causes an infection, called aspiration pneumonia.
“We used a test known as the ‘cough reflex test’, which very directly irritates the chemo receptors that sit on the vocal folds and produces a very unpleasant, profound cough response. It is a very short test but allows us to directly test the sensory nerve that controls cough and the response to cough.
“We decided to apply this test to our clinical population. We recruited the district health boards across New Zealand and started a clinical trial,” she says.
The original clinical trial began in 2010. It ran for one-and-a-half years and involved a sample of 312 acute stroke patients. The trial found that there were high rates of pneumonia among these patients, and although responses to the cough test predicted risk of pneumonia well, patients continued to get sick. Subsequently, the Dysphagia in Stroke Protocol was developed in response to the outcomes of the first clinical trial as a joint effort between the Canterbury District Health Board (CDHB) and Huckabee’s research team. It gives clinicians clear guidance on how to interpret the cough reflex test and what decisions to make for clinical management. Early research after implementation of the protocol has revealed a significant reduction rate in pneumonia.
In the CDHB catchment alone, the rate of pneumonia for patients who struggled with swallowing following a stoke dropped from 26 percent to 11 percent in a three year period following the implementation of Huckabee’s research results.
Another clinical trial is currently being conducted with the help of the CDHB to further evaluate this clinical protocol.
The research also resulted in potential cost savings to the national health system of about $1.4 million. The trial has not only improved patient outcomes and reduced health costs, but has facilitated a culture of research and innovation for frontline clinicians, which is a key priority for the New Zealand Health Research Council.
Huckabee has been at the forefront of setting up the University of Canterbury Rose Centre for Stroke Recovery and Research at St George’s Medical Centre*. The centre is a new state-ofthe- art facility, made possible by the generosity of Shirley Rose, who spent many of her final years tending to the needs of her husband who was affected by a stroke. The centre builds on the successes of the current Swallowing Rehabilitation Research Laboratory.
The recovery of swallowing in patients is complex, but Huckabee says that several approaches can be taken to rehabilitate patients.
“Many of the traditional approaches focus on muscle strengthening. Just as you would strengthen limb muscles in physiotherapy, we target the muscles of swallowing in swallowing therapy. We use various types of biofeedback instruments to help patients monitor, online, how they are swallowing so they can adapt movement patterns for more efficient and safe swallowing. It is all about improving skill and efficiency.
“Neuromodulatory techniques, involving direct manipulation of neural structures, are emerging into research and clinical practice and we are very interested in the development of biomedical technologies that can be used as biofeedback modalities for retraining swallowing. A key component of biomedical technology research in our lab is the development of biofeedback modalities that allow patients in some way to visualise and therefore adapt swallowing in a physiologically meaningful way for recovery.”
Before taking up a position at UC, Huckabee worked as a clinician in acute care and rehabilitation, addressing swallowing disorders.
“I love my academic career, but my biggest achievement isn’t the research I do — it is those individuals that either directly or indirectly benefit from the research. My biggest priority is the patient who isn’t even in the academic institution. We are making improvements for them.
“Behind the patients are the students that work with me and go on to do wonderful things. I am very proud of them too.”