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Monday 9th December 2019 | Auckland

Anna Miles

Dr Anna Miles

University of Auckland

Swallowing research: improved assessment, treatment, and medical education in dysphagia

Dr Anna Miles is a speech-language therapist. Anna is a senior lecturer at The University of Auckland. She is a researcher, lecturer and clinician in the area of voice and swallowing disorders. Anna runs a hospital-based student teaching clinic as well as an outpatient voice and swallowing rehabilitation clinic. She is the New Zealand Speech-language Therapists’ Association Clinical Expert in Adult Dysphagia. Dr Anna Miles started her career London after studying at University College London in the 1990’s. Anna has been in New Zealand since 2000.

The Swallowing Research Laboratory in the Centre of Brain Research at The University of Auckland, led by Dr Miles, strives to improve the lives of people with swallowing difficulties through improved assessment, treatment and medical education. The laboratory hopes to reduce the risks of pneumonia and death associated with swallowing difficulties as well as improve the quality of life of suffers.

Motor Neurone Disease: the changing role of speech therapy

Background: Bulbar dysfunction is common in people with Motor Neurone Disease (MND) and leads to swallowing (dysphagia), cough (dystussia), voice (dysphonia) and speech (dysarthria) difficulties. Consequences are severe and include reduced psycho-social wellbeing and quality of life, choking, aspiration pneumonia and malnutrition.

Objective: This presentation aims to summarise our understanding of bulbar dysfunction in MND and report on current evidence and new directions in assessment and treatment.
Summary of presentation: The newly published ‘Best Practice Guidelines for the Evaluation of Bulbar Dysfunction in ALS’ provide clinicians with holistic standards for bulbar assessment. They promote routine completion of validated self-reported questionnaires, as well as, instrumental speech intelligibility, swallowing and cough assessments. They advocate for early augmentative alternative communication (ACC) assessment including voice and message banking.

Until the 2000’s, speech therapy treatment for MND primarily focused on diet modification, mealtime compensations, feeding tube recommendations and ACC interventions. Advances have occurred in our understanding of swallowing efficiency and swallowing safety in MND in recent years. We have published instrumental measures of lingual and pharyngeal dysfunction and pharyngo-laryngeal sensory deficits. The critical importance of cough efficiency in swallowing safety has been proven.

With these advances, researchers have been able to explore novel treatment approaches. Speech therapists now have promising evidence for the benefits of exercise in maintaining and prolonging swallowing and cough function. This presentation will describe the enhancements in our understanding of physiological change in MND and the promising effects of lingual resistance exercises and expiratory muscle strength training in MND.

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