Tongue-pressure timing for liquid flow detection and control in swallowing

用于吞咽液体流量检测和控制的舌压计时

• 批准号: 8304114
• 负责人: Catriona Margaret Steele
• 金额: $ 18.65万
• 依托单位: TORONTO REHABILITATION INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-01 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8304114
• 关键词: Address; Adopted; Adult; Affect; Behavior; Bolus Infusion; Clinical Management; Clinical Protocols; Coffee; Deglutition; Deglutition Disorders; Dehydration; Detection; Development; Drug Formulations; Effectiveness; Elderly; Evaluation; Funding; Future; Goals; Guidelines; Health; Impairment; Indium; Individual; Industry; Injury; Intervention; Investigation; Learning; Liquid substance; Malnutrition; Measures; Neurologic; Oral cavity; Patients; Persons; Pharyngeal structure; Phase; Physiology; Play; Pneumonia; Practice Guidelines; Property; Protocols documentation; Quality of life; Research; Risk; Role; Stimulus; Stroke; Testing; Therapeutic; Thick; Time; Tongue; Training; Viscosity; Work; base; clinical practice; disability; drinking water; evidence base; experience; improved; liquid formulation; pressure; programs; public health relevance; sensory discrimination; young adult

DESCRIPTION (provided by applicant): Swallowing is something that most of us take for granted. We drink water when we are thirsty, and swallow our morning coffee without a second thought. Yet, dysphagia (swallowing difficulty) is a serious, costly and significant health concern, particularly for the elderly and people with neurologic injuries. Dysphagia puts individuals at risk for malnutrition, dehydration and pneumonia and adversely affects quality of life. People with dysphagia have particular difficulty swallowing thin liquids safely; the fast flow of liquids makes them difficult to control. The tongue plays a critical role in containing liquids in the mouth, and in directing and controlling flow through the pharynx (throat). We are engaged in a program of research to better understand tongue function in swallowing, particularly with respect to controlling the flow of liquids. This research is guiding the development and testing of interventions with the goal of rehabilitating tongue function, so that people with dysphagia might return to swallowing thin liquids safely. To date, we have learned that modulations of the time-scale of tongue-pressure application (tongue-pressure-timing) are a critical element in liquid swallowing. Healthy young adults modulate tongue-pressure-timing across liquids of differing viscosity. We are requesting funding for the next phase in this research, to examine tongue-pressure timing in healthy adults (young and elderly) and individuals with dysphagia. The proposed research is based on the idea that the primary purpose of tongue-pressure application to a liquid stimulus is to measure and control the flow properties of that liquid. We hypothesize that, in comparison to healthy young adults, healthy seniors and people with dysphagia will demonstrate differences in tongue-pressure timing. We expect that people with abnormal tongue-pressure timing (vs. healthy young controls) will be less able to detect differences in liquid viscosity and will show reduced tongue-pressure timing modulation in swallowing across viscosity. We specifically seek to confirm that impairments in tongue- pressure-timing co-occur with impairments in the detection of viscosity differences. We also want to conduct a preliminary test of an intervention protocol that we have developed, emphasizing the modulation of tongue- pressure-timing. We hypothesize that this intervention will: a) shift tongue-pressure timing values closer to those of healthy young adults; b) facilitate improved viscosity detection; and c) improve liquid bolus control. This study will answer a critical question for the clinical management of dysphagia, namely how large must a viscosity difference be to influence swallowing function? This will inform industry standards for the formulation of thickened liquids for dysphagia. The results of this study will support the development of evidence-based clinical protocols for tongue-pressure evaluation. Finally, this study will produce preliminary evidence of the effectiveness of tongue-pressure timing training to ameliorate bolus control difficulties in dysphagia. PUBLIC HEALTH RELEVANCE: Dysphagia (swallowing difficulty) is a serious health concern for the elderly and for individuals with stroke or other neurological conditions. This study will advance our understanding of the role of tongue pressure application in swallowing, and will advise future best-practice guidelines for dysphagia assessment and intervention. The results will guide the formulation of therapeutically useful, just-thick-enough liquids and will advance our ability to address liquid bolus control difficulties, - a major component of swallowing disability.

描述（由申请人提供）：吞咽是我们大多数人认为理所当然的事情。当我们口渴时，我们会喝水，并且会不假思索地吞下早晨的咖啡。然而，吞咽困难（吞咽困难）是一个严重、昂贵且重大的健康问题，特别是对于老年人和神经损伤患者。 吞咽困难使人面临营养不良、脱水和肺炎的风险，并对生活质量产生不利影响。 患有吞咽困难的人尤其难以安全吞咽稀薄液体；液体的快速流动使其难以控制。舌头在容纳口腔中的液体以及引导和控制流过咽部（喉咙）的液体方面起着至关重要的作用。我们正在进行一项研究计划，以更好地了解舌头在吞咽过程中的功能，特别是在控制液体流动方面。这项研究正在指导干预措施的开发和测试，以恢复舌头功能为目标，以便吞咽困难患者可以安全地吞咽稀薄液体。迄今为止，我们已经了解到舌压应用的时间尺度（舌压计时）的调节是液体吞咽的关键因素。健康的年轻人会调节不同粘度液体的舌压时间。我们正在为这项研究的下一阶段申请资金，以检查健康成年人（年轻人和老年人）和吞咽困难个体的舌压时间。 所提出的研究基于这样的想法：对液体刺激施加舌压的主要目的是测量和控制该液体的流动特性。我们假设，与健康的年轻人相比，健康的老年人和吞咽困难的人在舌压时间上会表现出差异。我们预计，舌压计时异常的人（与健康的年轻对照组相比）将不太能够检测到液体粘度的差异，并且在吞咽过程中会表现出降低的舌压计时调节。我们特别寻求确认舌压计时的损伤与粘度差异检测的损伤同时发生。我们还想对我们制定的干预方案进行初步测试，强调舌压时间的调节。我们假设这种干预措施将：a）使舌压计时值更接近健康年轻人的值； b) 促进改进粘度检测； c) 改善液体推注控制。这项研究将回答吞咽困难临床治疗的一个关键问题，即粘度差异必须有多大才能影响吞咽功能？这将为吞咽困难增稠液体配方的行业标准提供信息。这项研究的结果将支持开发基于证据的舌压评估临床方案。最后，这项研究将提供舌压计时训练对于改善吞咽困难的推注控制困难的有效性的初步证据。 公共卫生相关性：吞咽困难（吞咽困难）对于老年人和患有中风或其他神经系统疾病的人来说是一个严重的健康问题。这项研究将增进我们对舌压在吞咽中作用的理解，并为未来吞咽困难评估和干预的最佳实践指南提供建议。结果将指导治疗上有用的、足够稠的液体的配制，并将提高我们解决液体推注控制困难的能力，这是吞咽障碍的一个主要组成部分。