NIH National Heart, Lung, and Blood Institute

All-in-one measurement and exercise respiratory strength trainer with biofeedback and adherence tracking capability

R41 HL176339-01 (9/10/2024-9/9/2025)

Principal Investigator: Alicia Vose, PhD

This NIH STTR grant proposal targets the prevalent problem of chronic obstructive pulmonary disease (COPD) by introducing the RMT Complete—a comprehensive respiratory muscle strength training device and mobile application designed to overcome limitations in existing devices. We have developed an all-in-one, cost-effective device with integrated features like adherence monitoring, biofeedback, and pressure measurement. In Phase I, the proposal focuses on assessing the device's usability to guide device enhancements, laying the groundwork for an advanced respiratory training solution, and paving the way for Phase II clinical trials and commercialization to address challenges in respiratory rehabilitation and adherence monitoring.

NIH National Center for Advancing Translational Science

Acute Intermittent Hypoxia to Improve Airway Protection after Chronic Ischemic Stroke

KL2/K12 UF-FSU Clinical and Translational Science Award

UL1TR001427 (7/1/24 - 6/30/24)

Principal Investigator: Alicia Vose, PhD

This project addresses the critical need for improved rehabilitation strategies for chronic post-stroke dysphagia, a condition affecting nearly 40% of stroke survivors, impairing nutritional intake and increases the risk of aspiration pneumonia. Current rehabilitative strategies often fall short, with gains diminishing soon after training, leaving many patients dependent on enteral feeding for nutrition and hydration. This research explores a promising strategy to improve motor function by inducing plasticity via intermittent exposures to modest bouts of low oxygen (acute intermittent hypoxia [AIH]). Since induced recovery is most pronounced when AIH is combined with some form of task-specific training/rehabilitation, this project will test the hypothesis that combined use of AIH with task-specific swallow rehabilitation will enhance the magnitude and duration of swallowing rehabilitation (more than either strategy alone) in individuals with chronic post-stroke dysphagia. Additionally, the project seeks to identify genetic biomarkers linked to individual responsiveness to AIH, which could help predict who may benefit most from this therapy. Our goal is to enhance the effectiveness and functional benefit of dysphagia rehabilitation and to identify genetic biomarkers that improve stroke care precision.

Brooks Rehabilitation Collaborative Research Grant

Swallowing and Respiratory Function in Chronic Spinal Cord Injury

AWD13291 (1/1/2022 - 12/31/2024)

Principal Investigator: Alicia Vose, PhD

Respiratory complications, such as pneumonia, sepsis, and respiratory failure, are the leading causes of morbidity and mortality in individuals with spinal cord injury (SCI). Dysphagia, or swallowing impairment, contributes to these complications by increasing aspiration risk. In acute SCI, ~60% experience dysphagia, yet the prevalence and implications of dysphagia in chronic SCI are not well-understood. Reduced breathing capacity in chronic SCI can further disrupt breathing-swallowing coordination—a critical mechanism for airway protection—likely heightening the risk for aspiration and infection. This study will also test the hypothesize that individuals with moderate to severe respiratory impairments post-SCI will also exhibit impaired airway protection, which may exacerbate the risk for aspiration related respiratory infections. Additionally, we will explore the potential of acute intermittent hypoxia (AIH), an intervention involving brief, controlled low-oxygen exposure, to improve swallowing function in this population. AIH has shown promising results in enhancing breathing, walking, and hand function in SCI patients but has yet to be tested for swallowing improvement. The clinical significance of this work lies in its potential to identify an unrecognized contributor to respiratory disease in SCI, offering a new avenue to improve health outcomes.

FL Dept of Health: Brain and Spinal Cord Injury Research Trust Fund (BSCIRTF) Seed Award

Acute Intermittent Hypoxia to Improve Swallow Timing in Mild-Moderate TBI

Florida Department of Health; UF Brain Injury, Rehabilitation, and Neuroresilience Center

Principal Investigator: Alicia Vose, PhD

This project addresses the need for effective rehabilitation strategies to restore swallowing and airway protection in individuals with chronic traumatic brain injury (TBI), who face high rates of dysphagia (swallowing impairment) and aspiration-related complications. Approximately 93% of patients admitted to rehabilitation for TBI experience dysphagia, which, alongside impaired cough reflexes, increases their susceptibility to pneumonia, sepsis, and mortality. Traditional compensatory swallowing maneuvers, though widely used, demand high cognitive engagement, making them difficult to sustain in individuals with cognitive deficits like those seen in TBI. This research investigates a promising approach combining acute intermittent hypoxia (AIH)—a method that enhances neuroplasticity through brief episodes of low oxygen exposure—with traditional swallowing rehabilitation. The study will test whether this combined intervention will improve swallowing biomechanics and airway protection more effectively and for longer duration than traditional swallowing rehabilitation alone. If successful, this work could lead to a low-cost, easily translatable therapeutic option for individuals with TBI and has potential applications across other neurological conditions with significant dysphagia risk, such as stroke and spinal cord injury.

ClinicalTrials.gov ID: NCT06520358

ALS Association

Acute adenosine receptor antagonism to promote breathing plasticity in ALS

AWD11788 (1/1/22 - 12/31/2025)

Principal Investigator: Barbara Smith, PhD DPT; Co-Investigator/Site PI: Alicia Vose, PhD

The purpose of this research study is to determine the effects of a medication, istradefylline, in conjunction with breathing air with reduced oxygen for short periods of time (called acute intermittent hypoxia, or AIH), on breathing. This project will study breathing in people with amyotrophic lateral sclerosis (ALS) and unaffected, age-matched adults. Istradefylline is prescribed to increase movement in people with other neuromuscular conditions. A recently completed study found that people with ALS took deeper breaths, 60 minutes after using AIH.

ClinicalTrials.gov ID: NCT05377424