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（吞咽障碍）是中风后常见且严重的症状，经常涉及穿透和/或误吸（异物进入气道）。据报道，适度减少与吞咽困难相关的健康问题将为医疗保健系统节省数百万美元，并每年防止数千例与误吸相关的死亡。因此，每天监测吞咽安全性和效率非常重要。人们普遍认识到需要尽早识别高危个体的吞咽安全性和效率受损。这导致了许多不同的吞咽筛查方案的发展，这些方案在很大程度上依赖于在吞咽水任务期间观察吞咽困难的明显迹象。然而，与放射学吞咽检查相比，即使是最严格开发的吞咽筛查方案，检测吞咽安全性和效率受损的敏感性和特异性也有限。特别是，经常不存在暗示误吸的明显临床症状（例如咳嗽和清喉咙）或依赖于容量。因此，如果能够将用于监测吞咽安全性和效率的简单、非侵入性技术和方案引入常规初始临床筛查项目中，将是令人期望的。如果这种方法能够实现与当前性能最佳的吞咽筛查方案相似或更高的误吸检测准确性，则将有助于等效或改进吞咽风险的检测，同时克服感知临床判断的局限性以及人员培训和培训方面的巨大负担。遵守。在过去的4年里，我们的研究团队开发了一种无创吞咽筛查仪器——呼吸量计，它根据吞咽振动的处理和分析来检测问题。在最近的一项概念验证研究中，使用并发视频荧光镜验证，基于 154 个稀液体吞咽记录的训练集，肺活量计信号具有 90% 的灵敏度和 77% 的特异性。目前的研究旨在通过从同时接受视频透视检查的更大样本中获取吞咽加速测量信号，进一步提高呼吸量计的准确性。此外，我们将使用同位麦克风收集吞咽声学信息，以提高信号处理分类算法的准确性，以检测吞咽安全和效率问题。最后，我们将探索呼吸量计通过收集花蜜浓稠和蜂蜜浓稠液体的吞咽情况来检测稀薄液体吞咽范围之外的吞咽问题的潜力。最后一步将使我们能够确定 当患者等待综合评估时，肺活量计可确定质地改良饮食的口服摄入安全性。这项研究是将我们之前有关吞咽加速测量的基础研究成果转化为临床有用工具的必要步骤，用于监测疑似吞咽困难患者的吞咽安全性和效率。