Take 10 with... Anna Miles

1.  Describe your research topic to us in ten words or less.

Improving assessment and treatment of swallowing difficulties (dysphagia) across the lifespan

2. Now describe it in everyday terms!

I am a speech-language therapist and I work with people (babies all the way through to old age) who have a disease or disorder that has affected their swallowing. Swallowing difficulties can be caused by a neurological condition like cerebral palsy or a stroke but can also result from medical/surgical interventions such as spinal surgery, radiation for throat cancer or long periods in intensive care.

The University of Auckland Swallowing and Voice Research Laboratory studies ways to predict, diagnose and treatment these swallowing difficulties best. We have developed new tools and quantitative approaches to assess swallowing in children and adults and we study innovative ways to treat swallowing, voice and cough function across a range of diseases/disorders.

3.  Describe some of your day-to-day research activities.

We spend a lot of our time in our specialist Grafton Clinics assessing and treating people with swallowing difficulties. My primary collaborator in the lab, Associate Professor Jacqui Allen, is a laryngologist. We support a large number of psychology, speech science, engineering, food science and medical students. These students all volunteer in the clinics as part of their studies.

When we are not treating patients we are usually found in front of a large screen, taking digital measures from acoustic, x-ray, endoscopic and manometric swallowing and voice assessments. We use these specialised, state-of-the-art assessments to measure patterns in disease populations and changes in patients across time. They allow us to objectively ‘unpick’ the nature of swallowing and voice biomechanics as well as treatment effects.

4.  What do you enjoy most about your research?

The joy of clinical research is that I can work as an academic and answer clinical questions that I, as a speech-language therapist, want to know the answers to. But I can do this without having to give up my clinical work. I get to be a teacher, researcher as well as a clinician!

5.  Tell us about something that has surprised or amused you in the course of your research.

When I started my academic career in New Zealand, I had no idea how much of my job would be conducted overseas or how much I would love these international connections. I consider the swallowing disorders community some of my closest friends. Currently I co-supervise six PhD students in Australia, two in the US and two in the UK as well as four here in New Zealand. Supervising research overseas allows us to work with our colleagues on projects of shared interest. We answer more questions together than we could ever do in isolation.

6.  How have you approached any challenges you’ve faced in your research?

It is very difficult to treat people with dysphagia if you do not have a clear understanding of normal variance i.e. how different people swallow, how swallowing develops from birth and how it changes in older age.

In our lab we have worked hard to build a normative database of instrumental swallowing measures in healthy New Zealanders across the lifespan. We invited a large number of New Zealanders to volunteer for an x-ray of their swallowing – working hard to find people young and old and across different ethnicities to truly reflect New Zealand’s population. This has been a hugely valuable comparison group for our research with people with swallowing difficulties.

7.  What questions have emerged as a result of your recent work?

While we were able to get ethical approval to get consenting adults to take a short x-ray of their swallowing, this was not possible in children under 16 years old. Radiation for an x-ray swallow is small but is still radiation. We needed to think outside the box. Instead, we collected 1000s of x-ray swallows from children with swallowing difficulties who needed the x-ray for their clinical care. We are now using these x-rays to answer lots of questions about patterns of swallowing across population groups and risk factors for poor outcomes found on x-ray for these children.

8.  What kind of impact do you hope your research will have?

Our research is all about ‘impact’. We all love to eat and drink. Sharing a drink or meal with friends and family is so critical to our psychosocial wellbeing. We work closely with New Zealand and international speech-language therapists to develop tools to help them work better and more efficiently. We directly test new therapy approaches and therefore, we get to see the difference it makes to our patient’s everyday lives. Recently we have been testing a novel therapy for people with Parkinson’s disease. We are seeing positive improvements in swallowing, voice and cough function up to 12 months after therapy – suggesting this treatment supports people to hold back the effects of Parkinson’s disease on these functions.

9.  If you collaborate across the faculty or University, or even outside the University, who do you work with and how does it benefit your research?

Swallowing disorders lends itself to collaboration. We work with engineering to develop robot models and new devices. We work with food science to explore food structure and its relationship with swallowing function as well as designing easy-to-swallow foods. We work closely with Nutrition and Dietetics, Pharmacy and the Faculty of Medical & Health Sciences (medical and surgical). Most of our research takes place in New Zealand and Australian hospitals with local clinicians involved in the work. This means we can answer the ‘right’ questions and ensures that our findings can immediately be used to guide changes in clinical practice.

Swallowing disorders is a small field so for many of our research projects we also collaborate with international colleagues to share ideas and collect data faster. Currently we’re working with the University of Minnesota on a multisite project looking at pharmaceutical outcomes in swallowing for infants with spinal muscular atrophy. If we collected this data in New Zealand only, it would take us 50 yrs to see enough patients to have our answer!

10.  What one piece of advice would you give your younger, less experienced research self?

Say yes to every opportunity that is offered to you. Some of the greatest joy in my job has come from collaborations that were built on casual conversations in a lift or at a conference. Make friends and don’t be afraid to give ideas a go!