2021 MacDiarmid Medal: Relearning the ability to swallow

The award is presented for outstanding scientific research with the potential for human benefit.

Maggie-Lee Huckabee’s research is focused on rehabilitating those who have difficulty swallowing as a result of stroke, brain injury or neurological disease.  These patients have primarily suffered damage to the part of the brain that controls the swallowing reflex, but through her research and a novel use of existing technology, Maggie-Lee has shown that it is possible to recruit undamaged parts of the brain to serve that function, using principles of neuroplasticity.

For individuals with swallowing impairment, simply drinking a glass of water is a challenge, if not a life-threatening task. Because of this, many patients with swallowing difficulty remain on feeding tubes and miss out on the social interactions that come from of eating and drinking. Maggie-Lee is motivated by the desire to turn this around for her patients.

Early in Maggie-Lee’s career, electrodes were used around the neck and throat with the idea of strengthening the muscles associated with swallowing, but after seeing unexpected improvement in a patient that had severe brain damage in the area of the brain normally associated with swallowing, she realised that rather than training the muscles, the technique was training another part of the brain to control swallowing instead.

From this realisation, she has refined the technology into what she describes as ‘a therapeutic video game’ that allows patients to see aspects of their swallowing response on the screen. They then learn to better control swallowing by controlling the image on the screen. She says that offering a personalised view of swallowing for these individuals is key because it is easier to change something you are looking at rather than something that is intrinsically inside you and thus invisible.

In 2014, she founded the UC Rose Centre for Stroke Recovery and Research at the University of Canterbury, a multi-disciplinary research and clinical facility with a focus on bioengineering applications for stroke rehabilitation. Patients visit from around the world to undergo intensive treatment using her biofeedback techniques.  Evidence shows that early intensive treatment works best to rehabilitate swallowing in patients, and she is working to influence healthcare practice worldwide.

Her biofeedback rehabilitation protocol has been well-received across Europe and Australasia, leading to development of the soon-to-be-released, app-based wireless system, allowing intensive home rehabilitation without increased associated healthcare resources.

Maggie-Lee collaborated with engineering colleagues to develop this software platform and associated biomedical technologies, for which a start-up company was launched earlier in the year with Maggie-Lee as a Director.

She also leads a stream of research focussed on increasing sensitivity and specificity of clinical and instrumental assessment methods.

Included under this umbrella are comprehensive programmes of research evaluating cough reflex testing in clinical assessment and another programme of research evaluating the instrumental techniques of pharyngeal manometry and neuromuscular ultrasound. As the director of these research programmes, a series of post-graduate students have completed extensive research on validity and reliability of these assessment measures for translation to clinical practice.

One simple test (clinical test) has been translated internationally for use in 13 countries.  Another clinical test has resulted in decreased length of hospitalisation and rates of chest infection. Outcomes included decreasing pneumonia rates across New Zealand health boards from 28% to less than 10%, as well as decreasing length of hospitalisation and bounce-back admissions, and returning patients to oral diet sooner. This $2.80 test resulted in an approximate $1.4M cost avoidance in the Canterbury DHB in the one year following implementation. Maggie-Lee is currently leading an interdisciplinary team to develop a point-of-care device for predicting chest infection, using machine learning algorithms drawn from physiologic and clinical data.

She is also committed to training and educating the next generation of clinicians and researchers.

Professor Maggie-Lee Huckabee received her PhD in Speech Language Pathology at the University of Memphis in the US, followed by a Fulbright Fellowship at the Department of Neurology in the General Hospital of Vienna, Austria. She joined the University of Canterbury in 2000. In 2020 she won ‘Best Canterbury Health Tech Solution’, has twice been nominated for New Zealander of the Year awards, and received the University of Canterbury Innovation Medal in 2014.

Upon winning the award, Maggie-Lee said: "I’m very grateful to be selected as recipient of the MacDiarmid Medal. I may share celebration of this medal well with good food and drink, around a table with my colleagues from the Rose Centre, being well aware that this simple pleasure would evade most of the patients we work for.  So, as a clinician, turned clinical scientist, I am even more grateful that this award provides an opportunity to draw attention to the unseen, but not uncommon, condition of swallowing impairment.  Greater recognition may ultimately facilitate improved clinical services and options for recovery for these patients.

"I owe huge gratitude to a long list of these individuals, who have taught me about their condition and that I need to listen to them if I want to be effective in helping them. A special toast to my colleague, Eric Knapp, who is the true expert on dysphagia following stroke.  I’m also grateful to the University of Canterbury for being an academic home that mostly lets me get on with my work without intrusion or micromanagement but with good support when it’s needed."   

Award:
The MacDiarmid Medal is awarded annually to a person or team who, while in New Zealand, has undertaken outstanding scientific research that demonstrates the potential for application to human benefit, such as in the areas of health, environment and technology.

Citation:
To Maggie-Lee Huckabee for sustained excellence in translational research to improve patient outcomes, decrease healthcare costs and create innovative technologies for effective rehabilitation of swallowing impairment.