In collaboration with Drs. Kate Hutcheson (MD Anderson) and Nicole Rogus Pulia (University of Wisconsin Madison) we undertook a five-year dissemination and implementation (D&I) clinical trial in 2023 that seeks to scale up the recently validated Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) instrument via completion of the following specific aims:

1. Demonstrate validity of DIGEST in diverse oncology populations and imaging acquisition protocols
2. Examine context and fidelity of natural dissemination of DIGEST in real-world early adopters
3. Evaluate active implementation strategies to improve reach and fidelity of DIGEST in clinical practice.

This work is funded by the National Cancer institute (1R01 CA271223).

Dysphagia (swallowing impairment) is a common complication of cardiac surgical procedures leading to dehydration, reintubation, aspiration pneumonia, increased health care utilization, cost of care and length of hospitalization. Although preventable, dysphagia-related aspiration pneumonia is a major cause of 90-day mortality.

In this study we target current knowledge gaps that thwart clinical care models as we seek to identify: 1) Independent contributing risk factors for the development of dysphagia following cardiac surgery, 2) Sensitive clinical bedside biomarkers of swallowing impairment, and 3) Governing physiologic mechanisms of dysphagia during the postoperative recovery period. Information collected will be used to produce two pragmatic clinical tools that include: 

1. An open-access electronic dysphagia risk prediction calculator to enable accurate forecasting and facilitate personalized and evidenced-based triaged care pathways.
2. A validated bedside dysphagia screening tool to enable accurate and early detection of dysphagia in the cardiac intensive care unit. 

This clinical trial is funded by the National Institute of Nursing Research (R01 NR020175-01A1).

Dysphagia (swallowing impairment) is a serious health condition seen in many age-related diseases. Although videofluoroscopy is an international “gold standard” dysphagia diagnostic exam, normative physiologic healthy reference values across the age span do not exist to guide diagnostic interpretation. In our previous R01 (DC011020), we developed a rigorous method for measuring swallowing physiology: the Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT Method). In the current R01 renewal, we will:

1. Collect healthy reference values of swallowing for the ASPEKT outcome across the adult life span
2. Demonstrate scalability of the ASPEKT Method across commonly used variations in clinical videofluoroscopy testing protocols
3. Profile swallowing pathophysiology in clinical populations to identify clinical decision points that can be used for diagnosis and outcome measurement. 

Our vision is that the ASPEKT Method will enable clinicians to compare patient measures to healthy reference values, facilitating quantification and evidence-based interpretation of the presence, nature and severity of swallowing impairment. Ultimately, we seek to generate data that will shift subjective dysphagia diagnostic practices toward a quantitative and evidence-based diagnostic framework to improve resource utilization, treatment planning, and patient outcomes.

This clinical trial is being conducted in collaboration with Dr. Catriona Steele (University Health Network, Toronto) and Ashwini MacDonald (MacMasters University) and is supported by the National Institute of Aging (9R01 AG077481-09).

The objective of this proposal is to complete a small-scale human Phase II clinical trial (NCT04220021) to assess the safety and potential efficacy of metformin for the treatment of C9 ALS, identify relevant biomarkers, and prepare for a large multi-site placebo-controlled follow-up trial.

The specific aims of this study are to: (1) assess the safety of metformin for the treatment of C9 ALS; (2) test the hypothesis that metformin will reduce RAN protein levels in patient biofluids: (3) identify molecular and imaging biomarkers that may aid in future clinical trial design, patient selection, efficiency, and interpretation; and (4) prepare if the current trial is successful, for a large-scale placebo-controlled follow-up Phase III clinical trial. 

This Phase II clinical trial is supported by the Department of Defense (HT9425-23-1-0065)

Establishing Reference Values and Clinical Decision Points for Quantitative Videofluoroscopic Measures of Swallowing
Grant: National Institute of Aging, R01 AG077481-09
Role: Principal Investigator (MPI: Plowman & Steele)
Dates: 1/8/2022 – 7/30/2027

Mechanisms, Predictors and Clinical Markers of Dysphagia in Cardiac Surgical Patients 
Grant: National Institute of Nursing Research, R01 NR019183-01A1
Role: Principal Investigator (MPI: Plowman & Jeng)
Dates: 4/1/2022 – 3/31/2027

Dissemination and Implementation of DIGEST as an Evidence-based measurement tool in Cance.
Grant: National Institute of Cancer, 1R01 CA271223-01A1
Role: Co-Investigator (PI: K. Hutcheson)
Dates: 2/15/2023 - 1/30/2028

Metformin: Effects on RAN Proteins, Breathing, Imaging, and Metabolomic Outcomes
Grant: Department of Defense Clinical Trial Grant #13687585
Role: Co-Investigator (PI: L. Ranum)
Dates: 9/1/2023 – 8/30/2025

Plowman EK, Anderson A, York JD, DiBiase L, Vasilopoulos T, Arnaoutakis G, Beaver T, Martin T, Jeng EI. Dysphagia after cardiac surgery: Prevalence, risk factors, and associated outcomes. J Thorac Cardiovasc Surg. 2021 Mar 3:S0022-5223(21)00405-0. doi: 10.1016/j.jtcvs.2021.02.087. Epub ahead of print. PMID: 33814177.

Donohue, C., Wiele, L., Terry, A., Martin, T., Vasilopolous, T., Jeng, E., Plowman, E.K. Preoperative respiratory strength training is feasible and safe and improves pulmonary physiologic capacity in individuals undergoing cardiovascular surgery. J Thorac Cardiovasc Surg. Open. 2023. DOI: https://doi.org/10.1016/j.xjon.2023.07.005

Dallal York J, Leonard K, Anderson A, DiBiase L, Jeng EI, Plowman EK. Discriminant Ability of the 3-Ounce Water Swallow Test to Detect Aspiration in Acute Postoperative Cardiac Surgical Patients. Dysphagia. 2021 Jul 15. doi: 10.1007/s00455-021-10333-0. Epub ahead of print. PMID: 34268585.

Plowman, E. K., Chheda, N., Anderson, A., Dallal York, J., DiBiase, L., Vasilopoulos, T., Arnaoutakis, G., Beaver, T., Martin, T., BatJeng, E. (2020). Vocal Fold Mobility Impairment Following Cardiovascular Surgery: Incidence, Risk Factors and Sequela. The Annals of Thoracic Surgery, S0003-4975(20)31696-9. https://doi.org/10.1016/j.athoracsur.2020.07.074. PMID: 33075318.

Dallal-York J, Segalewitz T, Croft K, Vasilopoulos T, Pelaez A, Pipkin M, Machuca TN, Plowman EK. Incidence, risk factors, and sequelae of dysphagia mediated aspiration following lung transplantation. J Heart Lung Transplant. 2022 Aug;41(8):1095-1103. Epub 2022 May 26. doi: 10.1016/j.healun.2022.05.001. PMID: 35662492.

Dallal-York J, Croft K, Anderson A, DiBiase L, Donohue C, Vasilopoulos T, Shahmohammadi A, Pelaez A, Pipkin M, Hegland KW, Machuca TN, Plowman EK. A prospective examination of swallow and cough dysfunction after lung transplantation. Neurogastroenterol Motil. 2023 Apr;35(4):e14458. doi: 10.1111/nmo.14458. Epub 2022 Sep 27. PMID: 36168190.
Plowman EK, Gray LT, Chapin J, Anderson A, Vasilopoulos T, Gooch C, Vu T, Wymer JP. Respiratory Strength Training in Amyotrophic Lateral Sclerosis: A Double-Blind, Randomized, Multicenter, Sham-Controlled Trial. Neurology. 2023 Feb 20:10.1212/WNL.0000000000206830. doi: 10.1212/WNL. 0000000000206830. Epub ahead of print. PMID: 36805435.

Tabor Gray L, Locatelli E, Vasilopoulos T, Wymer J, Plowman EK. Dextromethorphan/quinidine for the treatment of bulbar impairment in amyotrophic lateral sclerosis. Ann Clin Transl Neurol. 2023 Jun 2. doi: 10.1002/acn3.51821. Epub ahead of print. PMID: 37265174.

Tabor Gray L, McElheny KL, Vasilopoulos T, Wymer J, Smith BK, Plowman EK. Predictors of Peak Expiratory Cough Flow in Individuals with Amyotrophic Lateral Sclerosis. Dysphagia. 2023 Apr;38(2):719-725. doi: 10.1007/s00455-022-10503-8. Epub 2022 Aug 5. PMID: 35931882.

Tabor-Gray, L., Vasilopoulos, T., Wheeler-Hegland, K., Wymer, J., & Plowman, E. K. (2020). Reflexive Airway Sensorimotor Responses in Individuals with Amyotrophic Lateral Sclerosis. Dysphagia, 10.1007/s00455-020-10171-6. Advance online publication. https://doi.org/10.1007/s00455-020-10171-6.

Link to all publications

Professor, 2023 - Present
Department of Otolaryngology - Head and Neck Surgery
The Ohio State University College of Medicine, Columbus, Ohio

2023  Elected Secretary-Treasurer, Dysphagia Research Society
2023  3rd Place Poster Presentation, 31st Dysphagia Research Society Virtual Meeting (senior author)
2022  Fellow, American Speech and Hearing Association
2022  2nd Place Poster Presentation, 30th Dysphagia Research Society Virtual Meeting (senior author)
2021  National Institute of Neurological Disorders & Stroke Story Landis Award for Outstanding Mentorship
2021  Doctoral Mentor of the Year, College of Public Health & Health Professions, University of Florida
2021  Superior Faculty Accomplishment Award, University of Florida
2021  1st Place Poster Presentation, 29th Dysphagia Research Society Virtual Meeting (senior author) 
2020  Deans Citation Award, College of Public Health & Health Professions, University of Florida
2020  1st Place Platform Presentation, 10th European Society of Swallowing Disorders Meeting (first author)
2020  1st Place Poster Presentation, 28th Dysphagia Research Society Virtual Meeting (senior author)
2020  Steven Leder Award, 28th Dysphagia Research Society Virtual Meeting (senior author)
2020  Research Finalist for Best Scientific Presentation, Society Thoracic Surgeons Meeting (first author)
2019  Finalist, International Symposium on ALS/MND Research Award, WA, Australia (senior author)
2019  Top Downloaded 2018-2019 Article, Muscle and Nerve (first author)
2019  1st Place Scientific Platform Presentation, 27th Dysphagia Research Society Meeting (first author)
2018  1st Place Poster Presentation, 26th Dysphagia Research Society Meeting (senior author)
2017  Deans Citation Award, University of Florida (first author)
2015  Finalist, International Symposium on ALS/MND Research Award, Brussels, Belgium (first author)
2014  1st Place Scientific Presentation, 22nd Dysphagia Research Society Meeting (senior author)
2013  1st Place Scientific Presentation, 3rd Cutting Edge Laryngology Meeting, London, U.K
2013  American Board of Swallowing and Swallowing Disorders Research Award
2013  2nd Place Scientific Platform Presentation, 21st Dysphagia Research Society Meeting (first author)
2012  American Speech-Language-Hearing Association Lessons for Success Alumni invited speaker
2012  Faculty Poster Award, 20th Dysphagia Research Society Meeting (first author)
2012  2nd Place Poster Award, 20th Dysphagia Research Society, Toronto, Canada (first author)
2012  Keynote Presenter, 5th Annual Norwegian Laryngology Conference, Hemsedal, Norway
2011  Keynote Presenter, Sydney Dysphagia & Oesophagology Course, Sydney, Australia
2010  Junior Keynote presenter NIDCD Symposium: Neuroplasticity in the mature brain, Washington, DC
2010  1st Place Scientific Presentation, NIDCD Integrative Neural Systems Symposium (first author)
2010  American Speech-Language-Hearing Association 8th Annual Lessons for Success Recipient
2010  2nd Place Scientific Presentation, 18th Dysphagia Research Society Meeting (first author)
2009  McKnight Brain Institute, Department of Neurology, Research Fellow of the Year
2009  Movement Disorders Society New Investigator Travel Grant
2009  Florida Society of Neurology Fellow Research Award
2008  1st Place Poster, 3rd Neuromuscular Plasticity Symposium (first author)
2005  Kenneth G. Bzoch Speech-Language-Hearing Research Award
2003  International Academic Scholar of the Year Award, University of Florida
2002  University of Florida Scholars Award for 4.0 GPA by Doctoral Student.
2001  American Speech-Language-Hearing Association Division 13 New Investigator Grant
2001  Best Scientific Paper by New Investigator, Dysphagia Research Society Meeting, Albuquerque, NM
2000  Awarded Curtin Speech & Hearing Outstanding Research Thesis Award
2000  Awarded First Class Honors for Research Thesis
2000  Letter of Academic Commendation, Curtin University of Technology, Australia
1999  Golden Key National Honor Society
1999  Rotary Citizenship Award
1999  President - Student Speech Pathology Association