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Kerstin Johansson

Lecturer

About me

I pursued my doctoral studies 2009-2013 under the supervision of assistant professor Ellika Schalling (KI), and co-supervisors professors Lena Hartelius (Gothenberg University, GU) and Sten Fredrikson (KI). My thesis includes works on voice and speech characteristics in multiple sclerosis (MS) and cervical spinal cord injury (CSCI), and effects of respiratory training such as glossopharyngeal breating in MS and CSCI, and Expiratory Muscle Strength Training (EMST) in MS.

I got my speech-language pathology (SLP) degree 1989 at the SLP program at GU. Current position (since 1997) is clinical SLP at Function Area Speech-Language Pathology at the Karolinska University Hospital, where my work focuses on assessment and treatment of speech and swallowing in patients with neurological conditions, such as stroke, Parkinson's disease, MS, ALS, Huntington's disease, and in frail patients, specifically elderly with cognitive disorders or dementia. Affiliatied to the division of speech-language pathology at the Department of Clinical Science, Intervention and Technology (CLINTEC) at the Karolinska Institutet, I am active in at the SLP program in teaching, clinical supervision, and supervision of students' thesis and master theses.

Research description

Research Area

Swallowing difficulties in the elderly: identification, intervention and prevention.

In national and international clinical research collaborations, projects are planned with the aim to reduce the risk for complications of dysphagia in the elderly. These complications include malnutrition, dehydration, airway complications and reduced quality of life. The overarching aim of the project is improved methods for identification and diagnostics of dysphagia in elderly and improved intervention and prevention for dysphagia in the healthcare. Several studies are planned within the project: 1) prevalence of dysphagia in elderly who visit a primary care central, 2) patient experiences of dysphagia and patient-reported needs for intervention in elderly with dysphagia, 3) validation of a clinical instrument for speech and language pathologists – KIS2018v2 – for the quantification of dysphagia and aspiration, 4) design of a multilevel screening tool to detect mealtime problems in older people with dementia in the community or residing in nursing homes, and 5) effects of different training methods for improved swallowing. The benefit for the individual is improved health and quality of life, for the health care increased knowledge and safer routines, for society reduced costs. The studies are carried out partly within the curriculum of students’ theses and master theses at the division of speech and language pathology and re planned in collaboration with Swedish or international researchers.

Speech after cervical spinal cord injury, CSCI.

After my dissertation in November 2013 in-depth studies of voice and speech in relation to respiratory function in CSCI (together with assistant professor Anita McAllister, KI). Four studies are planned with the aim of providing a basis for SLP intervention in this patient group. The project is also undertaken in collaboration with professor Johan Sundberg at the Speech, Music, and Hearing, Royal Institute of Technology, Stockholm. For study II, data has been collected in the respiratory laboratory of professor Mattias Heldner, Department of Linguistics, Stockholm University (SU).

Neuromotor speech disorders.

Together with assistant professor Ellika Schalling (KI) and professor Lena Hartelius (GU), surveys on self-perceived speech changes and services provided following MS, PD and CSCI have been performed. The questionnaires used included questions on perceived symptoms related to speech and communication, experienced restrictions in communicative participation, and services received.

In collaboration with professor Lena Hartelius and the Region Västra Götaland (Angered Hospital and Skaraborg Hospital) a clinical project is running during 2019-20 with the aim to study the Effects of Exspiratory Muscle Strength Training (EMST) on voice, speech and swallowing in Parkinson’s disease and Multiple Sclerosis (MS). EMST is a promising training method recently introduced in Sweden. Examples of documented effects on swallowing after EMST is a more efficient swallowing and a decrease in penetration and aspiration. A service evaluation of clinical experiences (K. Johansson, presentation at the National Conference of Logopedics, 2018) from the first years EMST has been offered in Sweden shows that the method is appreciated among patients. Also, compliance is high for patients who participate in EMST. The expiratory pressure (which reflects the strength in the exspiratory musculature) increases. Patients who have participated report positive effects such as reduced cough during meals, a generally more forceful cough and improved ”wind”. However, the effects of EMST on voice, speech and swallowing needs to be further evaluated, which is the aim of the above described project.

Supervision, ongoing master projects

SLP Emma Lindroos – Free from dysphagia?

SLP Jeanette Telford – Effects of contagious yawning on saliva production and swallowing in adults with traumatic brain injury – a possible treatment method

SLP Sanna Jansson – Effects of free water in patients with dysphagia

SLP Jeanette Holmgren Nilsson – Effects of pitch training on swallowing safety in individuals with neurological conditions, for example, ALS

Completed master project:

SLP Elisabet Östlund – Perception of pitch, identification of children's songs, and self-reported experiences of music in children with bilateral cochlear implants

Publications

Johansson K, Seiger, Å, Forsén, M, Holmgren Nilsson J, Hartelius, L, Schalling, L. Assessment of voice, speech and communication changes associated with cervical spinal cord injury. Int J Lang Commun Disord 2018 53(4):761-775. Epub Feb, 24, 2018DOI: 10.1111/1460-6984.12380

Schalling, E, Johansson, K, Hartelius, L. Speech and communication changes reported by people with Parkinsons's disease. Folia Phoniatr Logop 2017 69(3):131-141. Epub 2018 Jan 18. doi: 10.1159/000479927

Johansson K, Strömbergsson S, Robieux C, McAllister A. Perceptual detection of subtle dysphonic traits in individuals with cervical spinal cord injury using an audience response systems approach. J Voice. 2017 Jan;31(1):126.e7-126.e17. doi: 10.1016/j.jvoice.2015.12.015. Epub 2015 Dec 24.

Vogel AP, Keage MJ, Johansson K, Schalling E. Treatment for dysphagia (swallowing difficulties) in hereditary ataxia. Cochrane Database of Systematic Reviews 2015 11:1-20, CD010169. doi: 10.1002/14651858.CD010169.pub2.

Johansson K, Hartelius L, Kjellmer L, Fredrikson S, Schalling E. “I can walk briskly and talk at the same time!” - effects of Expiratory Muscle Strength Training (EMST) on respiration and speech in multiple sclerosis. J Med Speech Lang Pathol 2012 20(4):70-76

Johansson K, Nygren-Bonnier M, Schalling E. Effects of glossopharyngeal breathing on speech in severe multiple sclerosis: a case report. Mult Scler 2012 18(6):905-8. Epub 2011 Dec 19. 2012 Jun;18(6):905-8. doi: 10.1177/1352458511430223. Epub 2011 Dec 19.

Johansson K, Nygren-Bonnier M, Klefbeck B, Schalling E. Effects of glossopharyngeal breathing on voice in individuals with cervical spinal cord injury. Int J Ther Rehabil 2011 18(9):501-510 DOI: 10.12968/ijtr.2011.18.9.501. Epub 29 Sep 2013. Publikationsdatum papper 1 september 2011.

Widen Holmqvist L, von Koch L, Kostulas V, Holm M, Widsell, G, Tegler H, Johansson K, Almazán J och J de Pedro-Cuesta. A randomized controlled trial of rehabilitation at home after stroke in southwest Stockholm. Stroke 1998 29(3):591-7 https://doi-org.proxy.kib.ki.se/10.1161/01.STR.29.3.591

Education

Teaching Area

Course coordinator of the course Dysphagia (4.5 credits) in the SLP program at KI. Supervisor in clinical training of SLP students, and of students' and master theses.

In 2002, 2006 and 2010 course coordinator for the freestanding course Fiberendoscopy in SLP practice (7.5 hp), KI, in collaboration with assistant professors Ellika Schalling (in 2010) and Gunilla Henningsson (2002).

Academic honours, awards and prizes

Åke Ljundahlsstipendiet, Parkinsonförbundet, 2005

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