The Aspirometer: A noninvasive tool to detect swallowing safety and efficiency

呼吸量计：一种检测吞咽安全性和效率的无创工具

• 批准号: 8413468
• 负责人: Ervin Sejdic
• 金额: $ 32.99万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8413468
• 关键词: Acoustics; Address; Algorithms; Aspiration Pneumonia; Basic Science; Bolus Infusion; Cessation of life; Classification; Clinical; Coughing; Data Collection; Data Set; Deglutition; Deglutition Disorders; Dehydration; Detection; Development; Devices; Diet; Early Diagnosis; Early identification; Eligibility Determination; Esophagus; Goals; Gold; Health; Healthcare Systems; Honey; Impairment; Individual; Intake; Journals; Judgment; Larynx; Legal patent; Liquid substance; Malnutrition; Methods; Monitor; Neck; Nervous System Trauma; Oral; Oral cavity; Patients; Penetration; Personal Satisfaction; Pharyngeal structure; Physiological; Population; Positioning Attribute; Practice Guidelines; Process; Protocols documentation; Publications; Publishing; Reporting; Research; Risk; Safety; Sampling; Savings; Sensitivity and Specificity; Side; Signal Transduction; Specificity; Stroke; Surface; Technology; Testing; Texture; Thick; Time; Training; Translating; Validation; Water; base; computerized data processing; design; evidence base; high risk; improved; instrument; nervous system disorder; patient safety; prevent; programs; public health relevance; screening; sound; tool; vibration

DESCRIPTION (provided by applicant): Dysphagia (swallowing impairment) is a common and serious component following stroke and frequently involves penetration and/or aspiration (the entry of foreign material into the airway). It has been reported that a modest reduction in dysphagia-related health problems would result in multi-million dollar savings in the health care system and would prevent thousands of aspiration-related deaths annually. Therefore, it is important to monitor swallowing safety and efficiency on a daily basis. There is widespread recognition of the need to identify impaired swallowing safety and efficiency as early as possible in individuals at risk. This has led to the development of many different swallow screening protocols, which rely heavily on observation of overt signs of swallowing difficulty during water swallowing tasks. Nevertheless, even the most rigorously-developed swallow screening protocols have limited sensitivity and specificity detecting impaired swallowing safety and efficiency, compared to radiographic swallowing examinations. In particular, overt clinical signs implying aspiration (such as coughing and throat clearing) are frequently absent or volume-dependent. Therefore, it would be desirable if a simple, non-invasive technology and protocol for monitoring swallowing safety and efficiency could be introduced into routine initial clinical screening programs. If such a method could achieve similar or superior aspiration detection accuracy to the current best-performing swallow screening protocols, it would facilitate equivalent or improved detection of swallowing risk, while overcoming the limitations of perceptual clinical judgments and considerable burdens with respect to staff training and compliance. Over the past 4 years, our research team has developed a non-invasive swallow screening instrument, the Aspirometer, which detects problems based on the processing and analysis of swallowing vibrations. In a recent proof-of-concept study, using concurrent videofluoroscopic validation, the Aspirometer signals demonstrated with 90% sensitivity and 77% specificity, based on a training set of 154 thin liquid swallow recordings. The current study aims to further enhance the accuracy of the Aspirometer by acquiring swallowing accelerometry signals from a larger sample of individuals undergoing concurrent videofluoroscopy. Additionally, we will collect swallowing acoustic information with a co-located microphone in order to enhance the accuracy of signal processing classification algorithms to detect problems in swallowing safety and efficiency. Lastly, we will explore the potential of the Aspirometer to detect swallowing problems beyond the context of thin liquid swallows by collecting swallows of nectar-thick and honey-thick liquids. This last step will enable us to determine the ability of the Aspirometer to determine the safety of oral intake with texture-modified diets while patients are waiting for comprehensive assessment. This study is a necessary step in translating the findings of our previous basic research regarding swallowing accelerometry into a clinically useful tool for monitoring of swallowing safety and efficiency in patients with suspected dysphagia.

描述（由申请人提供）：吞咽困难（吞咽损伤）是中风后常见和严重的组成部分，并且经常涉及穿透和/或抽吸（将异物进入气道进入气道）。据报道，与吞咽困难相关的健康问题的适度减少将导致医疗保健系统中的数百万美元节省下来，并防止每年数千起与志向相关的死亡。因此，重要的是每天监视吞咽安全性和效率。人们普遍认识到需要尽早确定吞咽安全性和效率受损的人的需求。这导致了许多不同的吞咽筛选方案的发展，这些方案在很大程度上依赖于在吞咽任务期间观察到吞咽困难的明显迹象。然而，与放射学吞咽检查相比，即使是最严格发达的吞咽筛选方案也具有有限的敏感性和特异性检测吞咽安全性和效率的受损。特别是，明显的临床体征表明抽吸（例如咳嗽和喉咙清除）通常不存在或依赖体积。因此，如果可以将一种简单的，非侵入性的技术和用于监测吞咽安全性和效率的协议引入常规初始临床筛查计划，那将是可取的。如果这种方法能够达到与当前表现最佳的吞咽筛查方案相似或卓越的抽吸检测准确性，那么它将有助于对吞咽风险的等效检测，同时克服感知临床判断的局限性，并在员工培训和合规性方面负担相当大的负担。在过去的四年中，我们的研究团队开发了一种非侵入性吞咽筛选工具，即Asprymeter，该仪器基于吞咽振动的加工和分析来检测问题。在最近的一项概念证明的研究中，使用并发视频荧光验证，基于154个稀疏液体吞咽记录的训练集，Aspormoge信号以90％的敏感性和77％的特异性证明。当前的研究旨在通过从较大的同时视频荧光镜检查的个体样本中获取吞咽加速度学信号来进一步提高吸气计的准确性。此外，我们将使用共同确定的麦克风收集吞咽信息，以增强信号处理分类算法的准确性，以检测吞咽安全性和效率中的问题。最后，我们将通过收集花蜜厚和蜂蜜厚的液体的燕子来探索抽吸机的潜力，以检测出稀薄液体燕子的吞咽问题。最后一步将使我们能够确定 在等待全面评估的同时，使用质地改性饮食来确定口服摄入量的安全性。这项研究是转化我们先前有关吞咽加速度测定法的基础研究结果的必要步骤，以监测可疑吞咽困难患者的吞咽安全性和效率的临床有用工具。