Joanne Robbins, Ph.D.

Med Sc, Gastroent
Box 5124, Clinical Science Center-E6
Madison WI 53706
608-262-7000
jrobbin2@wisc.edu

Emphasis Group:
Human Nutrition

Principal Research Interest:
The Nature, Diagnosis, Treatment and Prevention of Senescent Swallowing (Dysphagia)

Research Summary:
Difficulty swallowing (dysphagia) affects approximately 18,000,000 adults in the U.S. Dysphagia has been associated with specific diseases of aging, most commonly stroke, although we have found that disease-free aging can also affect swallowing. In the University of Wisconsin/VA Swallowing Laboratory, the age-related changes being documented and their impact on the flow of food through the gastrointestinal system explain, at least in part, the life-threatening pneumonia, malnutrition, dehydration and reduced quality of life so frequently found in older individuals.

Another major focus is to improve diagnostic methods of radiographic imaging using a swallowed radiopaque barium bolus. We have been custom-designing barium with specific properties of viscosity, adhesiveness and taste in order to maximize diagnostic and treatment information derived from the routine clinical examination. We have patented our technology, and an industry partner is manufacturing the new bariums. Our materials are becoming the clinical and research standard.

I am also conducting two federally funded, multi-site clinical trials that focus on treatment of dysphagia. The trial, funded by the National Institutes of Health, is investigating the effect of a simple chin tuck or thickened liquids on the incidence of liquid aspiration pneumonia in patients with dementia, with or without Parkinson's disease. The other clinical trial, funded by the Department of Veterans Affairs, is evaluating the effect of lingual exercise on aspiration, pneumonia, tongue strength, muscle mass, swallowing physiology, swallowing-specific quality of life and diet in frail elderly patients with dysphagia.

Finally, we are studying esophageal physiology and its effect on bolus flow during swallowing. We hypothesize that clinicians may be confusing gastroesophageal reflux (GER) with intra-esophageal reflux (IER) and intra-esophageal stasis (IES). Unlike GER, with IER food may remain in the esophagus and back up into the throat where it can be inhaled by the lungs and cause respiratory illness, particularly in many older adults. Treatment implications are tremendous and could potentially diminish pneumonia, the third leading cause of death in the geriatric population.

Representative Publications:

Nicosia MA, Robbins J. The usefulness of the line spread test as a measure of liquid consistency. Dysphagia. 2007 Oct;22(4):306-11.

Humbert IA, Robbins J. Normal swallowing and functional magnetic resonance imaging: a systematic review. Dysphagia. 2007 Jul;22(3):266-75.

Robbins J, Kays SA, Gangnon RE, Hind JA, Hewitt AL, Gentry LR, Taylor AJ. The effects of lingual exercise in stroke patients with dysphagia. Arch Phys Med Rehabil. 2007 Feb;88(2):150-8.

Kays S, Robbins J. Effects of sensorimotor exercise on swallowing outcomes relative to age and age related disease. Semin Speech Lang. 2006 Nov;27(4):245-59.