It was a beautiful day on the west coast as well as the east coast, when Dr. Ianessa Humbert from Johns Hopkins University joined me for a virtual dysphagia-lite interview.
Dysphagia Cafe: Dr. Humbert, thank you so much for taking the time to “sit down” with me.
This being Dysphagia Café, it’s very important we establish some important biographical information for our audience.
How do you take your coffee in the morning?
Dr Humbert: I don’t – I take tea. Black, strong, and unsweetened.
Do you drink coffee to get you through the day?
No. Coffee makes me crazy(er)
What’s your tea of choice, Starbucks, Coffee Bean or is there another one in your area that you prefer?
My tea of choice is a Starbucks brand – Tazo “Awake”
I know a lot of graduate students can appreciate late night study sessions with several Starbucks runs. What were your late night study sessions like in school?
Believe it or not, I didn’t begin to drink caffeine regularly until I was about half way through my post-doc with my second baby. I had been drinking peppermint tea up until then and for some reason I thought it was caffeinated! That, to me, speaks to the power of the placebo effect. Anyway, regarding study sessions, in undergrad late night and early morning were pretty blurred. By the time I started my masters, I began to appreciate the importance of studying at my optimal time of the day (don’t recall what that was then – pre-parenting). During my doctoral and post-doctoral studies I had children, so my optimal time of day and all studying activity were directed by the whims of infants and toddlers.
What was the most difficult class/clinic for you in graduate school?
Hmmmmm. Any and all child language subjects were my least favorite and, thus, most difficult to spend time on because I was not particularly smitten by the subject matter.
Can you tell us at what point in time did you decide you wanted to become a Speech-Language Pathologist?
I was a French major in undergrad, but I couldn’t figure out what kind of career to move toward with a degree in French. So I asked my sister what she thought I should do during my junior and senior years. She replied, “you need to figure out how to get paid to correct people’s speech because that’s all you ever do!” Soon after, I went to the career counselor and asked what kind of job would allow me to correct speech and the rest is history.
What career path do you think you would’ve chosen if it wasn’t Speech-Language Pathology?
Probably medicine. Kinda wanted to be an ENT.
When you went into Speech-Language Pathology were you aware that there was a whole medical side to the field?
Yup. I had an outstanding A&P teacher at USF named Dr. Scheuerle (pronounced “surely”). She was a craniofacial anatomy expert. She infused clinical bits and pieces wherever she could and I really loved it.
At what point did you decide to go on for your PhD?
Ha ha…when the subject of child language had me by the neck yet again! After my masters, I decided to take a CFY in the public schools. OMG…not for me! I quickly decided that as soon as I got my CCCs, I would gladly take a monthly stipend of $1500 over my 50+K starting salary if it meant that I had the chance to learn incessantly.
Was there any one in particular who inspired you to pursue a PhD?
Yup. Dr. Scheuerle. After I re-took her A&P class after failing it the first time (…hey, even Michael Jordan struggled with basket ball in the beginning), she called me aside at the end of the class and told me I should consider doing a Ph.D. because I’m curious and I asked good questions. She planted the seed.
Who were/are some of your mentors in the field?
My research mentors are Christy Ludlow, JoAnne Robbins, Rebecca German, Pablo Celnik, and Nadine Connor.
Clinicians seem to have an “ah-ha” moment during their externship or CFY; What was yours?
I mostly had “uh uh” moments during my CFY. I felt completely lost and unsatisfied with treating kids in the school system. Some of it was my interest. Some of it was the system of treating kids in public schools.
What is it about dysphagia that drew you to dedicate your career to teaching, researching and treating patients?
I love anything mechanistic in our field. Cognition and language are too abstract for me. I would love to be a “head and neck engineer” if such a career existed.
It seems that Dysphagia is so misunderstood outside of SLP, ENT and of course several other exceptions. Do you agree? If so, why do you think that is?
Well if you mean among people who are not in the medical field at all, you’re right. People often think that swallowing can’t “go bad”. Within the medical community, I think its not well understood either. People who do not deal with dysphagia in their practice or research often think “Its simple. What’s the issue? Why can’t you understand it?” This is a clear sign that they don’t get it. Others, including myself, who are faced with diagnosing, treating, and/or researching dysphagia realize that, “Its complicated. That’s the issue. Its hard to understand”. I like to describe swallowing as “simply complicated”. Simple – because when it works, it works! Complicated – because when it doesn’t work, its not very easily restored.
Has anyone ever told you that, “swallowing is only a reflex” ? What was your response to them?
I hear it all the time. I don’t have a preference for reflexive versus volitional behaviors in general, so there is no offense taken when I hear this (i.e. there is no harm in reflexive behaviors, we all need to sneeze from time to time). I sometimes reply by asking people why they think of swallowing as only reflexive. It’s always good to consider why people believe what they believe, whether supported or not. You may leave the conversation with your opinions intact, but at least we are all talking about swallowing.
What runs through your head when you hear “did he pass or fail his swallow study?”
What is the definition of pass versus fail and why?
Do you have any personal favorite “myths” related to dysphagia that tends to be rampant in the greater medical community (i.e. “He can’t swallow, he doesn’t have a gag?”)
I don’t think we know enough about swallowing to define anything as an obvious myth. What I’ve learned is that for every point you want to make in medical science, there is a publication out there to support and to refute it.
I am very excited about the research out there that is being pursued in the area of exercise science and dysphagia rehabilitation. Can you comment on this area?
Hmmmmm. I think that exercise outcomes are clearer for OT and PT disciplines right now. I’m still deciding on how I feel about the literature on exercise for structures and functions involved in swallowing.
I know you have written a great deal on the topic of E-Stim. For the new clinician and maybe the seasoned clinician who is thinking about adding this to their therapy repertoire, what advice would you give them in regards to E-Stim?
Know your anatomy and physiology!
You recently published an article in the Dysphagia Journal “Human Hyolaryngeal Movements Show Adaptive Motor Learning During Swallowing.” What inspired you to address this area, and how do you see this manifesting in a clinical session?
I was exposed to the world of motor learning through Pablo Celnik, M.D., who is one of the mentors on my NIH career grant. I was very excited about how motor learning can be applied to help us to understand how swallowing works and for rehabilitation. I see it manifesting in a clinical session in diagnostic techniques wherein clinicians probe the swallowing system through perturbations and as treatment strategies that are based in skill learning and even in adaptation.
Is there a “must have” text out there that you think every dysphagia clinician should own?
Neuroscientific Principles of Swallowing by Arthur Miller. Challenge yourselves!
I love the “Swallowing Pocket Guide” you developed. Can you talk a little about it for those who may not be familiar?
I created this guide because many clinicians who attended my e-stim talks seemed to have difficulty identifying the peripheral motor and sensory systems that they are treating daily. I recalled that physicians have so many things to remember and often have pocket guides of all types with them. I thought, why not for swallowologists??
I remember when I finished my CF, I thought for a minute that there wasn’t anything that anyone could teach me about dysphagia treatment which I didn’t already know. Then I remembered I observed one of my graduate school professors in action with a dysphagia patient and I was immediately humbled, that I truly knew nothing at all : ). My bag of tricks was merely a change purse to her suitcase.
Do you have a routine or treatment method in your bag of tricks that others may find helpful?
Nothing that immediately comes to mind. The population I’ve been treating lately are in a SNF. There does not seem to be anything particularly routine about them, except that they really do not like altered diets, generally. One thing I really like to do at the start of some sessions is to ask them if they agree that they have a swallowing problem. I get so many “I don’t think so” responses, its pretty astounding.
Do you have any unorthodox treatment methods you wouldn’t mind sharing?
Hmmm… sometimes its interesting to ask the patient what they do or think they should be doing to treat their swallowing problems. Sometimes they can show you some pretty cool behaviors/ideas OR demonstrate the most horribly mal-adaptive strategies! This serves as good insight into what they are probably doing regularly to compensate in your absence (or 99% of the time), which could be assisting your treatment efforts or even countering them. Note: Its best to ask this question in a very non-judgmental, neutral way. Purely out of interest, not to condemn their answer.
Any advice or words of wisdom for clinicians who are embarking on a career in dysphagia?
Know your anatomy and physiology!
Well, a little confession. When I was at the Dysphagia Research Society Conference this year in Seattle, I remember there was a point where it feels like information overload. There were several sessions that stuck with me, because I knew it would have a clinical impact in our field. Having a small conference headache, I took the syllabus and book of abstracts and went to the Pike Place Market to find a place to sit down, relax, have a cup of coffee and digest some of the presentations. The original Starbucks was cool, but the line was way too long. I found a really nice French café and had an amazing latte. During this time of digestion and reflection, I particularly perked up (it wasn’t just the latte) when I reviewed your presentation about adaptive motor learning. I came up with the idea to start Dysphagia Café. Yes, there is so much out there to learn in the area of dysphagia, but I found such practical clinical insight from your contribution. I felt it was necessary to develop a forum to continue discussions on a greater scale with the SLP world. Your contributions to our field are very much appreciated by me and I am sure as you know, by many others.
Wow! I’m touched! I’m always surprised about how my seemingly small contributions actually have lasting impacts. Thanks very much for sharing that with me. I’m glad we’re in touch and I’m happy to have been asked to contribute to Dysphagia Café.
Thank you so much for your time, and for being the first ever Dysphagia Cafe interview : ) Any Closing remarks?
Its important to remember to:
1) Read the swallowing research literature. There is so much insight to be gained there.
2) If you think that dysphagia treatment will ever be like a recipe (i.e. laryngeal dysfunction —> mendelsohn —> etc), then we might as well hand swallowing practice off to technicians who do not need skills to treat, but only need Ikea-like instructions to complete the job. The reason we have graduate degrees is because we are expected to be skilled practitioners. Skills are honed over time. The basis of these skills is one’s understanding of the structure and function of swallowing.
Ianessa A. Humbert, Ph.D., CCC-SLP is an assistant professor at Johns Hopkins University in the Department of Physical Medicine and Rehabilitation. She has conducted research on the effects of electrical stimulation on hyo-laryngeal movement in healthy and dysphagic adults and vocal fold movement in healthy adults. Dr. Humbert’s current research activity focuses on understanding swallowing neurophysiology in healthy young and old adults and in disease. She also studies the effects of heightened sensory stimulation on swallowing as well as the principles of motor learning. Her interests include: family, gardening, dancing, and talking incessantly. Oh, and of course, Tazo Tea from Starbucks.
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