The impact of sensory intervention on motor output and feeding performance in term and preterm infants

感觉干预对足月儿和早产儿运动输出和喂养表现的影响

• 批准号: 10283252
• 负责人: Christopher Mayerl
• 金额: $ 11.4万
• 依托单位: NORTHEAST OHIO MEDICAL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10283252
• 关键词: 3-Dimensional; Address; Anatomy; Animal Model; Automobile Driving; Behavior; Biomechanics; Biomimetics; Bolus Infusion; Brain Stem; Breast; Child; Chronic; Complex; Cranial Nerves; Data; Deglutition; Deglutition Disorders; Development; Discipline of Nursing; Electromyography; Ensure; Environment; Ethics; Evidence based intervention; Exhibits; Faculty; Failure; Family suidae; Feedback; Food; Foundations; Funding; Generations; Goals; Hospitalization; Human; Infant; Intervention; Liquid substance; Measures; Mentors; Milk; Modeling; Motor; Motor output; Muscle; Muscle function; Musculoskeletal; Musculoskeletal System; Nature; Neuronal Plasticity; Nipples; Oropharyngeal; Outcomes Research; Output; Patients; Performance; Periodicity; Physiological; Physiology; Premature Infant; Property; Radiation; Research; Resolution; Safety; Sensory; Speed; Suction; System; Testing; Translating; Variant; Viscosity; base; career; design; experience; experimental study; feeding; genioglossus muscle; improved; insight; kinematics; neonate; neuromuscular; novel; premature; pressure; programs; relating to nervous system; response; sensory input; temporal measurement; therapy design; therapy development

Infant feeding is a complex behavior that requires the ability to both acquire milk, as well as transport and swallow it. Preterm infants often exhibit a decreased ability to generate suction pressure to acquire milk, and experience challenges transporting and swallowing milk. Understanding the mechanisms behind these challenges is difficult due to the complexity of infant feeding as well as the fragile nature of preterm infants. Feeding is controlled by multiple cranial nerves and over 25 muscles, yet we know little of how those muscles function due to the ethical and practical restrictions of acquiring data on human infants. Clinicians cannot control for the degree of prematurity in their patients, cannot measure muscle function accurately or precisely, and are limited in the temporal resolution of their data, due to radiation from videofluoroscopic swallowing studies. The objective of this proposal is to use a validated animal model to acquire controlled, high resolution data to study how term and preterm infants respond to interventions to improve feeding performance during feeding. This research will combine bi-planar (3D) high speed (100 fps) videofluoroscopy with chronic indwelling fine-wire electromyography to measure how muscles drive the kinematics, swallow safety, and fluid dynamics of term and preterm infant feeding. The central hypothesis is that term infants will show higher levels of pressure generation and ability to transport viscous fluids, but that the plastic neural system of preterm infants will enable them to exhibit a greater response to increases in pressure generation requirements and increases in viscosity. First, I will measure how the musculoskeletal system responds to changes in pressure generation requirements to acquire food in term and preterm infant pigs (SA1-K99), and then measure the neuromotor response to changes in viscosity in term and preterm infant pigs (SA2-K99). Following these, I will measure neuromotor function of term and preterm infants when feeding on a biomimetic nipple, compared to those currently available commercially (SA3-R00).This research will provide insight into the mechanisms driving feeding performance in infants and provide a foundation for developing interventions based off physiologic, rather than qualitative, indications of poor performance for patients with dysphagia. This is significant because it represents an important advance in the basic understanding of the mechanisms of infant feeding, and mechanisms of failure. As such these results will be the foundation for evidence-based interventions for neonate dysphagia. This project will directly advance my career goals to establish a federally funded research program grounded in understanding normal and pathophysiologic sensorimotor integration. NEOMED is an excellent environment for me to develop this research program, as there are an array of faculty within the department that conduct cutting edge research on musculoskeletal function, in addition to my research mentor, whom is an expert in the field of infant dysphagia.

婴儿喂养是一种复杂的行为，需要有获取乳汁、运输和运输乳汁的能力。 吞下它。早产儿通常表现出产生吸力以获取乳汁的能力下降，并且 经历运输和吞咽牛奶的挑战。了解这些背后的机制 由于婴儿喂养的复杂性以及早产儿的脆弱性，应对挑战是困难的。 进食是由多个脑神经和超过 25 块肌肉控制的，但我们对这些肌肉是如何控制的知之甚少 由于获取人类婴儿数据的伦理和实际限制，该功能无法发挥作用。临床医生不能 控制患者的早产程度，无法准确或精确地测量肌肉功能， 由于电视荧光镜吞咽的辐射，其数据的时间分辨率受到限制 研究。该提案的目标是使用经过验证的动物模型来获得受控的高分辨率 用于研究足月儿和早产儿如何对改善喂养表现的干预措施做出反应的数据 喂养。这项研究将双平面 (3D) 高速 (100 fps) 视频透视与慢性 留置细线肌电图测量肌肉如何驱动运动学、吞咽安全性和液体 足月儿和早产儿喂养的动态。中心假设是足月婴儿的表现会更高 压力产生水平和输送粘性流体的能力，但塑料神经系统 早产儿将使他们对压力产生需求的增加表现出更大的反应 并增加粘度。首先，我将测量肌肉骨骼系统如何响应变化 足月和早产仔猪获取食物的压力产生要求（SA1-K99），然后 测量足月和早产仔猪 (SA2-K99) 对粘度变化的神经运动反应。 接下来，我将测量足月儿和早产儿在喂养时的神经运动功能 仿生奶嘴，与目前市售的奶嘴 (SA3-R00) 相比。这项研究将提供 深入了解驱动婴儿喂养表现的机制，并为发育提供基础 干预措施基于生理学而非定性的表现不佳的患者表现 吞咽困难。这很重要，因为它代表了对基本理解的重要进步。 婴儿喂养的机制和失败的机制。因此，这些结果将成为基础 针对新生儿吞咽困难的循证干预措施。这个项目将直接推进我的职业目标 建立一个联邦资助的研究计划，以了解正常和病理生理学为基础 感觉运动整合。 NEOMED 为我开发这个研究项目提供了一个极好的环境，因为 该系内有许多教师从事肌肉骨骼方面的前沿研究 除了我的研究导师，他是婴儿吞咽困难领域的专家。

项目成果

The Function of the Mammal Extrinsic Tongue Musculature in the Transition from Suckling to Drinking.

哺乳动物外在舌头肌肉组织在从哺乳到饮水过渡中的功能。

• 发表时间: 2023-09-15
• 影响因子: 2.6
• 作者: Steer, K E;Johnson, M L;Adjerid, K;Bond, L E;Howe, S P;Khalif, A;Nkachukwu, K C;Edmonds, C E;German, R Z;Mayerl, C J
• 通讯作者: Mayerl, C J

Anatomical and physiological variation of the hyoid musculature during swallowing in infant pigs.

仔猪吞咽过程中舌骨肌肉组织的解剖和生理变化。

• 发表时间: 2021-11-01
• 作者: Mayerl, Christopher J;Steer, Kendall E;Chava, Almasi M;Bond, Laura E;Edmonds, Chloe E;Gould, Francois D H;Hieronymous, Tobin L;Vinyard, Christopher J;German, Rebecca Z
• 通讯作者: German, Rebecca Z

The Pathway from Anatomy and Physiology to Diagnosis: A Developmental Perspective on Swallowing and Dysphagia.

从解剖学和生理学到诊断的途径：吞咽和吞咽困难的发展视角。

• 发表时间: 2023-02
• 影响因子: 2.6
• 作者: Mayerl, C J;Gould, F D H;Adjerid, K;Edmonds, C;German, R Z
• 通讯作者: German, R Z

Increased viscosity of milk during infant feeding improves swallow safety through modifying sucking in an animal model.

通过改变动物模型中的吸吮，增加婴儿喂养期间牛奶的粘度可以提高吞咽安全性。

• 发表时间: 2021-12
• 影响因子: 3.2
• 作者: Mayerl, Christopher J;Edmonds, Chloe E;Gould, Francois D H;German, Rebecca Z
• 通讯作者: German, Rebecca Z

The effect of stiffness and hole size on nipple compression in infant suckling.

刚度和孔尺寸对婴儿哺乳时乳头压缩的影响。

• 发表时间: 2023-01
• 作者: Adjerid, Khaled;Johnson, Maxwell L.;Edmonds, Chloe E.;Steer, Kenall E.;Gould, Francois D. H.;German, Rebecca Z.;Mayerl, Christopher J.
• 通讯作者: Mayerl, Christopher J.