Diagnostic Capabilities of Ultrasound on the Oropharynx and Larynx
A Rigid Body Database on Human Movement
Ultrasound and Videofluoroscopic Imaging in Oral-Pharyngeal Dysphagia in Neurologically Impaired Subjects
Development of Normative Ultrasound Databases of Tongue Surface Configuration
Oxygen Uptake Kinetics During Recovery from Maximal and Submaximal Exercise
Linking Occupational Therapy Process and Patient Performance: The Personal Computer in Occupational Interventions
Rehabilitation Medicine Department Screening Protocol
Coping Responses of Patients with Chronic Disease
INTRAMURAL
RESEARCH PROJECT
Z01 CL-60011-21 RM
October 1, 1999 to September 30, 2000
Title of Project:
Diagnostic Capabilities of Ultrasound on the Oropharynx and Larynx
Principal Investigator:
B.C. Sonies, Ph.D. (Senior Investigator)
RM, CC, NIH
Bethesda, MD 20892
Other Personnel:
L.H. Gerber, M.D., RM
C.V. Waes, M.D., NIDCD
G.C. Fishman, Ph.D., RM
J. Miller, Ph.D., IRTA, NICHD
Collaborating Units:
NINDS
NIDCD
NCI
MED Diet (Plymouth, MN: Don Tymchuck)
Staff-Years:
0.66
Human Subjects:
x (a) Human subjects (b) Human tissues (c) Neither
(a1) Minors (a2) Interviews
Summary of Work: The purpose of this project is to evaluate and develop a variety of clinical applications for noninvasive ultrasound imaging to the diagnosis and treatment of impaired swallowing and speech and to evaluate the oropharyngeal structures (tongue, palate, floor muscles, hyoid, larynx, pharynx) in both normal and abnormal populations.
This past year we have successfully developed a new three-dimensional ultrasound system for imaging the oropharynx. This system allows us to systematically track head and neck tumor growth, inflammatory changes in oral tissues, and soft tissue changes in the oropharynx resulting from concurrent radiation therapy, chemotherapy and surgery in patients with advanced head and neck tumors. We are collaborating with NIDCD and NCI in this application. We have collected long-term recovery (24 to 30 months) and morbidity data on our original 23 subjects and an additional 11 patients with head and neck tumors. The natural evolution of swallowing function and course of recovery of oral motor function and return of eating behaviors is now under study. An outcome's matrix is being used to chart dependence/independence during eating, swallowing function and oral safety.
Analysis of the effects of viscosity and volume on hyoid motion in 31 normals revealed that there were significant effects of the thickness of the bolus on hyoid motion. Age and gender differences were also found during swallowing that suggest anatomical variations, sensory acuity and muscle force changes occur with normal aging that can effect swallowing kinematics.
INTRAMURAL
RESEARCH PROJECT
Z01 CL-60017-10 RM
October 1, 1999 to September 30, 2000
Title of Project:
A Rigid Body Database on Human Movement
Principal Investigator:
S.J. Stanhope, Ph.D. (Senior Investigator)
RM, CC, NIH
Bethesda, MD 20892
Other Personnel:
K.L. Siegel, M.A., P.T., RM
T. M. Kepple, M.A., RM
L. H. Gerber, M.D., RM
Collaborating Unit:
None
Staff-Years:
0.25
Human Subjects:
x (a) Human subjects (b) Human tissues (c) Neither
(a1) Minors (a2) Interviews
Summary of Work: The ability to accurately predict the effects of disease and treatment on an individual's ability to function relies entirely on our capacity to understand the complex process that transforms muscular effort into functional movements. The purpose of this project was to extend existing human movement analysis methodology by developing analytical techniques that can provide direct estimates of the influence muscular effort has on the movement of all joints, body segments, and overall functional movement task performance. A previous application of one technique to data from a group of normal walkers clearly indicated the muscles that cross the ankle joint are the primary contributors to normal walking performance. Clinical case studies involving patients with physical impairments continue to reveal a vast array of compensatory movement control strategies. The analytical techniques being developed under this protocol add significantly to the foundation of our ability to ultimately understand the influence of disease on function and to predict the on set of physical disability.
INTRAMURAL
RESEARCH PROJECT
Z01 CL-60042-13 RM
October 1, 1999 to September 30, 2000
Title of Project:
Ultrasound and Videofluoroscopic Imaging in Oral-Pharyngeal Dysphagia in Neurologically
Impaired Subjects
Principal Investigator:
B.C. Sonies, Ph.D. (Senior Investigator)
RM, CC, NIH
Bethesda, MD 20892
Other Personnel:
M. Dalakas, M.D., NINDS
M. Hallett, M.D., NINDS
G.C. Fishman, Ph.D., RM
B. Solomon, M.S., RM
C. Frattali, Ph.D., RM
Collaborating Unit:
NINDS
Staff-Years:
0.8
Human Subjects:
x (a) Human subjects (b) Human tissues (c) Neither
(a1) Minors (a2) Interviews
Summary of Work: We are currently analyzing the swallowing data from a group of patients with progressive supranuclear palsy who were given denepezil to control neurological symptoms. We designed a study using both ultrasound and videofluorography to examine drug effects on swallowing. Patients were seen for baseline and three followup evaluations where ultrasound and videofluorographic swallowing studies were administered along with complete oral motor function examinations. Data on swallowing performance on patients with corticobasal degeneration and apraxia of swallowing are still being analyzed.
We completed a study to determine the kinematic strategies that are used during randomized discrete and sequential swallows on 30 subjects age 20 to 79 years. Significant differences were revealed for these two tasks relative to age, gender and movement of the hyoid bone in support of a theory of motor performance that suggests that the deglutitive motor system is more flexible than previously known.
INTRAMURAL
RESEARCH PROJECT
Z01 CL-60043-13 RM
October 1, 1999 to September 30, 2000
Title of Project:
Development of Normative Ultrasound Databases of Tongue Surface Configuration
Principal Investigator:
B.C. Sonies, Ph.D. (Senior Investigator)
RM, CC, NIH
Bethesda, MD 20892
Other Personnel:
G.C. Fishman, Ph.D., RM
J. Miller, Ph.D., IRTA, NICHD
Collaborating Unit:
CIT (K. Kempner, M.D.; W. Gandler, M.D.)
Staff-Years:
0.5
Human Subjects:
x (a) Human subjects (b) Human tissues (c) Neither
(a1) Minors (a2) Interviews
Summary of Work: During this past year our three-dimensional (3D) ultrasound imaging system was completed. This system now contains all of the capabilities necessary to acquire images, to measure volume, to segment out specific muscle groups, to post process data and to create surface-rendered images while obtaining dynamic in vivo views of the oral soft tissues.
The 3D organization of the soft tissues of the tongue and floor of the mouth, larynx, and facial muscles are being studied. Segmentation and contouring of intrinsic and extrinsic muscle regions is now possible and will be applied to a variety of swallowing tasks to aid us in creating a biomechanical model of lingual function.
INTRAMURAL
RESEARCH PROJECT
Z01 CL-60050-04 RM
October 1, 1999 to September 30, 2000
Title of Project:
Oxygen Uptake Kinetics During Recovery from Maximal and Submaximal Exercise
Principal Investigator:
B. Drinkard, M.S., P.T. (Investigator)
RM, CC, NIH
Bethesda, MD 20892
Other Personnel:
S. Stanhope, Ph.D., RM
J. Shah, M.D., RM
Collaborating Unit:
Kansas State Univ. (T. Barstow, Ph.D.)
Staff-Years:
0.1
Human Subjects:
x (a) Human subjects (b) Human tissues (c) Neither
(a1) Minors (a2) Interviews
Summary of Work: We have completed all data collection for this study without complications. Data analysis is on going. We have ensemble averaged multiple exercise trials for each subject and are presently optimizing the mathematical model used to describe the data. The results of this study are expected to improve our understanding of the effect of exercise intensity on dynamic changes in oxygen uptake during exercise recovery.
INTRAMURAL
RESEARCH PROJECT
Z01 CL-60051-04 RM
October 1, 1999 to September 30, 2000
Title of Project:
Linking Occupational Therapy Process and Patient Performance: The Personal Computer
in Occupational Interventions
Principal Investigator:
S. Robertson, M.S., OTR/L, FAOTA (Senior Investigator)
RM, CC, NIH
Bethesda, MD 20892
Other Personnel:
A.P. Colborn, Ed.D., OTR/L, FAOTA, Research Consultant, RM
Collaborating Units:
NIMH National Rehabilitation Hosp. (Washington, DC; S. Smith)
Staff-Years:
0.1
Human Subjects:
x (a) Human subjects (b) Human tissues (c) Neither
(a1) Minors (a2) Interviews
Summary of Work: The Occupational Therapy Section has completed a study of occupational therapy process in routine treatment sessions. The purpose of the study was to devise a way to examine process and outcome links in a treatment session. Future plans are to link session outcomes to the overall effect of a treatment program.
Twenty patients (ten male, ten female) with a variety of diagnoses (mental illness 35 percent, neurological 25 percent, cancer 20 percent, musculoskeletal 10 percent, and spinal cord injury 10 percent) have participated in the study. Examination of 60 interviews of patients at NIH and National Rehabilitation Hospital revealed four occupational therapy process variables: occupational form and performance, goals, and reflection. These process variables showed a clear distinction between description (of treatment goals, task, environment, and performance) and analysis, in the form of reflection, during review of experiential learning using typical therapeutic occupations.
Descriptive statistics showed that reflection was most frequently cited by patient (48 percent) and therapist (37 to 40 percent) in each of three post-session interviews of patient by treating therapist. Three types of reflection were revealed: Content reflection (analysis of occupational form), process reflection (analysis of occupational performance), and premise reflection (analysis of self-management).
Further, Spearman Correlation Coefficients found a significant negative correlation between patient performance and reflection for both patient and therapist in all three sessions. Description and analysis are related but separate process variables. Patterns of process in a treatment session are worthy of further examination
A followup study to compare two interview formats to assess the nature and proportion of reflection in post-session interviews continues.
INTRAMURAL
RESEARCH PROJECT
Z01 CL-60052-03 RM
October 1, 1999 to September 30, 2000
Title of Project:
Rehabilitation Medicine Department Screening Protocol
Principal Investigator:
L.H. Gerber, M.D. (Senior Investigator)
RM, CC, NIH
Bethesda, MD 20892
Other Personnel:
None
Collaborating Unit:
None
Staff-Years:
0.3
Human Subjects:
x (a) Human subjects (b) Human tissues (c) Neither
x (a1) Minors (a2) Interviews
Summary of Work: The primary function of the Rehabilitation Medicine Department (RMD) is to diagnose and treat patients who have a dysfunction in locomotion, activities of daily living, occupational or avocational roles, communication, deglutition or chronic pain. The major goal of the department is to help patients achieve maximal function so that they may resume optimal performance in their daily living activities. The screening protocol provides clinicians in the RMD a vehicle for developing and piloting new tests, techniques, technology, or equipment for evaluation and treatment of patients and or subjects.
INTRAMURAL
RESEARCH PROJECT
Z01 CL-60053-01 RM
October 1, 1999 to September 30, 2000
Title of Project:
Coping Responses of Patients with Chronic Disease
Principal Investigator:
M. Mattiko, M.Ed., RT (Investigator)
RM, CC, NIH
Bethesda, MD 20892
Other Personnel:
S. Ballard, M.Ed., CTRS, RM
M. Duquette, M.S., CTRS, RM
J. Ganz, M.S., CTRS, RM
R. Hunt, M.B.A., CTRS, RM
G. Patrick, Ph.D., CTRS, RM
R. Stubbs, Ph.D., CTRS, RM
Collaborating Unit:
None
Staff-Years:
0.4
Human Subjects:
x (a) Human subjects (b) Human tissues (c) Neither
(a1) Minors (a2) Interviews
Summary of Work: The assumption of this descriptive biopsychosocial research project assumes that having chronic disease and being hospitalized is stressful. The coping protocol is attempting to determine the outcome of this stressful event by mapping the coping responses of patients with chronic disease. The correlation between symptom intensity, mood state and coping response are being formally measured. The assumption here is that the intensity of symptoms patients experience affects mood. Our overall affective state, mood, affects if not determines our reaction, coping response. Therefore, by correlating symptom intensity with mood and coping response the study hopes to elucidate how patients effectively handle the stress of chronic illness.
Secondary hypothesis is looking at whether patients in different diagnostic categories cope differently from other diagnostic clusters. For example, do patients with mental health diagnosis cope differently than those patients with medical surgical diagnosis? Do patients within the same diagnostic category cope differently at different stages of the disease (i.e., arthritis)? Finally, several groups are being studied longitudinally; alcoholic: type 1 and type 2; bipolar: type 1 and type 2 and bone marrow transplantation. Patients receiving solid organ transplants have been added. Patients will receive a CRI at screening, 1-week post transplant and at 6-month follow up.
This protocol was officially terminated on May 30, 2000. Protocol 96-CC-0047 accrued 506 of its allotted 540 subjects.
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Annual Report of Clinical Research Activities FY 2000
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