NIDCD Strategic Plan: FY 2003-2005

Background

Diseases and Disorders of Human Communication Are Significant Health Problems

Effective communication is essential for the function of modern society. While science and technology have greatly improved our capacity for communication, many aspects of contemporary life remain profoundly difficult for individuals with communication disorders. It is estimated that one of every six Americans experiences some form of communication disorder (e.g., hearing impairment, dizziness, balance problems, smell and taste disorders, and voice, speech, or language disturbances). Communication disorders often compromise social, emotional, educational, and vocational aspects of an individual's life. The cost of these disorders in terms of quality of life and unfulfilled potential is substantial. As the population ages and the survival rate for medically fragile infants and individuals who have sustained injury improves, the number of individuals with communication disorders will continue to increase.

The mission of the National Institute on Deafness and Other Communication Disorders (NIDCD) is to conduct and support basic and clinical research and research training in the normal and disordered processes of hearing, balance, smell, taste, voice, speech, and language. Basic and clinical research studies focused on understanding the normal processes and disorders of human communication are motivated by intrinsic scientific interest, the importance of allowing all individuals to reach their full potential, and importance to the health of the Nation.

In January and February 1999, the NIDCD convened a group of 18 distinguished scientists and members of the public to provide recommendations for a Strategic Plan for the NIDCD for Fiscal Years 2000-2002. The Strategic Planning Group was asked to identify areas of research that fell within the mission of the NIDCD. The Strategic Planning Group considered the research currently supported by the Institute, as well as NIH-wide scientific initiatives. In addition, oral presentations and written statements from public organizations with an interest in research supported by NIDCD were provided to ensure that the public's perspective would be assimilated into the recommendations for a Strategic Plan. The final draft of the plan was discussed in detail at the NDCD Advisory Council meeting on May 27, 1999. To keep current with the state-of-the-science and advances in the field, the plan was reviewed and updated at the January 18, 2002, meeting of the NDCD Advisory Council.

Research Areas That Offer Extraordinary Scientific Opportunity

1. Determine the Molecular and Epidemiological Bases of Normal and Disordered Communication Processes
   
   
   • Utilize genomic and proteomic approaches, as well as other molecular biologic and genetic approaches, to study normal and disordered human communication, including gene identification, regulation, expression, and associated mutations.
     
     
   • Apply emerging technologies in genetics and molecular biology (including DNA microarrays and other genomic strategies) to the clinical setting and encourage multidisciplinary approaches to the prevention, detection, diagnosis, and treatment of communication disorders.
     
     
   • Assess the extent of common human DNA variation and its impact on the range of human communication phenotypes.
     
     
   • Investigate complex, multifactorial disorders of human communication that arise from the interactions of several different genes. Identify and analyze factors that influence variability and susceptibility to disease and response to treatment.
     
     
   • Develop animal models to identify specific disease gene loci, to identify and isolate specific cell populations, and to investigate cellular processes.
     
     
   • Develop in vitro systems to facilitate the study of function at the molecular level (e.g., gene and protein expression systems, organ and cell culture systems).
     
     
   • Apply genomic, proteomic, informatic, bioinformatic, and expression profiling technologies to understand the molecular bases of disordered communication. Examples include the development of comprehensive expressed sequence databases from sensory organs (olfactory neuroepithelium, cochlear and vestibular hair cells, taste receptor cells, laryngeal cells and tissues, etc.); these scientific databases will be used to identify many of the genes selectively expressed in these organs.
     
     
   • Explore the pathogenesis, treatment, and prevention of viral and bacterial infections in the ear.
     
     
2. Study the Development, Deterioration, Regeneration, and Plasticity of Processes Mediating Communication
   
   
   • Characterize age-related changes in structural and functional plasticity of communication processes.
     
     
   • Develop and apply novel techniques, e.g., functional imaging to assess structural and functional plasticity.
     
     
   • Determine cellular and molecular mechanisms underlying sensory cell regeneration (cochlear and vestibular hair cells, olfactory and gustatory cells), which may lead to the development of new therapeutic interventions.
     
     
   • Use in vitro assays to investigate molecular factors involved in stimulating embryonic and adult stem cells to differentiate into specific cell types used in communication. (All investigations using human stem cells must satisfy current Federal guidelines).
     
     
   • Use cultured and organ tissue/cell systems to investigate the molecular microenvironment of specific cell types involved in communication processes.
     
     
   • Investigate cellular and molecular protective mechanisms used by the body to protect olfactory, gustatory, auditory, and vestibular receptor cells. Develop methods to enhance these processes to improve survival of these sensory cells following trauma or disease.
     
     
   • Elucidate mechanisms underlying development, maturation, aging, and recovery of function needed for communication, including cell proliferation, differentiation, axon targeting, pattern formation, and cell death and survival.
     
     
3. Study Perceptual and Cognitive Processing in Normal and Disordered Communication
   
   
   • Investigate the molecular mechanisms of neurotransmission at key synapses between sensory receptor cells in the inner ear, taste buds, and olfactory epithelium and their neuronal targets, as well as those in the central nervous system that relay and integrate information.
     
     
   • Apply physiologic approaches, such as functional neuroimaging and multi-electrode, multi-unit recording in animal models to dissect the pathways, and define the location and sequence of neuronal activity essential for peripheral and central processing of sensory input. Define abnormalities of neural pathways and spatiotemporal neuronal activity patterns associated with disordered communication.
     
     
   • Develop quantitative methods to analyze sensory, sensori-motor, and cognitive processing in humans, in particular those processes not readily studied in animal models.
     
     
   • Investigate the perceptual and cognitive consequences of disordered communication and determine how these processes change with treatment.
     
     
   • Combine cellular, molecular, and physiologic approaches with behavioral analyses in basic science and clinical studies to understand normal mechanisms of sensory processing, cognition, and perception.
     
     
4. Develop and Improve Devices, Pharmacologic Agents, and Strategies for Habilitation and Rehabilitation of Human Communication Disorders
   
   
   • Capitalize on emerging technologies to design and improve devices that enhance communication.
     
     
   • Use clinical trials and other clinical studies to evaluate the efficacy of newly developed devices, drugs, and other therapies for individuals with communication disorders.
     
     
   • Develop and refine diagnostic criteria and capabilities to facilitate early diagnosis and prevention of communication disorders.
     
     
   • Use clinical trials and other clinical studies to develop and assess medical and behavioral interventions for infants and children who have a communication disorder.
     
     
   • Develop cost-effective techniques for the assessment of speech/language development and disorders in the broad range of languages currently used by residents of the United States, taking into account all cultural and ethnic groups.
     
     
   • Use modern behavioral, molecular genetic, electrophysiological, imaging, and other approaches to precisely define the phenotypes of communication disorders as a basis for optimizing clinical diagnosis and intervention.
     
     
   • Investigate the utility of reparative tissue methodologies, including the use and application of embryonic and adult stem cells, as potential sources of cell replacement and tissue regeneration following disease or injury in communication. (All investigations using human stem cells must satisfy current Federal guidelines).
     
     

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