My research focuses on elucidation of the role of the tongue in neonatal feeding. Safe, oral feeding requires coordination of sucking, swallowing and breathing which involves multiple sensory-motor systems and the tongue plays a key role. Work from the Goldberg-McClung lab was the initial catalyst for my interest in tongue muscle and preterm infant feeding. They reported a number of neuromuscular changes in tongue muscle for tube-fed versus dam-reared rat pups including reduction in the number and size of muscle fibers, retarded hypoglossal motoneuron growth, and increased fatigability of the muscle. They concluded that nutritive sucking behavior (breast or bottle) was necessary for normal tongue development and changes observed in artificially reared rat pups might also occur in premature infants artificially fed for extended periods of time. Such a finding would explain the high incidence of feeding difficulties in this population (up to 70%). My proof-of-concept work in this area was to devise and test a method for measuring tongue force and posterior tongue size in neonates. The work was funded by the Kentucky Science and Engineering Foundation (Grant/Award Agreement #148-502-l0-260 with the Kentucky Science and Technology Corporation). The result was an approach deriving tongue force from deformation kinematics of a nipple/pacifier synchronized with pressure throughout the suck-swallow-breathe cycle via sonomicrometry. Continuous measurement of tongue dynamics in concert with nipple cavity pressure measurements allowed us to evaluate, temporally and spatially, the contributions of anterior and posterior tongue forces at the nipple interface to the suck- swallow-breath coordination cycle. Posterior tongue size was measured using ultrasound. Results indicated significantly less tongue force during nutritive sucking coupled with reduced posterior tongue size for preterm infants as compared to term infants.
Results from proof-of-concept work prompted a shift in research focus to development and validation of a scalable tool to measure important sucking parameters (amplitude, number of sucking bursts, sucks-per-burst, inter-suck interval) that could be used crib side to identify infants at risk for feeding difficulties. Iterative prototyping was funded internally (UK College of Health Sciences Office of Research Grant 1012003440) which resulted in design freeze. The device, nfant® Feeding Solution, is currently being used to study early sucking as a predictor of neurodevelopmental outcomes at Kentucky Children’s Hospital with internal grant support from the UK NIH Center for Clinical and Translational Science (NIH CTSA UL1TR000117) and UK College of Health Sciences Office of Research (Grant 1012003440). nfant Feeding Solution (www.nfant.com) was recently cleared by the FDA and registered as a Class II medical device. It is being integrated clinically in NICUs across the country including Children’s Hospital of Orange County, Carolina Medical Center, and Texas Children’s Hospital. The device is also being used to answer important scientific questions related to sucking and collaborating institutions include Boston Children’s Hospital, Brigham and Women’s Hospital, and Cincinnati Children’s Hospital.
I teach undergraduate and graduate students in Communication Sciences and Disorders, as well as doctoral students in the Rehabilitation Sciences doctoral program. As part of my affiliation with the RHB doctoral program, I am available to serve on committees, supervise research apprenticeships and independent studies as requested. In addition, I provide regular guest lectures for the University’s Human Development Institute, College of Education, and College of Dentistry.
I am actively involved in clinical work. I serve as an SLP on a multidisciplinary clinic team serving children with a history of prematurity or complications at birth. I also provides direct services, prn, in the UK Children’s Hospital Neonatal Intensive Care Unit.