Joanne Robbins

Julie A. Mares, Ph.D.

Ph.D., Northwestern University
Professor, Department of Medicine- Geriatrics
Associate Director, Geriatric Research Education and Clinical Center

Emphasis Group:
The Nature, Diagnosis, Treatment and Prevention of Senescent Swallowing

Principal Research Interests:

Difficulty swallowing (dysphagia) affects approximately 18,000,000 adults and millions of children in the U.S. Dysphagia has been associated with specific diseases of aging, most commonly stroke, although we have found that disease-free aging also can affect swallowing. In the University of Wisconsin/VA Swallowing, Speech And Dining Enhancement Program (SSWAL-ADE), the age-related biomechanical and physiological changes we have documented and their impact on the flow of food beginning in the oropharynx through the gastrointestinal system explain, at least in part, the life-threatening pneumonia, malnutrition, dehydration, and reduced quality of life so frequently found in older individuals.

Another major focus of our work is to improve diagnostic imaging and treatment interventions for dysphagia. We have custom-designed barium with specific rheologic properties including viscosity, adhesiveness, and taste in order to maximize fluoroscopic diagnostic imaging and treatment information derived from the routine clinical radiographic examination. We have patented our technology through the Wisconsin Alumni Research Foundation (WARF), and an industry partner manufactures the new bariums. Our materials are becoming the clinical and research standard. Beverages that match the diagnostic fluids are currently under development to improve treatment for dysphagic patients. In addition to developing new diagnostic materials for fluoroscopic imaging, the use of (fast) magnetic resonance imaging will be explored for its utility in swallowing diagnosis in coming years.

A federally funded grant supported our work and collaboration with UW Nutritional Sciences, focusing on the effect of lingual exercise on swallowing-related outcomes including aspiration, pneumonia, tongue strength, muscle mass, swallowing physiology, swallowing-specific quality of life and diet in frail elderly patients with dysphagia. Novel anatomic MR imaging techniques were applied to oropharyngeal structures to investigate effects of interventions on sarcopenia in the head and neck. Functional magnetic resonance imaging is being applied to swallowing to elucidate central nervous system influences and neural plasticity in response to swallowing rehabilitation including oropharyngeal exercise and/or sensory stimulation, including taste. Esophageal physiology and its effect on bolus flow during swallowing are also studied. We have hypothesized that clinicians may be confusing gastroesophageal reflux (GER) with intra-esophageal reflux (IER) and intra-esophageal stasis (IES). Unlike GER, with IER food may remain in the esophagus and back up into the throat where it can be inhaled by the lungs and cause respiratory illness, particularly in many older adults. Treatment implications are tremendous and could potentially diminish pneumonia, the third leading cause of death in the geriatric population.

Finally, the U.S. Department of Agriculture (USDA) has funded our work collaborating with the Department of Food Science at the UW, determining important rheologic parameters in addition to viscosity, that are integral in improving bolus flow toward our goal of developing optimal biophysically designed fluids for people suffering from dysphagia.

Dr. Robbins is inventor on four U.S. patents administered by the Wisconsin Alumni Research Foundation (WARF) and she is the founder of Swallow Solutions, LLC.


Representative Publications:

Buehring, B., Hind, J., Fidler, E., Krueger, D., Binkley, N., & Robbins, J. (2013). Tongue strength is associated with jumping mechanography performance and handgrip strength but not with classic functional tests in older adults. Journal of the American Geriatrics Society, 61(3), 418-422.
View publication via DOI: DOI:10.1111/jgs.12124

Malandraki, G.A., & Robbins, J. (2013). Effects of aging on oral contributions to deglutition. In R. Shaker, G. Postma, P. Belafsky, & C. Easterling (Eds). Principles of Deglutition: A Multidisciplinary Text for Swallowing and its Disorders. New York: Springer.

Juan, J., Hind, J., Jones, C., McCulloch, T., Gangnon, R., & Robbins, J. (2013). Case study: Application of isometric progressive resistance oropharyngeal therapy using the Madison oral strengthening therapeutic device. Topics in Stroke Rehabilitation, 20(5), 450-470.
View publication via DOI: DOI:10.1310/tsr2005-450

Rogus-Pulia, N., & Robbins, J. A. (2013). Approaches to the rehabilitation of dysphagia in acute poststroke patients. Seminars in Speech and Language 34(3), 154-69.
View publication via DOI: DOI:10.1055/s-0033-1358368

Malandraki, G. A., Kaufman, A., Hind, J., Ennis, S., Gangnon, R., Waclawik, A., & Robbins, J. (2012). The effects of lingual intervention in a patient with inclusion body myositis and Sjogren’s syndrome: A longitudinal case study. Archives of Physical Medicine and Rehabilitation, 93(8), 1469-1475.
View publication via DOI: DOI:10.1016/j.apmr.2012.02.010

Hind, J., Divyak, E., Zielinski, J., Taylor, A., Hartman, M., Gangnon, R., & Robbins, J. A. (2012). Comparison of standardized bariums with varying rheological parameters on swallowing kinematics in males. Journal of Rehabilitation Research and Development 49(9), 1399-404.
View publication via DOI: DOI:10.1682/JRRD.2011.09.0180

McCullough, G., Crary, M., Schmidley, J., Kamarunas, E., Mann, G., & Robbins, J. (2012). Effects of Mendelsohn maneuver on measures of swallowing duration post-stroke. Topics in Stroke Rehabilitation 19(3), 234-43.
View publication via DOI: DOI:10.1310/tsr1903-234

Kammer, R., & Robbins, J. (2011). Rehabilitation of Heavily Treated Head and Neck Cancer Patients. In J. Bernier (Ed.), Head and Neck Cancer (pp. 629-639). New York: Springer.
View publication via DOI: DOI:10.1007/978-1-4419-9464-6_45

Malandraki, G., & Robbins, J. (2011). Dysphagia Neurorehabilitation. In M.J. Aminoff , F. Boller, D.F. Swaab (Eds.), Handbook of Clinical Neurology series, 3rd ed.

Kind, A., Anderson, P., Hind, J., Robbins, J., & Smith, M. (2011). Omission of dysphagia therapies in hospital discharge communications. Dysphagia, 26(1), 49-61.
View publication via DOI: DOI:10.1007/s00455-009-9266-4

Malandraki, G.A., Johnson, S.C., & Robbins, J. (2011). Functional MRI of swallowing: From neurophysiology to neuroplasticity. Head and Neck, 33(S1), S14-S20.
View publication via DOI: DOI:10.1002/hed.21903

Malandraki, G.A., Hind, J. A., Gangnon, R., Logemann, J.A., & Robbins, J. (2011). The Utility of Pitch Elevation in the Evaluation of Oropharyngeal Dysphagia: Preliminary Findings. American Journal of Speech-Language Pathology, 20(4), 262-268.
View publication via DOI: DOI:10.1044/1058-0360(2011/10-0097)

Humbert, I.A., McLaren, D.G., Malandraki, G., Johnson, S.C., & Robbins, J. (2011). Swallowing Intentional Off-State in Aging and Alzheimer’s disease: Preliminary Study. Journal of Alzheimer’s Disease, 26(2), 347-54.
View publication via DOI: DOI:10.3233/JAD-2011-110380

Kays, S., Hind, J., Gangnon, R., Robbins, J. (2010). Effects of dining on tongue endurance and swallowing-related outcomes. Journal of Speech, Language, and Hearing Research, 53, 898-907.
View publication via DOI: DOI:10.1044/1092-4388(2009/09-0048)

Humbert, I.A., McLaren, D.G., Kosmatka, K., Fitzgerald, M., Johnson, S., Porcaro, E., Kays, S., Umoh, E.O., & Robbins, J. (2010). Early deficits in cortical control of swallowing in Alzheimer’s disease. Journal of Alzheimer’s Disease, 19(4), 1185-97.
View publication via DOI: DOI:10.3233/JAD-2010-1316

Hind, J., Stewart, J., Schelman, W., & Robbins, J. (2010). Breast Cancer. In H.N. Jones, & J.C Rosenbek (Eds.), Dysphagia in rare conditions: An encyclopedia (Chapter 8). Plural Publishing, Inc.

Robbins, J., Daniels, S., & Baredes, S. (2009). Neurological swallowing disorders. In A. Blitzer, M. Brin, & L. Ramig (Eds.) Neurologic disorders of the larynx (chapter 16, 2nd ed.). New York: Thieme.

Ney, D., Weiss, J., Kind, A.J.H., & Robbins, J. (2009). Senescent swallowing: Impact, strategies and interventions (Invited Review). Nutrition in Clinical Practice, 24(3), 395-413.
View publication via DOI: DOI:10.1177/0884533609332005

White, R., Cotton, S.M., Hind, J., Robbins, J., & Perry, A. (2009). A comparison of the reliability and stability of oro-lingual swallowing pressures in patients with head and neck cancer and healthy adults. Dysphagia, 24(2), 137-44.
View publication via DOI: DOI:10.1007/s00455-008-9181-0

Robbins, J., Hind, J., & Barczi, S. (2009). Disorders of swallowing. In W. Hazzard & J. Halter J, et. al. (Eds.), Hazzard’s geriatric medicine and gerontology: Principles of geriatric medicine & gerontology (6th ed.). New York: McGraw Hill Professional.

Jou, J., Radowsky, J., Gangnon, R., Sadowski, E., Kays, S., Hind, J., Gaumnitz, E., Taylor, A., & Robbins, J. (2009). Esophageal clearance patterns in normal older adults as documented with videofluoroscopic esophagram. Gastroenterology Research and Practice.
View publication via DOI: DOI:10.1155/2009/965062

Humbert, I.A., Fitzgerald, S., McLaren, D., Johnson, S., Porcaro, E., Kosmatka, K., Hind, J., & Robbins, J. (2009). Neurophysiology of swallowing: Effects of age and bolus type. NeuroImage, 44(3), 982-991.
View publication via DOI: DOI:10.1016/j.neuroimage.2008.10.012

Hind, J.A., Gensler, G., Brandt, D.K., Miller Gardner, P., Blumenthal, L., Gramigna, G., Kosek, S., Lundy, D., McGarvey-Toler, S., Rockafellow, S., Sullivan, P., Villa, M., Gill, G., Lindblad, A.S., Logemann, J.A., & Robbins, J.A. (2009). Comparison of trained clinician ratings with expert ratings of aspiration on videofluoroscopic images from a randomized clinical trial. Dysphagia , 24(2), 211-7.
View publication via DOI: DOI:10.1007/s00455-008-9196-6

McHorney, C.A., Martin-Harris, B., Robbins, J., & Rosenbek, J. (2008). Clinical validity of the SWAL-QOL and SWAL-CARE outcome tools with respect to bolus flow measures. Dysphagia, 23(4), 461.
View publication via DOI: DOI:10.1007/s00455-005-0026-9

Humbert, I.A., & Robbins, J. (2008). Dysphagia in the elderly. Phys. Med. Rehabil. Clin. N. Am., 19(4), 853-66.
View publication via DOI: DOI:10.1016/j.pmr.2008.06.002

Robbins, J., Butler, S.G., Daniels, S.K., Diez Gross, R., Langmore, S., Lazarus, C.L., Martin-Harris, B., McCabe, D., Musson, N., & Rosenbek, J. (2008). Swallowing and dysphagia rehabilitation: translating principles of neural plasticity into clinically oriented evidence. J. Speech Lang. Hear Res., 51(1), S276-300.
View publication via DOI: DOI:10.1044/1092-4388(2008/021)

Hewitt, A., Hind, J., Kays, S., Nicosia, M., Doyle, J., Tompkins, W., Gangnon, R., & Robbins, J. (2008). Standardized instrument for lingual pressure measurement. Dysphagia, 23(1), 16-25.
View publication via DOI: DOI:10.1007/s00455-007-9089-0

Humbert, I.A., Reeder, S.B., Porcaro, E.J., Kays, S.A., Brittain, J.H., & Robbins, J.A. (2008). Simultaneous estimation of tongue volume and fat fraction using IDEAL-FSE. Journal of Magnetic Resonance Imaging, 28(2), 504-508.
View publication via DOI: DOI:10.1002/jmri.21431

Robbins, J.A., Gensler, G., Hind, J.A., Logemann, J.A., Lindblad, A.S., Brandt, D., Kosek, S., Dikeman, K., Kazandjian, M., Gramigna, G., McGarvey-Toler, S., Miller & Gardner, P. (2008). Comparison of two interventions for liquid aspiration on pneumonia incidence: A randomized controlled trial. Annals of Internal Medicine, 148(7), 509-518.

Logemann, J., Gensler, G. Robbins, J., Lindblad, A.S., Brandt, D.K,. Hind, J., Kosek, S., Dikeman, K., Kazandjian, M., Gramigna, G., Lundy, D., & McGarvey-Toler, S.A. (2008). Randomized study of three interventions for aspiration of thin liquids in patients with dementia or Parkinson’s disease. Journal of Speech, Language, and Hearing Research, 51(1), 173-83.
View publication via DOI: DOI:10.1044/1092-4388(2008/013)

Humbert, I.A., & Robbins, J. (2007). Normal swallowing and functional magnetic resonance imaging: a systematic review. Dysphagia, 22(3), 266-75.
View publication via DOI: DOI:10.1007/s00455-007-9080-9

Robbins, J., Kays, S.A., Gangnon, R.E., Hind, J.A., Hewitt, A.L., Gentry, L.R., & Taylor, A.J. (2007). The effects of lingual exercise in stroke patients with dysphagia. Arch. Phys. Med. Rehabil., 88(2), 150-8.
View publication via DOI: DOI:10.1016/j.apmr.2006.11.002

Fried, L.F., Biggs, M.L., Shlipak, M.G., Seliger, S., Kestenbaum, B., Stehman-Breen, C., Sarnak, M., Siscovick, D., Harris, T., Cauley, J., Newman, A.B., & Robbins, J. (2007). Association of kidney function with incident hip fracture in older adults. J. Am. Soc. Nephrol., 18(1), 282-6.
View publication via DOI: DOI:10.1681/ASN.2006050546

Robbins, J., Kays, S., & McCallum, S. (2007). Team management of dysphagia in the institutional setting. J. Nutr. Elder., 26(3-4), 59-104.
View publication via DOI: DOI:10.1300/J052v26n03_04

Kim, H., Kim, Y., Lee, K., Chung, C., & Robbins, J. (2007). Dysphagia characterized by aspiration subsequent to pontine stroke. Journal of Medical Speech-Language Pathology, 15(2), 161.

Nicosia, M., Hoffman, S., & Robbins, J.A. (2007). The usefulness of the line spread test as a measure of liquid consistency. Dysphagia, 22(4), 306-11. (GRECC Manuscript #99-05).
View publication via DOI: DOI:10.1007/s00455-007-9086-3

Kays, S., & Robbins, J. (2006). Effects of sensorimotor exercise on swallowing outcomes relative to age and age-related disease. Semin. Speech Lang., 27(4), 245-59.
View publication via DOI: DOI:10.1055/s-2006-955115

Robbins, J. (2006). New frontiers in dysphagia rehabilitation. Semin. Speech Lang., 27(4), 217-8.
View publication via DOI: DOI:10.1055/s-2006-955111

Robbins, J.A., Bridges, A., & Taylor, A. (2006). Oral, pharyngeal and esophageal motor function in aging. In R.K. Goyal, & Shaker, R. (Eds.), Goyal and Shaker’s GI motility online. New York: Nature Publishing Group.

Hind, J.A., Nicosia, M.A., Gangnon, R., & Robbins, J. (2005). The effects of intraoral pressure sensors on normal young and old swallowing patterns. Dysphagia, 20(4), 249-53.
View publication via DOI: DOI:10.1007/s00455-005-0020-2

Robbins, J., Gangnon, R.E., Theis, S.M., Kays, S.A., Hewitt, A.L., & Hind, J.A. (2005). The effects of lingual exercise on swallowing in older adults. Journal of the American Geriatrics Society, 53(9), 1483-9.
View publication via DOI: DOI:10.1111/j.1532-5415.2005.53467.x

Robbins, J., Hind, J., & Logemann, J. (2004). An ongoing randomized clinical trial in dysphagia. Journal of Communication Disorders, 37(5), 425-35.
View publication via DOI: DOI:10.1016/j.jcomdis.2004.04.006

Robbins, J.A., & Barczi, S.R. (2003). Disorders of swallowing. In W. Hazzard & J. Halter (Eds.), Principles of geriatric medicine (5th ed.). New York: McGraw Hill.

Robbins, J., Langmore, S., Hind, J.A., & Erlichman, M. (2002). Dysphagia research in the 21st century and beyond: proceedings from Dysphagia Experts Meeting, August 21, 2001. J. Rehabil. Res. Dev., 39(4), 543-8.

Robbins, J. (2002). The current state of clinical geriatric dysphagia research. J. Rehabil. Res. Dev., 39(4), vii-ix.

McHorney, C.A., Robbins, J., Lomax, K., Rosenbek, J.C., Chignell, K., Kramer, A.E., & Bricker, D.E. (2002). The SWAL-QOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults: III. Documentation of reliability and validity. Dysphagia, 17(2), 97-114.
View publication via DOI: DOI:10.1007/s00455-001-0109-1

Robbins, J., Langmore, S., Hind, J.A., & Erlichman, M. (2002). Dysphagia research in the 21st century and beyond: proceedings from Dysphagia Experts Meeting, August 21, 2001. Journal of Rehabilitation Research and Development, 39(4), 543-8.

Hind, J., Nicosia, M., Carnes, M., Roecker, E., & Robbins, J. (2001). Comparison of effortful and non-effortful swallowing in healthy middle aged and older adults. Archives of Physical Medicine and Rehabilitation, 82, 1661-1665.
View publication via DOI: DOI:10.1053/apmr.2001.28006

Barczi, S., Sullivan, P., & Robbins, J. (2000). How should dysphagia care of older adults differ? Establishing optimal practice patterns. Sem. Speech and Language Path., 21, 347-361.

Kim, H.K., Chung, C.S., Lee, K.H., & Robbins, J.A. (2000). Aspiration subsequent to pure medullary infarction: Lesion sites, clinical variables and outcome. Archives of Neurology, 57, 478-483.

Nicosia, M.A., Hind, J.A., Roecker, E.B., Carnes, M., Doyle, J., Dengel, G.A., & Robbins, J. (2000). Age effects on temporal evolution of isometric and swallowing pressure. Journal of Gerontology, Medical Sciences, 55(11), M634-M640.
View publication via DOI: DOI:10.1093/gerona/55.11.M634

Barczi, S., Sullivan, P., & Robbins, J. (2000). How should dysphagia care of older adults differ? Establishing optimal practice patterns. Sem. Speech and Language Path., 21, 347-361.

Kim, H.K., Chung, C.S., Lee, K.H., & Robbins, J.A. (2000). Aspiration subsequent to pure medullary infarction: Lesion sites, clinical variables and outcome. Archives of Neurology, 57, 478-483.

Robbins, J. (1999). The evolution of swallowing neuroanatomy and physiology in humans: A practical perspective [Invited Editorial]. Annals of Neurology, 36, 279-280.
View publication via DOI: DOI:10.1002/1531-8249(199909)46:3<279::AID-ANA1>3.0.CO;2-1

Robbins, J. (1999). Old swallowing and dysphagia: Thoughts on intervention and prevention. Nutrition in Clinical Practice, 14(5), S21-S26.
View publication via DOI: DOI:10.1007/PL00009610

Robbins, J., Coyle, J., Roecker, E., Rosenbek, J., & Wood, J. (1999). Differentiation of normal and abnormal airway protection during swallowing using the penetration-aspiration scale. Dysphagia, 14(4), 228-232.

Priefer, B., & Robbins, J. (1997). Eating changes in mild stage Alzheimer’s disease: A pilot study. Dysphagia, 12(4), 212-221.
View publication via DOI: DOI:10.1007/PL00009539

Robbins, J.A., Levine, R.L., Wood, J., Roecker, E., & Luschei, E. (1995). Age effects on lingual pressure generation as a risk factor for dysphagia. Journal of Gerontology, Medical Sciences, 50A(5), M257-M262.
View publication via DOI: DOI:10.1093/gerona/50A.5.M257

Robbins, J.A., Levine, R.L., Maser, A., Rosenbek, J.C., & Kempster, G.L. (1993). Swallowing after unilateral cerebral stroke. Archives of Physical Medicine and Rehabilitation, 74, 1295-1300.

Robbins, J.A., & Levine, R.L. (1993). Swallowing after lateral medullary stroke syndrome plus. Clinics in Communicative Disorders, 3(4), 45-55.

Robbins, J.A., Hamilton, J.W., Lof, G.L., & Kempster, G. (1992). Oropharyngeal swallowing in normal adults of different ages. Gastroenterology, 103, 823-829.