Bridging Neuroscience and Rehabilitation: The Future of Dysphagia Treatment

In December, Janina Wilmskoetter, Ph.D., CCC-SLP, a faculty member in the College of Health Professions’ (CHP) Division of Speech-Language Pathology, received a prestigious five-year NIH R01 grant totaling $2.2 million. Her study, Brain Networks Supporting Oral and Pharyngeal Swallow Function after Stroke, to be conducted across two sites – the Medical University of South Carolina (MUSC) and the University of South Carolina (USC) – seeks to pave the way for personalized stroke rehabilitation by uncovering the complex brain networks involved in swallowing dysfunction, known as dysphagia, following a stroke.

“We lack a comprehensive understanding of the neural mechanisms underlying the swallowing process, hindering our ability to predict patient outcomes and develop effective interventions accurately,” noted Wilmskoetter. “That we know so little about how the brain controls swallowing is surprising given that dysphagia is one of the most common but also life-threatening complications after a stroke. Our study addresses this issue by identifying the brain regions that support the oral and pharyngeal phases of swallowing, which could ultimately improve our ability to develop targeted interventions and enhance patient outcomes.”

Sponsored by the National Institute of Neurological Disorders and Stroke (NINDS), the study promises significant advancements in speech-language pathology and stroke rehabilitation. Specifically, Wilmskoetter and her team aim to improve early identification of patients at risk for dysphagia; provide accurate predictions of swallowing impairments, enabling timely and targeted interventions; and reduce life-threatening complications associated with swallowing disorders, such as airway obstruction, lung infections, and malnutrition.

“As information on stroke lesion location and pre-stroke brain health (i.e., white matter hyperintensities) is typically available shortly after hospital admission, results from our study could help clinicians identify early on those who are at risk for dysphagia and require closer monitoring,” said Wilmskoetter. “If lesion locations predict the specific swallowing impairment, this information could be used alongside swallowing assessments to enhance diagnosis accuracy and prognosis.” Ultimately, these insights will aid clinicians in optimizing nutrition and airway protection for patients shortly after their stroke and pave the way for the development of innovative treatment approaches.

Collaboration is critical to the success of the team’s research, with retrospective recruitment taking place at MUSC and USC—two major stroke centers in the southern U.S. By recruiting from more than one center, the team will increase the generalizability of their results and the feasibility of reaching their enrollment target of N=400, which, to their knowledge, will be the largest study cohort to date for assessing relationships between stroke lesions and dysphagia. Besides Wilmskoetter, who is a speech language pathologist, the interprofessional team at MUSC comprises Bethany Wolf, Ph.D. (biostatistician), Christine Holmstedt, DO, FAHA (neurologist), Vittoria Spampinato, M.D. (radiologist), LuAnne O’Connor, CRA (grants administrator), Stephanie Cute, CCC-SLP (speech language pathologist and project manager), and Roland Cote, BS (project coordinator). At USC, the team includes Heather Bonilha, PhD, CCC-SLP (speech language pathologist), Leonardo Bonilha, MD, PhD (neurologist), and Souvik Sen, MD, MPH (neurologist). Thanks to this multidisciplinary approach, stroke survivors and their families stand to benefit from reduced stress and enhanced recovery outcomes, which contribute to improved quality of life.

For Wilmskoetter, the fight against dysphagia stems from both professional and personal inspiration. She views eating and drinking as fundamental aspects of life, integral not only to health but also to social interactions and emotional wellbeing. “I have worked as a speech-language pathologist for many years and have seen firsthand the devastating impact dysphagia has on people,” she shared. “However, we know surprisingly little about how to help people regain their swallowing function. Thus, as an SLP, I found myself in the dilemma of wanting to help my patients but not knowing how. This has motivated me to pursue a research career focusing on dysphagia.”

Both compassion and curiosity have led Wilmskoetter to envision spanning the distance between neuroscience and rehabilitation, thus bringing hope to stroke survivors and advancing the field of speech-language pathology. “People with stroke have always held a special place in my heart, and I have a desire to help these individuals.”

“Brain Networks Supporting Oral and Pharyngeal Swallow Function after Stroke”

Main PI: Janina Wilmskoetter

MUSC team:
Site PI: Janina Wilmskoetter
Co-Is: Christine Holmstedt, Beth Wolf, Maria Spampinato
Program Manager: Stephanie Cute,
Program Coordinator: Roland Cote
Grants administrator: LuAnne O’Connor

USC Team:
Site PI: Heather Bonilha
Co-Is: Leonardo Bonilha, Souvik Sen