Dr. Julie Regan

This PhD research focused on the clinical adaption of the Functional Lumen Imaging Probe to evaluate the upper oesophageal sphincter (UES) during swallowing. In intially, the safety and feasibility of probe positioning and dilation was investigated in healthy and clinical populations during videofluoroscopy. Secondly, UES compliance was piloted in healthy adults during ramp distensions using the EndoFLIP. This data collection took place with collaborators Prof. Nathalie Rommel and Prof. Jan Tack in KU University Hospital, Leuven, Belgium. This initial study informed the acquisition of normative data on UES distensibility and estimated UES diameter and intra-balloon pressure changes during swallowing events in a healthy adult cohort. Finally, distensibility of the pharyngo-oesophageal segment was evaluated in adults with laryngectomy in St. James' Hospital Dublin and differences between clinical and healthy profiles were calculated. Findings from these studies suggested that the functional lumen imaging probe has the potential to provide new insights into UES dynamics which could be of great value to clinical dysphagia practice.

Dysphagia (difficulty swallowing) is the most common presenting symptom of oesophageal cancer. It is multifactorial, initially caused by a narrowing of the gullet (oesophagus), preventing food and drinks from passing into the stomach. Following treatment with surgery, radiation therapy and chemotherapy, or various combinations of these modalities, swallowing problems often persist. Surgery for instance can lead to significant anatomical and physiological alterations (e.g., removal of part of the oesophagus) which impact on swallowing. Additionally, the recurrent laryngeal nerve can be damaged during oesophagectomy surgery which can further exacerbate swallowing. Consequently, dysphagia is a prominent issue for survivors of oesophageal cancer (Kaneoka et al, 2018). While compensatory treatments have been developed to relieve the symptoms of dysphagia in people with oesophageal cancer (e.g., stents, dilatation, laser therapy, photodynamic therapy, alcohol injection), no evidence-based rehabilitation programmes are in place within clinical practice to prevent, minimise or reverse the presence of a swallowing difficulty. This is a major service gap with dreadful ramifications both on the person and the healthcare service. There is clearly an unmet need for an evidence based treatment to optimise swallowing in this population. This PPA funded project is in collaboration with Prof. John Reynolds, Professor of Surgery and Consultant Surgeon in the National Oesophageal Cancer Centre in St. James' Hospital, Dublin. The aim of this pioneering research is to establish if a novel swallow prehabilitation programme can improve clinical and QOL measures in adults with oesophageal cancer. Initially, a feasibility study will be conducted in the National Oesophageal Cancer Centre in St. James' Hospital (SJH) to ensure the programme is safe and acceptable. Findings will inform a randomised control trial. Clinical and quality of life measures will be obtained from participants post-diagnosis. Participants will be randomised into treatment and control groups. Within the treatment group, participants will embark on a novel 12 week dysphagia intervention programme with weekly on-site meetings in SJH. Tests will be conducted before and after the dysphagia programme and six months post prehabilitation to determine change from clinical and quality of life perspectives.

Respiratory muscle strength training has been shown to improve aspiration status in adults with head and neck cancer. While respiratory muscle strength training is used to optimise respiratory reserve and prevent physical decline in adults with oesophageal cancer, its benefits have not been explored fro ma dysphagia perspective. This research aims to investigate the feasibility of expiratory muscle strength training at different time points throughout the oesophageal cancer treatment pathway and to determine the impact of this exercise-based rehabilitation on clinical and quality of life outcomes.

I am leading this research project which is in collaboration with the speech and language therapy department in Tallaght Hospital. Ethical approval has been obtained from the Joint (TUH/SJH) Research Ethics Committee. This project will initially investigate factors (mode of drinking, neuromuscular stimulation and saline intensity) on pharyngeal pressure and impedance recordings during swallowing using metrics recommended by the International Pharyngeal High Resolution Manometry working group. Data will be analysed using Swallowgateway, an online semi-automated analysis system. In the second stage of this research, the impact of sensory stimulation (cold, sour, carbonation) will be investigated in adults with Parkinson's Disease and Chronic Obstructive Pulmonary Disease (COPD). The impact and acceptability of sensory stimulation on pressure and impedance metrics will be determined and the role of genetic taste status in response to stimulation will be explored. Differences in response to sensory stimulation between neurogenic (i.e., Parkinson's disease) and non-neurogenic (COPD) cohorts will be examined.

This study aims to establish the clinical characteristics of dysphagia and communication difficulties amongst adults with COVID-19 admitted in hospital settings across Ireland. It also seeks to identify the factors associated with successful patient outcomes. Thirdly, it aims to establish the rehabilitation needs and services provided to this clinical population. Ethical approval was been obtained from the National Research Ethics Committee- COVID-19 (NREC) in June 2020. Speech and language therapy departments from 21 clinical sites across Ireland will provide data for analysis. Data collection will begin in June 2020. Study findings will advance our understanding of this distinct clinical cohort and tailor future service delivery to optimise patient outcomes.