JMU and RMH Collaborate to Launch Specialized Voice and

First of Its Kind in Virginia
JMU and RMH Collaborate to
Launch Specialized Voice and
Swallowing Service at RMH
By Neil Mowbray
R
MH and James Madison University have teamed up to
offer a specialized service at RMH to diagnose and u·eat
patients with voice and swallowing disorders due to injrny,
illness or disease process.
RMH Voice and Swallowing Services represents a major advance
in health care services in the community as well as the region, says
Kay Harrison, RMH vice president, Business Development.
Before this new service began, many people with voice and
swallowing issues had to travel out of state for diagnosis and
treatment. "RMH is unique in Virginia in offering this array of
treatments and services," Harrison notes. "Now people in our
community, around the state and even beyond who need this
specialized type of care can find it at RMH."
The service is located on the first floor of the RMH Outpatient
Center. The team saw its first patients in Decem bet; and in a few
short months has seen patients fi·om Vtrginia, West Vrrginia and
North Carolina.
RMH Voice and Swallowing Services is an outgrowth of the
]MU-RMH Collaborative. The Collaborative, in its sixth yeat;
su·ives to foster collaboration among RMH staff and JMU staff,
faculty and students that will benefit one or both institutions as well
as the community.
The Collaborative has fostered dozens of successful projects, says
Harrison, a charter member of the Collaborative Steering Team.
"It's exciting to see an idea evolve from concept to reality due to the
energy and enthusiasm of our two staffs," she says. "And the benefit
to our organizations, our community and our patients is beyond
measure."
A team of medical and academic professionals
provides care.
The JMU speech pathologists with the Service are faculty and
staff members who have many years of experience in providing
testing and diagnostic services, Harrison explains, wlllle RMH
offers a convenient, comfortable clinical setting for care.
Voice and Swallowing Services offers state-of-the-art testing and
n·eaunent for patients with voice, speech, swallowing and vocal fold
movement disorders secondary to a variety of conditions. Those
conditions include, but are not limited to, sn·oke, Parkinson's
disease, head injury, head and neck cancet; paradoxical vocal fold
movement disorders affecting breathing, and other neurological
problems, explains Christy Ludlow, PhD, aJMU professor of
speech pathology and co-director of the service at RMH. Dr.
Ludlow joined the JMU Deparunent of Communication Sciences
and Disorders in 2009.
Dr. Ludlow is a pioneer in the development of modern
technology for the assessment of voice and swallowing disorders.
Before joining JMU, she headed an internationally recognized
laboratory at the National Institutes of Health for many years.
That lab developed many of the new methods for treating voice
and swallowing disorders (dysphagia) that are in use today or will
become available in the near future.
"Currently, only about a dozen of these specialized voice and
swallowing services exist in the United States, and this is the first
one in the state ofVrrginia," she notes. "In the last drree years,
before this service was up and running, I referred a lot of patients to
Johns Hopkins University in Baltimore, or to George Washington
in \Vashington, D.C. We hope this new service will become a
center for referral of many people in the region."
The Voice and Swallowing Services team includes co-director
andJMU professor Cyntllia O'Donoghue, PhD, who also serves
as head of the JMU Department of Communication Sciences and
Disorders. Dr. O'Donoghue teaches graduate courses and conducts
research in adult neurogenic communication disorders and
dysphagia. She presents nationally and internationally in her areas
of expertise. Notable contributions include serving as legislative
representative from the Commonwealth ofVirginia to the
American Speech-Language-Hearing Association (ASHA); Board
ofTrustees President for Crossroads to Brain Injury Recovety, Inc.;
and chair of the Nominations and Elections Committee, Virginia
Brain Injury Council.
Dr. O'Donoghue authored tl1e "Dysphagia Best Practice
Guidelines" for the Vrrginia Deparunent of Education and served
on the ASHA Task Force that developed "Guidelines for SpeechLanguage Pathologists Providing Feeding and Swallowing Services
in Schools." She is currently grant-funded drrough Commonwealth
Neurotrauma Initiative Trust Fund.
The research program of the new Service is under the direction
of Dr. Ludlow and is developing new treatments for helping
patients witl1 voice and swallmving problems drrough research
grants from the National Institutes ofHealtl1. Currently, Erin
Kamarunas, PhD, a research associate atJMU, is conducting
research with patients with swallowing problems, and Carrie Jones,
M. Ed, is conducting research on voice problems in persons with
Parkinson's disease.
Harrisonburg otolaryngologist (ear, nose and throat specialist)
C. Wayne Gates, MD, is medical director of the Service. Dr. Gates
graduated frorri Louisiana State University School of Medicine.
He completed his internship at the U.S. Public Health Service
Hospital and his surgical residency at Tulane University, followed
by an otolaryngology residency at LSU in New Orleans. He
joined the RMH Medical Staff in 1985 and is board certified in
Otolatyngology/Head and Neck Surgery. Over the years he has
served RMH on many committees, including the RMH Board of
Directors. Dr. Gates has also served the state as president of the
Virglilia Society of Otolaryngology. He is in private practice at
Meadowcrest ENT & Facial Cosmetic Center in H arrisonburg.
"This is a rare opportunity to provide the most progressive
and advanced techniques to patients with voice and swallowing
disorders," says Dr. Gates. "The staff fromJMU are exceptional,
and I am honored to be part of tlusJMU-RMH collaboration."
1l1e reason these specialized services are so rare is that they
require a combination of otolaryngologists and speech pathologists
who are interested in voice and swallowing, along with state-of-theart instrumentation, Dr. Ludlow explains.
"As otolmyngology has been encompassing both voice and
swallowing disorders in recent years, and as speech pathology has
become more adept in not only assessing, but also treating voice
and swallowing disorders, collaboration between the two fields has
made these specialized services possible," she says. "This service
is really providing a nice collaboration not only between RMH
and JMU, but also between otolatyngology and speech pathology.
We're working together in seeing patients rather tlu.n seeing tl1em
independently, and that parmership is a real benefit for patients.
They go see one team, rather than going place to place."
Research is an important component ofVoice
and Swallowing Services.
\Vhen she moved to Virginia, Dr. Ludlow brought with her
all of the specialized equipment she used at NIH. H er research
laboratory atJMU is filled with the tools of her trade, as are
the drree clinical rooms at RMH where she and her colleagues
see patients. The instrun1ents are state-of-the-art and provide
diagnostic capabilities that are not otherwise available in this area,
Dr. Ludlow notes.
She and the Voice and Swallowing Services team conduct
ongoing research atJMU and RMH. Dr. Kamarunas is conducting
J\TIH-funded research on a medical device to help people who have
a swallowing disorder following stroke. People wear the device,
called a Passy Muir Swallowing Self-Tester, or SST, on their neck to
provide sensory stimulation to the tissues and nerves that can help
them swallow.
"We're evaluating the device to see how it helps patients swallow,
how patients like it, how they may possibly want it modified, and also
eventually to see if they could use it at home to retrain themselves,
rather than coilling in regularly for therapy," Dt: Kamarunas says.
"We're vety much interested in going out into tl1e community to work
with people who have swallowing problems as a result of stroke."
Spring2013
27
EVEN
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May 9, 23, June 13, 27. July 11, 25-East Rockingharn
May 10, June 24-Timberville Drug Store
May 13, June 18-VMRC parking lot in front of Park Gables
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This combined clinical and research focus creates an ideal
enviromnent for training future clinicians and researchers.
Dt: Ludlow, who also heads the PhD program in speech
conummication sciences and disorders atJMU, says she and Dr.
O'Donoghue have plans to invite their doctoral students to assist in
diagnosing and treating Voice and Swallowing Services patients.
One of the voice disorders Dr. Ludlow investigated at the
Nlli was spasmodic dysphonia, a condition that typically starts
in middle-aged women and is characterized by periods of vocal
spasms, hoarseness and tighmess in the throat. Treatment for
spasmodic dysphonia is botulinum toxin (BOTOX®) injections
into the vocal folds, a service that Dt: Gates provides, using
electromyography, a method of testing the electrical signals of
muscles and nerves to determine their health.
"These vocal fold injections are not available in many places, so
this will be a big help to those patients who require it," Dr. Ludlow
says.
Once diagnosed, many voice and swallowing
disorders are highly treatable.
Voice disorders can occur for m any reasons, D1: Ludlow says.
These include viral injuries to the nerves controlling the larynx, or
voice box, or abnormal growths like nodules or polyps that develop
on the vocal folds, the parts of the larynx that vibrate to produce
sound.
"Nodules can develop when patients don't use their voice
correctly, as when they shout too much," Dr. Ludlow explains.
"Therapy can often help reduce these growtl1s by relieving tl1e
tension in the vocal folds so tlut the nodules are reduced, without
surgery."
Cancer of the larytu may also account for certain voice problems,
and any patient with hoarseness of unknown origin lasting for more
than two weeks should be seen by an otolaryngologist, she advises.
"That's one of tl1e advantages of having Dr. Gates as our
medical directot~" Dr. Ludlow continues. "We always want the
otolaryngologist to look at the lary:tu first to make sure there isn't
cancer or some otl1er serious medical condition."
The sources of swallowing disorders are equally varied and
include neurological disorders like Parkinson's disease and stroke, as
well as more conunon conditions like GERD, or gastroesophageal
reflux disease.
GERD is a frequent cause of botl1 voice and swallowing
disorders, notes Teresa Drulia, MS, a JMU specialist in swallowing
disorders who sees patients in the Service. As acid flows (refluxes)
from tl1e stomach into the esophagus, it can cause typical sy:tnptoms
of heartburn and chest discomfort. But tl1e acid also can damage
the larytu, affecting the voice, or cause sensmy changes that make
swallowing difficult.
Even simple aging can contribute to swallowing difficulties. It's
estimated tl1at at least 60 percent of older adults have swallowing
problems.
"As we get older, muscles tend to get weaker," Dr. Ludlow says,
"and the swallowing system may not work as quickly or smootl1ly
as it used to. We evaluate what's safe for people and what's not safe,
and tl1en we have them do exercises that reu-ain them to swallow."
Dr. Ludlow emphasizes that tl1e1-apy for voice and swallowing
disorders can be vety effective in the majority of cases-but not
every case.
"Take swallowing, for example. There's a lot we can do today
to treat tl1ose problems," she says. "In the past, we had to rely on
simple measures like changing a person's diet. But now we reu-ain
people on how to swallow, which is vety important. We're actually
rehabilitating the swallowing system rather than just training people
in ways to get around it."
Patients to be seen by the service will include patients referred
by their physicians as well as patients referred for research purposes
tlu·oughJMU.
"For our research we are interested in seeing persons who need
additional help for voice and swallowing disorders after they receive
speech or swallowing thet-apy," says Dt: Ludlow.
Physicians may refer their patients to Voice and Swallowing
Services at RMH by calling the RMH Central Scheduling
deparonent at 540-689-6000. Most insm-ance providers do cover
these services, but patients will need to check and confirm witl1
their individual insm-ance providers. •
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June 1"1-Bridgewater Retirement; van parked off the Cherry Lot
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July 1-New Market Community Center
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