Quadriplegia: A Study about Videoconferencing Oral Hygiene Training
Guest: Dr. Hon Yuen – Department of Health Professions, MUSC
Host: Dr. Linda Austin – College of Medicine - Dean’s Office, MUSC
Dr. Linda Austin: Dr. Hon Yuen is Associate Professor in the Division of Occupational Therapy, in the Department of Health Professions. In this podcast, we’re going to talk about a very interesting and exciting study. I understand, Dr. Yuen, that you actually got a perfect score on your NIH submission of this grant. So, tell us what the purpose of your study is.
Dr. Hon Yuen: The purpose of this study is to see whether oral hygiene training for community adults with quadriplegia using videoconferencing is effective.
Dr. Linda Austin: Dr. Yuen, tell us some more about this program. It sounds very important to help folks with quadriplegia to have good oral hygiene.
Dr. Hon Yuen: This is an individualized program of oral hygiene training using a personal computer with a Web camera and videoconferencing between each individual with quadriplegia and an occupational therapist, with collaboration from a dental hygienist. We are going to use a videoconferencing system that can be utilized via the World Wide Web. We’ll provide adaptive oral hygiene devices such as electric toothbrushes, dental cleaning devices, and Water Pik oral irrigators, as well as teach patients adaptive ways to perform oral hygiene.
All of this is a part of the repetition training to improve independency in performing oral hygiene. Training will be conducted once a week for twelve consecutive weeks. During the repeated training and supervised practice sessions, immediate feedback and reinforcement on using these adaptive devices correctly, safely, and independently to perform oral hygiene will be provided.
Dr. Linda Austin: Dr. Yuen, what is the potential for this study?
Dr. Hon Yuen: This study has the potential to extend access to dental care to individuals with quadriplegia who, historically, received antiquated dental hygiene training, as well as provide continuity of care with conventional dental services. This at-home oral care is by no means to replace traditional dental visits for cleaning and education from dental health professionals. It is complementary to the work of dental health professionals in providing holistic oral health care for these patients.
In addition, training from an occupational therapist, in collaboration with a dental hygienist, on the use of adaptive devices and adaptive ways to perform oral hygiene is a step toward integrating oral home care into a broad, interdisciplinary, comprehensive telerehabilitation program to maintain general health and improve the quality of life for individuals with quadriplegia.
Dr. Linda Austin: What is the uniqueness of this study?
Dr. Hon Yuen: Well, the uniqueness of this study is the education and training of oral hygiene for individuals with quadriplegia in the home environment, rather than a dental office. Oral hygiene training in the home environment has the potential benefit of maintaining skills and habits long-term.
Dr. Linda Austin: And what is the merit of videoconferencing?
Dr. Hon Yuen: The merit of videoconferencing is that the therapist can see exactly what the participant is doing in terms of oral hygiene performance, and the therapist can actually show the participant what to do.
Dr. Linda Austin: Why do you choose individuals with quadriplegia?
Dr. Hon Yuen: Well, because of the injury to their spinal cord, many individuals with quadriplegia have difficulty using a regular toothbrush and are unable to manipulate dental floss to clean their teeth. Poor hygiene performance and dry mouth from their medications can increase the chance for dental caries and periodontal disease. And regular dental visits can be a problem because of their limited mobility and use of a wheelchair. Some dental exam rooms may not be wheelchair accessible.
In addition to being at high risk for oral disease, individuals with quadriplegia have reduced respiratory function and coughing ability, because of their impaired breathing muscles; such as the diaphragm, which puts them at increased risk for aspiration pneumonia. Finally, because of their limited hand function, individuals with quadriplegia often use their teeth to assist in various daily activities, so preserving their teeth is important; to assist them with such activities.
Dr. Linda Austin: Why is an occupational therapist, rather than a dental hygienist, involved in this study?
Dr. Hon Yuen: Well, occupational therapists are rehabilitation professionals who specialize in helping people with disabilities perform self-care activities safely and independently. Within their scope of practice, occupational therapists recommend various adaptive oral hygiene devices and provide training in the correct, safe, and independent use of these devices. They also incorporate behavior modification techniques to motivate individuals with quadriplegia to complete daily oral hygiene routines and assist in establishing oral hygiene habits.
Dr. Linda Austin: Anything else you want to say about this?
Dr. Hon Yuen: It’s an exciting project, and I’m looking forward to implementing it in the next two years.
Dr. Linda Austin: Well, it is a very exciting project. How many patients do you anticipate enrolling in this study?
Dr. Hon Yuen: We’re going to enroll about 55 adults with quadriplegia.
Dr. Linda Austin: Wow – very interesting, and important. And, how much was the grant award?
Dr. Hon Yuen: About $275,000.
Dr. Linda Austin: Fantastic. Congratulations to you and your colleagues on what, I know, is a very important study for people who have quadriplegia.
Dr. Hon Yuen: Thank you very much.
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