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Leader in the Field of Swallowing Disorders Reflects on Her Groundbreaking Career

Bonnie Martin-Harris is a pioneer in the standardization of identifying and treating swallowing disorders. Martin-Harris, the Alice Gabrielle Twight Professor in the Roxelyn and Richard Pepper Department of Communication Sciences, delved into her career-defining work during the 12th annual Pepper Lecture at the Francis Searle Building on April 19.

“Safe and efficient swallowing requires fifty-five pairs of muscles, complex neural control, and coordination of multiple body systems,” said Martin-Harris, who is also the Associate Dean for Academic Affairs for the School of Communication. “Unlike healing an arm or a leg, the ability to rewire the synergy involved in swallowing is a complicated and often difficult process…. We all know what it feels to swallow something and have it go down the wrong way, but imagine feeling that every time you swallow a sip of water.”

The lecture was made possible by the generous donation of Northwestern alumni Roxelyn and Richard Pepper, who endowed the Communication Sciences and Disorders Department in 2005. Before the lecture, School of Communication Dean Barbara O’Keefe thanked them for their longstanding support.

Martin-Harris, who has spent her career focusing on patient-centric research, spent years fighting for standardization in the diagnosis and treatment of dysphagia—swallowing disorders—which can be caused by such conditions as cancer, stroke, parkinson’s disease, and trauma. Martin-Harris was inspired to seek standardization after working with patients, one of whom was a vibrant woman who’d lost the ability to swallow after treatment for jaw and mouth cancer. Her patient, who died in 2012, first came to her with files of tests she’d taken with other clinicians — but Martin-Harris said she was unable to glean any useful information from them.

“She had ten swallowing reports, but none was like the other,” Martin-Harris said. “I had to restudy her again. And that should not be. I felt patients should be able to go from one speech pathologist to another and not have to re-run the same tests.”

Jeri Logemann, a renowned Northwestern Communication Sciences and Disorders professor who passed away in 2014, established the gold standard for diagnosing dysphagia in the 1970s, the Modified Barium Swallow Study (MBS), where she asked patients to swallow barium while the action was captured in real time using x-ray. While this was a groundbreaking tool for diagnosing patients, Martin-Harris said the lack of standardization meant that speech pathologists and other clinicians across the world might do this test in a variety of different ways, which meant no two tests were the same.

“They’d have patients swallow everything from liquid to a piece of sandwich,” she said. “They’d often come into the radiologist’s room with a whole tray full of different things and each result was then different.” This unsafe and invalidated practice occurred in part because the purpose of the test was lost due to inconsistent training for students and practicing clinicians. The MBS became a feeding assessment rather than an examination of the swallowing mechanism meant to guide treatment and make informative recommendations for safe swallowing.

Martin-Harris sought to change this state of affairs by beginning research that would standardize the training of clinicians, method and materials used to conduct the exam, interpret and report the results and guide treatment. She began by hosting a conference of leading experts and researchers in Charleston, where she was formerly based, in 2004. They validated through expert consensus a model of swallowing impairment to test, which Martin-Harris then used to establish a metric of 17 characteristics of swallowing to examine during the MBS. Once tested for validated and reliable use between clinicians, she worked to transform the black-and-white x-rays taken from the exams into data-driven images to facilitate learning as students and clinicians are trained in the approach (Modified Barium Swallowing Impairment Profile, MBSImPâ). She worked with a medical illustration company to bring to life the 17 components of normal swallowing and 77 abnormal swallowing variations in animated color.  

Martin-Harris then created a web-based learning environment using the innovative animations to train clinicians and students to accurately assess swallowing impairment. This led to a standardization of both diagnosing patients and training students.

“The program also generates a standardized, electronic report for each patient,” she said. “Doctors, patients, and even their family members can read this report and know exactly what it means. And this also gives them a way to target different treatments to help them recover.” De-identified data from the reports are entered into the first global dysphagia registry that will permit future study of the natural course of dysphagia and the effects of treatment methods.

Now, the system she created has trained more than 5,000 clinicians across the world, and 92 communication sciences and disorders graduate programs in the U.S. use this system to train their students.

Assistant Professor Elizabeth Norton, who researches biomarkers for dyslexia and autism, called Martin-Harris’ work inspiring.

“I’m in a different field, yet, her work truly inspires me,” Norton said. “She’s shown us it’s feasible to do sweeping, game-changing research that can revolutionize evaluation and treatment.”

-Cara Lockwood