Program Overview for Raele Robison
Doctoral Committee: Emily Plowman, PhD, CCC-SLP David Fuller, PhD; Erin Patrick, PhD; Elisabeth Barton, PhD; Catriona Steele, PhD, S-LP(C), CCC-SLP (Special Member)
Graduation Date: Summer 2020
Future Plans: Dr. Robison is now completing a post-doctoral fellowship at the William S. Middleton Memorial Veteran’s Hospital in Madison, Wisconsin. She will be mentored by Dr. Nicole Rogus-Pulia and co-mentored by Dr. Nadine Connor. Dr. Robison is funded by the Advanced Fellowship in Women’s Health and eventually will begin the K00 phase of her NIH Blueprint F99-K00 award.
Dissertation Title: “Running on Reserve: Impact of Lingual Physiologic Reserve Homeostenosis on Deglutition in ALS”
Dissertation Abstract: Preservation of nutritional homeostasis, the balance between energy intake and energy expenditure, is essential to optimal functioning and survival [1,2]. Nutritional homeostasis relies on intact swallowing function that is safe (no airway invasion) and efficient (no residue) to effectively transport food and liquids through the swallowing tract so their energy byproducts can be processed and stored for later consumption. The tongue is an integral swallowing muscle that serves roles in both swallowing safety and efficiency. The difference between maximum anterior isometric lingual pressure (MAIP) versus the amount of lingual pressure used during the functional task of swallowing is referred to as lingual physiologic reserve (LPR) and it is thought that LPR contributes to effective swallowing [3].
In individuals with amyotrophic lateral sclerosis (ALS), there is early and extensive lingual impairment which results in homeostenosis (reduction) of LPR [4,5]. Further, ALS patients are noted to demonstrate unsafe and inefficient swallowing which leads to the negative sequaelae of dehydration and malnutrition [6,7]. Despite the essential relationship between LPR, swallowing function and, ultimately, the ability to maintain nutritional homeostasis; it remains unclear how LPR homeostenosis evolves in ALS and how reduced LPR affects bulbar function during disease progression.
This proposal sought to characterize LPR homeostenosis in ALS and examine the impact of reduced LPR capacity on swallowing function in this patient population. The central hypothesis was that LPR homeostenosis would be associated with impairments in swallowing safety and efficiency in ALS. LPR homeostenosis was assessed using raw value (Experiments 1 and 2) and waveform pattern (Experiment 3) measurement approaches.
Experiment 1 revealed that MAIP was reduced in ALS as compared to normative values and these reductions were associated with inefficient and unsafe swallowing. Experiment 2 found that ALS patients demonstrated longitudinal homeostenosis of LPR secondary to a progressive decline in MAIP. Further, LPR homeostenosis was predictive of a six-month decline in /ba/ articulatory rate. Finally, experiment 3 revealed unsafe and inefficient swallowers demonstrated lower peak lingual pressures and an increased duration to reach these pressures. Critical thresholds of MAIP depletion were also identified for inefficient (<37) and unsafe (<46) swallowing.
Select Peer Reviewed Publications
Waito, A. A., Plowman, E. K., Barbon, C. E., Peladeau-Pigeon, M., Tabor-Gray, L., Magennis, K., Robison, R. & Steele, C. M. (2020). A Cross-Sectional, Quantitative Videofluoroscopic Analysis of Swallowing Physiology and Function in Individuals With Amyotrophic Lateral Sclerosis. Journal of Speech, Language, and Hearing Research, 1-15. doi: 10.1044/2020 _JSLHR-19-00051
Plowman, E. K., Tabor‐Gray, L. , Rosado, K. M., Vasilopoulos, T., Robison, R. , Chapin, J. L., Gaziano, J. , Vu, T. and Gooch, C. (2019), Impact of expiratory strength training in amyotrophic lateral sclerosis: Results of a randomized, sham‐controlled trial. Muscle Nerve, 59: 40-46. doi:10.1002/mus.26292
Arslan, S., Azola, A., Sunday, K., Vose, A., Plowman, E., Tabor, L., Singer, M., Robison, R., Humbert, I. (2018). Effects of Submental Surface Electrical Stimulation on Swallowing Kinematics in Healthy Adults: An Error-Based Learning Paradigm. Am J Speech Lang Pathol, 27(4), 1375-1384. doi: 10.1044/2018_AJSLP-17-0224
Robison, R., Tabor-Gray, L. C., Wymer, J. P., & Plowman, E. K. (2018). Combined respiratory training in an individual with C9orf72 amyotrophic lateral sclerosis. Annals of clinical and translational neurology, 5(9), 1134-1138. doi:10.1002/acn3.623
Select Honors and Awards
2020: Advanced Fellowship in Women’s Health, William S. Middleton Memorial Veteran’s Hospital, Madison, WI
2019: NIH NINDS Blueprint D-Span F99/K00 Grant
2018: NIH NINDS Diversity Supplement Award
2018: Dysphagia Research Society 26th Annual Meeting, 1st Place Research Poster Presentation Award
2017: University of Florida Annual Graduate Diversity Research Symposium; 1st Place-Biological Sciences Poster Division