RESEARCH

The mission of the SSR Lab is generate research that will translate into low-cost, efficient assessment tools, and interventions to improve respiratory support for speech and swallowing in adults with neurologic disorders.

Research: Research

CURRENT PROJECTS

The Impact of Noninvasive Ventilation (NIV) on Speech and Swallowing

Use of noninvasive ventilation (NIV) to provide ventilatory support without the need for a tracheostomy has been on the rise for more than a decade. These projects involve mixed methods, including qualitative and quantitative analyses, to examine the impact of various forms of NIV on speaking and swallowing in individuals with neurodegenerative conditions impacting respiration.

The Effect of Intervention for Unilateral Vocal Fold Immobility (UVFI) on Cough Effectiveness

Unilateral vocal fold immobility (UVFI) is a common condition characterized by reduced movement of one of the vocal folds. This condition can lead to a weak voice, fatigue with speaking, difficulty swallowing, and a weak cough. The impact of intervention for UVFI on voice quality has been well studied, but little is known about the impact on the ability to effectively cough. In this study, we compare objective measures of cough effectiveness and vocal fold kinematics in patients before and after medical intervention for UVFI.

Breathing-swallowing coordination in people with amyotrophic lateral sclerosis (PALS)

Breathing-swallowing coordination (BSC) and the ability to cough are essential pulmonary defenses. Difficulty with the ability to swallow (dysphagia) and/or cough (dystussia) is associated with respiratory compromise. Dysphagia is common in people with amyotrophic lateral sclerosis (PALS). In PALS, both cough and BSC may become impaired due to progressive involvement of the respiratory and/or bulbar (speech & swallowing) musculature. This project examines associations between BSC and cough-related airflow measures and risk of aspiration in individuals with ALS.

Effect of direction and location of stimulation in globus pallidus (GP) on speech in people with Parkinson disease (PD)

This study is part of a larger study headed by Dr. Delaram Safarpour in the Department of Neurology at OHSU. The purpose of this study is to determine the added benefit of directional stimulation on motor symptoms of PD, as well as the effects of therapeutic directional electrode contacts (e.g., more posterolateral or anteromedial stimulation) versus ring stimulation with regard to clinical outcomes in speech and gait after implantation of GP deep brain stimulation (DBS) electrodes.

Impact of Testosterone on Respiratory System for Voice in Transgender Individuals

This pilot study examines the impact of testosterone therapy, as part of medical treatment to align gender identity, on measures of respiration and voice.

Dysphagia in Ehlers Danlos Syndrome

This is a piolet study to investigate the potential impact of Ehlers Danlos Syndrome (EDS) on swallowing. EDS is a hereditary connective tissue disorder that impacts collagen and often presents with systemic manifestations, including — dermatological, musculoskeletal, pulmonary, digestive, neurological, and more. The goal of this study is to begin to identify, elucidate, and describe the patterns of and experiences with dysphagia in people with EDS.

PUBLICATIONS

Books

Yorkston, K.M., Miller, R.M., Strand, E.A. & Britton, D. (2012). Management of Speech and Swallowing Disorders in Degenerative Diseases (3rd ed.). Pro-Ed., Inc., Austin, TX.

Miller, R. & Britton, D. (2011). Dysphagia in Neuromuscular Disease. Plural Publishing, Inc., San Diego, CA.

Book Chapters

Miller, R. & Britton, D. (2010). Progressive Bulbar Palsy (PBP). In Jones, H.N. & Rosenbek, J.C. (Editors). Dysphagia in Rare Conditions, Plural Publishing, Inc., San Diego, CA.

Britton D., & Baarslag-Benson, R. (2007). Spinal Cord Injury. In Beukelman DR, Garrett KL, Yorkston KM. (Editors), Communication Strategies for Adults with Acute or Chronic Medical Conditions, Paul H. Brookes Publishing Co., Baltimore, Maryland.

Refereed Publications

Britton, D., Pullen, E., Hoit, J.D., Benditt, J.O. (2021). Effects of mouthpiece noninvasive ventilation on speech in men with muscular dystrophy: A pilot study. American Journal of Speech-Language Pathology (AJSLP)

Britton, D., Hoit, J.D., Pullen, E., Benditt, J.O., Baylor, C.R., & Yorkston, K.M. (2019). Experiences of speaking with noninvasive positive pressure ventilation (NPPV): A qualitative investigation. American Journal of Speech-Language Pathology (AJSLP), 28(2S): 784-792.

Britton, D., Hoit, J.D., Poon, J., Hansen, M., Benditt, J.O., Baylor, C.R., & Yorkston, K.M. (2019). Swallowing with noninvasive positive pressure ventilation (NPPV). Dysphagia. Advance online publication. doi: 10.1007/s00455-019-09997-6

Palmer, A.D., Bolognone, R.K., Thomsen, S., Britton, D., Schindler, J., & Graville, D.J. (2018). The safety and efficacy of expiratory muscle strength training (EMST) for rehabilitation after supracricoid partial laryngectomy: A pilot investigation. Annals of Otology, Rhinology & Laryngology, 128(3), 169-176. doi:10.1177/0003489418812901

Britton, D., Karam, C. & Schindler, J. (2018). Swallowing and secretion management in neuromuscular disease. Clinics in Chest Medicine, 39, 449-457.

Britton, D., Roeske, A., Ennis, S. K., Benditt, J. O., Quinn, C., & Graville, D. (2018). Utility of Pulse Oximetry to Detect Aspiration: An Evidence-Based Systematic Review. Dysphagia, 33(3), 282-292. DOI 10.1007/s00455-017-9868-1

Yorkston, K.M., Baylor, C.R. & Britton, D. (2017). Speech versus speaking: The experiences of people with Parkinson’s disease and implications for intervention. American Journal of Speech-Language Pathology, Vo. 26 (2S): 561-568. DOI 10. 1044/2017_AJSLP-16-0087.

Britton, D., Hoit, J.D. & Benditt, J.O. (2017). Dysarthria of spinal cord injury (SCI) and its management. Seminars in Speech and Language, Vol 38 (3): 161-172. DOI 10.1055/s-0037-1602835.

Yorkston, K.M., Baylor, C.R. & Britton, D. (2017). Incorporating the principles of self-management into treatment of dysarthria associated with Parkinson’s Disease. Seminars in Speech and Language, Vol. 38 (3): 210-219. DOI 10.1055/s-0037-1602840.

Britton, D., Benditt, J.O. & Hoit, J.D. (2016). Beyond tracheostomy - Noninvasive ventilation and potential positive implications for speaking and swallowing. Seminars in Speech and Language, Vol 37(3): 173-84. DOI 10. 1055/s-0036-1583545.

Britton, D. (2016). The impact of aging and progressive neurological disease on swallowing: A concise overview. Journal of Texture Studies, Online 25 APR 2016, DOI 10.1111/jtxs.12189.

Britton, D., Benditt, J.O., Merati, A.L., Miller, R.M., Stepp, C.E., Boitano, L., Hu, A., Ciol, M.A., & Yorkston, K.M. (2014). Associations between laryngeal and cough dysfunction in motor neuron disease with bulbar involvement. Dysphagia, Vol. 29: 637-646. DOI 10.1007//s00455-014-9554-5.

Britton, D., Yorkston, K.M., Eadie, T., Stepp, C.E., Ciol, M., Baylor, C., & Merati, A.L. (2012). Endoscopic assessment of vocal fold movements during cough. Annals of Otology, Rhinology and Laryngology, Vol. 121: 21-27.

Hanson, E., Yorkston, K.M. & Britton, D. (2011). Dysarthria in amyotrophic Lateral Sclerosis: A systematic review of characteristics, speech treatment and AAC options. Technical Report Number 7, Academy of Neurologic Communication Disorders and Sciences. Journal of Medical Speech Pathology, Vol. 19, No 3: 12-30.

Baylor, C., Burns, M., Eadie, T., Britton, D., & Yorkston, K. (2011). A qualitative study of interference with communication participation across communication disorders in adults. American Journal of Speech-Language Pathology, Vol. 20: 269-287. **Winner of the ASHA 2011 Editors’ Award for the article of highest merit in AJSLP.

Baylor, C., Yorkston, K., Bamer, A., Britton, D. & Amtmann, D. (May 2010). Variables associated with communication participation in people with multiple sclerosis: A regression analysis. American Journal of Speech-Language Pathology, Vol. 19: 143-153.

Britton, D., Goldstein, B., Jones-Redmond, J., & Esselman, P. (2005). Case Report: Baclofen pump intervention for spasticity affecting pulmonary function. Journal of Spinal Cord Medicine, Vol 28; No 4:343-347

Britton, D., Jones-Redmond, J., & Kasper, C. (2001). The use of speaking valves with tracheostomized and ventilator-dependent patients. Current Opinion in Otolaryngology & Head and Neck Surgery, Vol. 9:147-152.

Non-Refereed Publications

Britton, D., Cleary, S. & Miller, R. (March 2013). What is ALS and what is the philosophy of care? Perspectives on Swallowing and Swallowing Disorders, American Speech-Language-Hearing Association, Division 13, Vol 22; No 1:4-11. DOI: 10.1044/sasd22.1.4.

Miller, R. & Britton, D. (2007) Experience With Amyotrophic Lateral Sclerosis: Incidence, Pathology, and Treatment Considerations. Perspectives on Gerontology, American Speech-Language-Hearing Association, Division 15, Vol 12:17-22. DOI:10.1044/gero12.1.17.

Selected Conference Proceedings

Britton, D., Benditt, J.O., Poon, J., Baylor, C.R., Yorkston, K.M. & Hoit, J.D. (March 2-4, 2017). Swallowing with noninvasive positive pressure ventilation (NPPV) in individuals with muscular dystrophy. Proceedings from the Dysphagia Research Society 25th Annual Meeting, Portland, Oregon.

Britton, D., Lederle, A., Ennis, S.K., Benditt, J.O., Quinn, C. & Graville, D. (March 2-4, 2017). Utility of pulse oximetry in detecting aspiration – Evidence based systematic review. Proceedings from the Dysphagia Research Society 25th Annual Meeting, Portland, Oregon.

Britton, D., Merati, A., Benditt, J., Stepp, C., Hu, A., Miller, R., & Yorkston, K. (March 13-16, 2013). Associations between laryngeal and cough dysfunction in motor neuron disease (MND). Proceedings of the Dysphagia Research Society 21st Annual Meeting, Seattle, Washington.

Britton, D., Merati, A., Benditt, J., Stepp, C., Max, L., & Yorkston, K. (March 7-12, 2012). Associations between vocal fold movements and peak expiratory cough flow in healthy middle-aged adults: Preliminary analyses. Proceedings of the Dysphagia Research Society 20th Annual Meeting, Toronto, Ontario, Canada.

Stepp, C.E., Britton, D., Chang, C., Merati, A., & Matsuoka, Y. (April 27 – May 1, 2011). Feasibility of game-based electromyographic biofeedback for dysphagia rehabilitation. Proceedings of the 5th International IEEE EMBS Conference on Neural Engineering of the IEEE Engineering in Medicine and Biology Society, Cancun, Mexico. **Winner of the NSF Neural Engineering Travel Award