Not just a reflex: Swallowing is complicated, but this researcher is making it easier

Note to Journalists: A photograph of Georgia Malandraki, as well as b-roll and a video produced for social media that shows the differences in swallowing, are available for journalists to use via a Google Drive at https://purdue.university/2PUEBJt. Soundbites from the professor also are available in this folder.

WEST LAFAYETTE, Ind. — People swallow hundreds of times a day – often without realizing they’re doing it. But for some people, being able to safely swallow means the difference between life and death.

Georgia Malandraki, associate professor of speech, language, and hearing sciences at Purdue University, is uncovering the relationship between the brain and swallowing to develop treatments for children and adults who have difficulty swallowing. This condition, also known as dysphagia, affects 10 million adults and more than a half million children in the United States every year.

“What most people don’t know is that the prevalence of swallowing disorders is very high. Swallowing disorders probably affected someone in your life at some point,” said Malandraki, the research director of Purdue’s I-EaT Swallowing Research Laboratory and Clinic in Purdue’s College of Health and Human Sciences. “What we often say is that these are not visible disorders. Someone with a swallowing disorder might be speaking and walking fine but could have a tube in their stomach just to help them nourish themselves and survive, and you would never know. “

Malandraki is a neurophysiologist, a certified speech-language pathologist and a board-certified specialist in swallowing and swallowing disorders.

Swallowing disorders can affect anyone and this video shows the difference between normal and abnormal. But children, including infants, especially those born prematurely, and older adults with age-related disorders such as Parkinson’s disease, are the most susceptible, Malandraki said. Swallowing disorders also are common in patients affected by stroke, cerebral palsy, traumatic brain injuries and head and neck cancer.

Malandraki’s lab includes MRI/fMRI analysis equipment, electromyographic and respiratory recording and analysis equipment, and multiple swallowing diagnostic and intervention tools. These tools are used to answer questions about how swallowing is controlled by our muscles and brain. The lab works in conjunction with the Purdue I-EaT Swallowing Research Clinic, one of the first dedicated fully-equipped university-based dysphagia clinics in the country. Malandraki also is working on developing telehealth and wearable technologies to improve access of care for patients with swallowing disorders. Telehealth is the distribution of health care services and information through electronic and telecommunication technologies. It allows long-distance patient and clinician care, contact and education.

malandraki-swallowingGeorgia Malandraki, associate professor of speech, language, and hearing sciences at Purdue University, is uncovering the relationship between the brain and swallowing to develop treatments for children and adults who have difficulty swallowing. (Rebecca McElhoe/Purdue University)

“My interest in telehealth began during my doctoral studies at the University of Illinois, Urbana-Champaign, where I worked on the first large-scale telemedicine program in the U.S. to remotely evaluate swallowing disorders,” Malandraki said.

The positive results, coupled with her experience as a native of Greece where resources in the area of dysphagia are limited, fueled her interest in exploring ways to improve access to care for as many patients with dysphagia as possible.

Swallowing used to be seen as a pure reflex, with little involvement from higher centers in the brain. But current research including our work, Malandraki said, is showing just how big of a role all levels of the central and peripheral nervous systems in general play in swallowing – and ultimately how the brain affects swallowing.

“This knowledge was really important because, with this knowledge, we started seeing that we can actually help the brain change and help rehabilitate swallowing function,” Malandraki said. “Being able to document and claim that swallowing was not just a reflex, but a much more complex neural function, was a big shift in swallowing research and clinical practice.”

That shift started about 20 years ago, Malandraki said. Now, the focus is on how to get the brain and the nervous system in general to change in a way that will facilitate recovery and improvement of swallowing.

“We are looking at how the brain controls swallowing in both healthy populations and populations with brain damage, such as patients who have suffered a stroke or who have cerebral palsy,” Malandraki said. “We are examining how the brain control is altered in these populations and what adaptations these patients have developed. From there, we can start designing treatments that can directly affect the brain and help these patients change that control if needed, or develop “good” adaptations.”

Some of the typical symptoms of dysphagia include difficulties getting food or liquids down on the first try, pain during swallowing, gagging or choking during swallowing and losing weight because of lack of nutrition. Infants might experience problems with the coordination of sucking, swallowing and breathing while nursing or bottle feeding and, ultimately, failure to thrive.

“When you can’t swallow, typically the first thing we have to address is how we’re going to nourish and hydrate you,” Malandraki said. “At times we have to think about alternative types of nutrition, but also how we’re going to manage your particular situation and rehabilitate your swallow. These are both equally important.”

If untreated, dysphagia can be deadly, she said. Patients can aspirate food and liquid into their lungs, which can lead to infections and pneumonia.

Because of the brain’s ability to change throughout an individual’s lifetime – also known as neuroplasticity – Malandraki’s lab is focused on developing neuroplasticity-driven rehabilitation protocols.

“This really is the way to truly help these patients,” Malandraki said. “When we can get to the core of the issue and see how the brain and the muscles are behaving, we can truly design treatments that will help the muscles and brain adapt and improve.”

Malandraki emphasizes that dysphagia extends beyond physical health. The psychological effects that often accompany it can be devastating.

“Dysphagia is a very isolating condition,” Malandraki said. “All of our social events – weddings, parties, even funerals – are centered around food and drinks, and when you can’t eat or drink, it really isolates you. Our patients frequently deal with depression and don’t want to leave the house.”

The ability to improve the health and quality of life of people experiencing dysphagia is a constant motivator for Malandraki.

“I want to help patients be able to eat and grow, nourish themselves,” Malandraki said. “Being able to help someone survive or help make the difference between whether they live or die is something extraordinary. It is a heavy responsibility but also an enormous privilege I don’t take for granted. Our mission is to find effective ways to rehabilitate swallowing so that we help people live long, healthy and happy lives.”

Malandraki also is helping to support the university’s technology commercialization and licensing initiatives. Her work is supported by the National Institutes of Health (National Institute on Deafness and Other Communication Disorders and the National Institute of Biomedical Imaging and Bioengineering), the American Academy of Cerebral Palsy and Developmental Medicine and the Pedal-with-Pete Foundation, the Ralph W. and Grace M. Showalter Research Trust, the SMART Consortium, the Indiana Clinical and Translational Sciences Institute, and the Women’s Global Health Initiative.

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