Dysphagia and Recovery After Vagal or Laryngeal Nerve Injury

迷走神经或喉神经损伤后的吞咽困难和恢复

• 批准号: 8213614
• 负责人: Rebecca Z German
• 金额: $ 44.36万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-02-01 至 2015-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8213614
• 关键词: Address; Affect; Anatomy; Animal Model; Behavior; Bilateral; Biomechanics; Bolus Infusion; Clinical; Complex; Contralateral; Data; Deglutition; Deglutition Disorders; Denervation; Disease; Electromyography; Ethics; Event; Extravasation; Failure; Family suidae; Financial compensation; Functional disorder; Genetic Crossing Over; Health; Human; Human Activities; Infant; Injury; Ipsilateral; Laryngeal Nerves; Larynx; Lesion; Longevity; Measurement; Measures; Mechanics; Medical; Methods; Modeling; Motor; Motor Activity; Movement; Muscle; Muscle function; Nerve; Neural Pathways; Operative Surgical Procedures; Oral cavity; Oropharyngeal; Pattern; Penetration; Peripheral; Personal Satisfaction; Pharyngeal structure; Recovery; Recurrent Laryngeal Nerve; Rehabilitation therapy; Research; Rest; Sensory; Side; Signal Transduction; Soft Palate; Stimulus; Structure; Structure of superior laryngeal nerve; System; Trauma; Upper Esophageal Sphincter; base; design; kinematics; motor control; motor deficit; nerve injury; neuroregulation; public health relevance; research study; response

DESCRIPTION (provided by applicant): Swallowing is a critical human activity; failure seriously compromises health and well-being. Normal swallowing function depends on the bilateral integrity of the peripheral neural pathways for safe and efficient transport of the bolus through the mouth and pharynx. Due to its extensive anatomic course and vulnerability to disease and trauma, injury to the vagus and its laryngeal branches is not an uncommon medical finding across the lifespan. The specific impact of these injuries and the mechanisms causing the associated dysphagia are debated, while the contralateral effects of these nerve injuries are unknown. The overarching objective of this project is to understand the changes in patterns of EMG activity and in oropharyngeal kinematics during pathophysiologic swallowing following nerve injury. The specific aims include determination of the impact of three independent, unilateral nerve injuries, superior laryngeal nerve (SA1), recurrent laryngeal nerve (SA2) and proximal vagus (SA3), on swallowing in an infant pig model. The response variables include synchronous measurements of the kinematics of oropharyngeal and laryngeal structures and of bolus transit, as well as the EMG activity patterns in the hyoid, soft palate and pharyngeal musculature. We predict that the oro-pharyngeal behavior after these sensory and motor lesions will be disordered in specific ways so that these results can be used to predict specific dysfunctions which, for ethical reasons, can only be incompletely measured in humans. An understanding of the effect of isolated experimental nerve lesions on swallowing is critical to the assessment of naturally occurring dysfunction. This is especially so in this complex system, where one compromised structure can significantly disrupt other components that are interlinked both in terms of mechanics and control systems. The results from this study can ultimately serve as a basis for the design of clinical rehabilitative strategies. PUBLIC HEALTH RELEVANCE: Due to its extensive anatomic course and vulnerability to disease and trauma, injury to the vagus and its laryngeal branches is not an uncommon medical finding across the lifespan. Determination of the functional consequences of such injuries will elucidate how disruption of the biomechanical integrity of the oropharyngeal system produces dysphagia. Establishing the pathophysiologic basis for dysphagia is the first step towards developing an effective rehabilitative strategy for this condition.

描述（由申请人提供）：吞咽是一项关键的人类活动；失败严重损害了健康和福祉。正常的吞咽功能取决于周围神经途径的双边完整性，以通过口腔和咽部安全有效地运输推注。由于其广泛的解剖学病程以及对疾病和创伤的脆弱性，因此对迷走神经及其喉部分支的伤害并不是整个生命周期中罕见的医疗发现。这些伤害的特定影响和引起相关吞咽困难的机制是有争议的，而这些神经损伤的对侧影响尚不清楚。该项目的总体目的是了解神经损伤后病理生理吞咽过程中EMG活性模式和口咽运动学模式的变化。具体目的包括确定三个独立的单侧神经损伤的影响，上喉神经（SA1），复发性喉神经（SA2）和近端迷走神经（SA3）对婴儿猪模型的吞咽。响应变量包括对口咽和喉结构的运动学的同步测量，推注，推注，以及舌，软pa和咽肌肉中的EMG活性模式。我们预测，在这些感觉和运动病变之后的脑咽部行为将以特定的方式无序，以便这些结果可用于预测特定的功能障碍，而这些功能障碍，出于道德原因，这些功能只能在人类中无法完全测量。对孤立的实验神经病变对吞咽的影响的理解对于评估天然发生功能障碍至关重要。在这个复杂的系统中尤其如此，在这种复杂的系统中，一个受损的结构可以显着破坏与力学和控制系统相互联系的其他组件。这项研究的结果最终可以作为设计临床康复策略的基础。 公共卫生相关性：由于其广泛的解剖过程以及对疾病和创伤的脆弱性，对迷走神经及其喉部分支的伤害并不是整个生命周期中罕见的医疗发现。确定这种伤害的功能后果将阐明口咽系统生物力学完整性的破坏如何产生吞咽困难。建立吞咽困难的病理生理基础是制定有效的康复策略的第一步。