Partnership helps fill void in treating voice, swallowing disorders

James Madison University and Rockingham Memorial Hospital have teamed up to offer dedicated state-of-the-art treatment services in Virginia for persons with voice, speech and swallowing disorders.

RMH Voice and Swallowing Services, a JMU-RMH Collaborative, offers assessment and treatment of voice and swallowing problems associated with reflux, stroke, neurological conditions, head injury, and head and neck cancer. Housed in the RMH outpatient facility, the joint initiative also includes clinical research into new treatment methods for voice and swallowing problems.

RMH Voice and Swallowing Services was established in late 2012 after more than three years of planning and began accepting patients in mid-January.

“We’re augmenting the [voice and swallowing] services available in Virginia significantly,” said Dr. Christy Ludlow, professor of communication sciences and disorders at JMU and co-director of RMH Voice and Swallowing Services. Previously, area residents with these disorders would have to travel to Washington D.C., or Johns Hopkins in Baltimore, Md., for treatment.

Before joining the faculty at JMU in the fall of 2010, Ludlow spent 35 years at the National Institutes of Health, where she helped pioneer many of the modern methods for treating voice and swallowing disorders. She currently directs JMU’s Neural Bases of Communication and Swallowing laboratory and is coordinator of the Ph.D. program within communication sciences and disorders.

The RMH Voice and Swallowing Services team also includes Dr. Cynthia O’Donoghue, professor and head of communication sciences and disorders, research associate Dr. Erin Kamarunas and JMU speech pathologist Teresa Drulia. Local otolaryngologist Dr. C. Wayne Gates, a member of the RMH medical staff since 1985, serves as the medical director. JMU communication sciences and disorders students are involved in the research program.

RMH Voice and Swallowing Services receives patients via physician referrals. Ludlow, O’Donoghue, Kamarunas and Drulia are licensed to provide assessment and treatment while RMH provides the clinical space and handles patient scheduling.

Although voice and swallowing problems can occur throughout the lifespan, the center focuses on the treatment of adult disorders, which range from hoarseness and chronic cough to more serious conditions such as vocal fold paralysis — which leaves sufferers short of breath — and difficulty speaking or swallowing from Parkinson’s disease or stroke.

As we age, Ludlow explains, we are more prone to these types of disorders due to muscle weakness in the larynx, overuse of the vocal folds in the voice box, injury to the head and neck, and certain neurological conditions. For seniors, in particular, these disorders can negatively affect quality of life. “If a person has trouble swallowing, they can’t go to lunch with people or eat with others — even their own family,” she said. “It really isolates the patient.” Similarly, persons with voice disorders tend to shy away from using the telephone or socializing with friends.

RMH Voice and Swallowing Services has the equipment to test sensory function of the larynx and to examine the vibrations of the vocal chords in slow motion to look for irregularities. Injections into the larynx can be used to help manage conditions such as voice tremors and spasmodic dysphonia, rare disorders that affect mostly middle-aged and older women.

The research component to RMH Voice and Swallowing Services is focused on how persons with neurological disorders can be retrained to enhance their own voice and swallowing functions. Upon request, these sessions can be conducted in the patient’s home.

“It’s a different model,” Ludlow said, “but an important one, I think, because the patient becomes the focal person in charge of their therapy. The speech pathologist trains them to become their own [case] manger and we use devices to help the patient do the retraining.”

With the help of a $50,000 grant from NIH, RMH Voice and Swallowing Services is currently recruiting volunteers to study the effects of an experimental treatment device from Passy-Muir designed to help patients regain normal swallowing following a stroke.

RMH Voice and Swallowing Services is also engaged in two studies related to voice and speech disorders stemming from Parkinson’s disease. The first is a collaborative study with Purdue University on the use of a wearable device to improve patients’ speech. The other involves evaluating differences in patients’ speech patterns in a clinical setting versus at home.

RMH Voice and Swallowing Services are currently available four afternoons per week. As demand for its services grows, the center will be able to accommodate 12-15 patients per day.

Ludlow said the goal in the short term is to introduce RMH Voice and Swallowing Services to the community. An information session on swallowing disorders was held June 12 at RMH. In the near future, Ludlow wants to continue to develop services and add new facilities and instrumentation. “We want to become a center of excellence,” she said. 

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By Jim Heffernan (’96), JMU Public Affairs