Research projects on the development of USES
Ultrasound evaluation of swallowing – the development of a hyoid tracker (2021-22)
- Principal Investigator: Dr Joan Ma
- Research Team: Prof Alan Wrench, Mridhula Murali, Jonathan Balch-Tomes & Gemma Cartney
- This project was funded to support the development of data acquisition protocol and data analysis of UltraSound Evaluation of Swallowing (USES), and was completed in July 2022. Through this project, a protocol for collecting swallowing data with the 60mm convex probe was established, with the use of a contoured acoustic gel pad and a custom-made probe holder. USES data was collected from healthy participants, which were used as training data to improve the accuracy of the automatic tracking of the mandible, tongue and hyoid. The use of an automatic tracker helps to improve the reliability as well as clinical usability of USES.
- Output:
- Ma, J. K. -Y. and Wrench, A. A. (2022). Automated assessment of hyoid movement during normal swallow using ultrasound. International Journal of Language & Communication Disorders, 57(3), 615–629. pp. https://doi.org/10.111/1460-6984.12712
- Ma, J. K-Y., Wrench, A. A. & Cartney, G. (2024). Are all swallows equal in continuous cup drinking? An analysis of hyoid kinematics using Ultrasound Evaluation of Swallowing (USES). European Society of Swallowing Disorders (ESSD) Annual Conference, Muenster, Germany.
- Ma, J. K-Y., Quezada, G. & Wrench, A. (2024). Intrapersonal variability in hyoid movement during normal swallow. Proceedings of the UK Swallowing Research Group Conference, Birmingham, UK.
- Ma, J, K-Y. & Wrench, A. (2023). Using glossogram to investigate tongue movement in ultrasound evaluation of swallowing. Proceedings of European Society of Swallowing Disorders (ESSD) Annual Conference, Toulouse, France.
- Cartney, G & Ma, J. K-Y. (2023). Hyoid trajectory analysis of sequential and discrete healthy swallows using ultrasound evaluation of swallowing (USES). Proceedings of European Society of Swallowing Disorders Annual Conference, Toulouse, France.
- Archer, A., Ma, J. K-Y., & Wrench A. (2023). Investigating the effect of carbonation on the swallow using ultrasound evaluation of swallowing (USES). Lothian Health and Care Conference, Edinburgh, UK.
- Ma, J. K-Y. & Wrench, A. (2022). Automated tracking of hyoid movement using ultrasound. Proceedings of Ultrafest X, Manchester, UK.
Pilot study on the clinical utility of ultrasound evaluation of swallowing (2022- 2023)
- Principal Investigator: Dr Joan Ma
- Research Team: Prof Alan Wrench & Jonathan Balch-Tomes
- The project aims to evaluate the suitability of the USES data acquisition protocol in the clinical setting. Pilot studies will be conducted with different clinical populations to evaluate and identify adaptions required for USES in clinical settings. In addition, the automatic tracking of the mandible, tongue and hyoid will be performed on the clinical data to evaluate the accuracy of the trackers. Analyses will be performed to identify key markers for penetration, aspiration and dysphagia. Through working with existing and new clinical partnerships, we will conduct small-scale pilot studies to build the evidence base to support the clinical translation of USES.
- Output:
- Research communication (Dec, 2024)
- Ma, J. K-Y., Quezada, G, Allen, J.E., Mossey- Gaston, C. & Wrench, A. (2024). Piloting Ultrasound Evaluation of Swallowing (USES) in the Clinical Population with Neurological Diseases. British Laryngological Association ‘Cutting Edge Laryngology Conference’, London, UK
- Ma J, K-Y., Quezada, G, Allen, J.E., Mossey- Gaston, C. & Wrench, A. (2023). Ultrasound Evaluation of Swallowing in People with Neurological Diseases – A Pilot Study. Proceedings of European Society of Swallowing Disorders Annual Conference, Toulouse, France.
Scoping exercise on paediatric laryngeal ultrasound assessment by speech and language therapists (2023-2024)
- Principal Investigator: Dr Joan Ma
- Research Team: Dr Mari Viviers, Ms Louise Edwards, Prof Alan Wrench
- This research project will expand our ultrasound research into a new clinical area in airway assessment, focusing on the larynx and the vocal folds. Vocal fold paralysis could present in the paediatric populations due to a range of conditions, such as direct injury of the cranial nerve during delivery or cardiac surgery, laryngomalacia and infection. Using ultrasound to evaluate vocal fold movement in the paediatric clinical population represents a novel and non-invasive approach to assessment compared to flexible nasal endoscopy. This project aims to seek the perspectives of the stakeholders in the planning and development of the research, and develop an assessment protocol for laryngeal ultrasound suitable for the paediatric and potentially also the neonatal population.
- Output:
- Ma, J. K-Y., Viviers, M. & Edwards, L. (2024). Assessing vocal fold movement in infants and children using laryngeal ultrasound by speech and language therapists (SLT): a feasibility study. Newcastle Voice Conference, Newcastle, UK.
- Viviers, M., Ma, J. K-Y. & Edwards, L. (2024). Co-designing research: Exploring the experience of parents/carers of children undergoing vocal fold examination and the potential use of laryngeal ultrasound by paediatric speech and language therapists. British Laryngological Association ‘Cutting Edge Laryngology Conference’, London, UK.
- Edwards, L., Viviers, M. & Ma J. K-Y (2024). Exploring speech and language therapists’ opinion on the use of laryngeal ultrasound in children and young people. European Society of Swallowing Disorders (ESSD) Conference 2024, Muenster, Germany.
Ultrasound Evaluation of Swallowing: Clinical Feasibility and Stakeholders Engagement (2023 - Current)
- Principal Investigator: Dr Joan Ma
- Funded by Royal Society of Edinburgh (Personal Fellowship)
- Swallowing disorders in clinical populations, such as stroke, are common. They can lead to severe consequences such as poor nutrition, chest infections and death. Using ultrasound to assess swallowing can provide a cheaper and less invasive option than the current gold standard of swallowing x-ray (videofluoroscopy). Our works established a reliable method of data collection and analysis in healthy individuals, and an ongoing pilot is extending the research to clinical populations.
Building on our current research, the proposed project aims to develop evidence in three main areas:
1. Data recording and analysis in clinical populations
2. Enablers and barriers to using ultrasound in different clinical settings
3. Patient and public’s perceptions and experiences of ultrasound for swallowing assessment
PhD Projects
Doctoral Candidate: Gemma Cartney (2021 – current)
- Supervisor Team: Dr Joan Ma & Prof Jim Scobbie
- This PhD project will use USES to evaluate swallowing movements of the hyoid and tongue in people with Parkinson’s (PwP). This project involves PwP who have functional swallowing, as well as PwP who have clinical dysphagia. USES measures will be used to investigate evidence of early, subclinical effects of Parkinson’s on swallowing movements in PwP who have functional, non-dysphagic swallowing. USES measures will be compared with VFSS assessment results to examine how swallowing movement corresponds to clinical components of dysphagia. Findings will contribute to knowledge on the early effects of Parkinson’s on swallowing, which may facilitate early identification and proactive treatment of swallowing function, potentially enabling improved patient outcomes. Analysis of PwP user’s perspectives will guide further patient-centred development of USES procedures.
- This project is due to be completed in 2026
- Output:
- Cartney, G., Ma, J. K-Y., & Scobbie, J.M. (2024). Ultrasound Evaluation of Swallowing to detect subclinical changes in swallow kinematics and timings in early Parkinson’s.[Paper presentation]. European Society of Swallowing Disorders (ESSD) Conference 2024, Muenster, Germany.
Doctoral Candiate: Gabriella Quezada (2023 - current)
- Supervisor team: Dr Joan Ma & Prof Erna Haraldsdottir
- External Advisor: Jodi Allen
- This PhD project aims to determine whether USES can be used to monitor the progression of dysphagia in people living with progressive neurological conditions (plwPNC). The project will use USES to evaluate hyoid bone movements in both healthy adults and plwPNC. The first stage will investigate typical intra-person variation in hyoid movement in healthy adults, to gain a broader understanding of what the variation in ‘typical’ swallowing looks like. The second phase will be a longitudinal study looking at whether USES can be used to identify clinically meaningful progression of dysphagia, using measures of the hyoid bone. The project will include the perspectives of plwPNC on USES and aims to remain person-centred. The findings of this project aim to contribute to our knowledge on USES and swallowing in plwPNC. In particular, it aims to determine whether USES can be used to identify clinically meaningful changes in swallow function which could facilitate early intervention and improve QOL and health-related outcomes for plwPNC.
- This project is funded by Cunningham Trust and is due to be completed in August 2026.
- Output:
- Quezada, G., Ma, J. K-Y., & Haraldsdottir, E. (2024). An exploration of intrapersonal variability in swallow function among healthy individuals using ultrasound evaluation of swallowing. European Society of Swallowing Disorders (ESSD) Conference 2024, Muenster, Germany.
Doctoral Candiate: Danah Alqattan (2023 - current)
- Supervisor team: Dr Joan Ma & Dr Felix Schaeffler
- External advisor: Dr Margaret Coffey
- This PhD project will investigate the potential use of ultrasound biofeedback as a tool in supporting the acquisition of swallowing manoeuvres (such as Mendelson manoeuvre & supraglottic swallow) for individuals with dysphagia. The overarching goal of this project is to determine the influence of using ultrasound as a biofeedback tool on the precision of learning and the execution of these manoeuvres when compared to traditional methods. In addition, the aspects of motor learning regimens required for individuals with dysphagia to attain proficiency in swallowing manoeuvres and necessary for optimal skill acquisition will be investigated. The findings will add evidence for the potential use of ultrasound as a biofeedback tool in dysphagia interventions, broaden understanding of motor learning regimens, and improve the entire learning experience for individuals with swallowing difficulties.
- This project is due to be completed in August 2026.
- Output:
- Alqattan, D., Ma, J. K-Y., & Schaeffler, F. (2024). Exploring the application of laryngeal ultrasound as a biofeedback tool for enhancing the learning of Supraglottic Manoeuvre. European Society of Swallowing Disorders (ESSD) Conference 2024, Muenster, Germany.
MSc Projects
MSC Student: RACHEL CLARK (2022 – 2024)
- Supervision: Dr Joan Ma
- This MSc project will explore the ability of the final year speech and language therapy (SLT) students in identifying anatomical landmarks on different types of imaging used during instrumental swallowing assessments. Further, it will investigate the effect of different types of training on improving the ability to identify anatomical landmarks and generalization to ultrasound images, which is relatively new to SLT clinical management.