“Among adults, stroke is the number one cause of dysphagia affecting the mouth and throat (oral/pharyngeal dysphagia),” Perlman said, adding that “fortunately, a high percentage recover” from it with appropriate diagnoses and treatment, typically provided by a speech pathologist. Unfortunately, residents of sparsely populated areas served by small, rural hospitals may not have ready access to speech pathologists with expertise in the diagnosis and treatment of this type of dysphagia. Often, Perlman said, patients experience the added discomfort and expense of traveling or being transported long distances by ambulance to urban hospitals that are better equipped and staffed.
But that’s all about to change as a result of a project Perlman has begun with assistance from the UI’s National Center for Supercomputing Applications. NCSA awarded Perlman a fellowship to develop a telemedicine project that uses the Internet to connect radiology suites at small community hospitals with professionals at big-city hospitals. The radiologists transmit real-time, dynamic video images of the patient to the speech pathologist, who directs the examination. Later, “the expert can view the images in real time, slow motion, pause them, and analyze them frame by frame,” she said.
“With dysphagia, things can go wrong in the mouth, throat or esophagus,” Perlman said. “I look at oral/pharyngeal dysphagia, while a gastroenterologist treats problems with the esophagus.” The ability to see a real-time visualization of what is occurring as a patient swallows food, then have the capability to store the images and study them is critical in diagnosis and treatment, she said. That’s because it takes less than a second for food to go from the mouth to the esophagus.
“Oral/pharyngeal dysphagia is far more common than people believe,” Perlman said. “It occurs at all stages of life – from the infant with a neuromotor disorder to the young person in an automobile accident with traumatic brain injury to the elderly who’ve had a stroke.” It is associated with a number of diseases, including Parkinson’s disease and head and neck cancer, she said.
Perlman is receiving technical assistance with the telemedicine project from Weerasak Witthawaskul, a UI doctoral student in computer science. She and Witthawaskul are exploring start-up plans with a local hospital, and with another based at the University of Tennessee. At this stage, “it is ready to use in test mode in hospitals,” she said.
Perlman believes the system will have applications not only for patients in remote areas of the United States, but also in the diagnosis and treatment of patients across international borders. That will fill a critical need in some parts of the world, according to Perlman, who said, “I once visited a country where there was only one qualified speech pathologist in the whole country.”