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: 8321108
• 负责人: Rebecca Z German
• 金额: $ 5.2万
• 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/8321108
• 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）：吞咽是一项重要的人类活动；失败会严重损害健康和福祉。正常的吞咽功能取决于双侧周围神经通路的完整性，以确保食团安全有效地通过口腔和咽部运输。由于其广泛的解剖过程以及容易受到疾病和创伤的影响，迷走神经及其喉部分支的损伤在整个生命周期中并不是罕见的医学发现。这些损伤的具体影响以及导致相关吞咽困难的机制存在争议，而这些神经损伤的对侧影响尚不清楚。该项目的首要目标是了解神经损伤后病理生理性吞咽过程中肌电图活动模式和口咽运动学的变化。具体目标包括确定三种独立的单侧神经损伤：喉上神经（SA1）、喉返神经（SA2）和近端迷走神经（SA3）对幼猪模型吞咽的影响。响应变量包括口咽和喉部结构以及食团运输运动学的同步测量，以及舌骨、软腭和咽部肌肉组织的肌电图活动模式。我们预测，这些感觉和运动损伤后的口咽行为将以特定方式紊乱，因此这些结果可用于预测特定功能障碍，由于伦理原因，这些功能只能在人类中进行不完全测量。了解孤立的实验性神经损伤对吞咽的影响对于评估自然发生的功能障碍至关重要。在这个复杂的系统中尤其如此，其中一个受损的结构可能会严重破坏在机械和控制系统方面相互关联的其他组件。这项研究的结果最终可以作为临床康复策略设计的基础。 公众健康相关性：由于其广泛的解剖过程以及易受疾病和创伤的影响，迷走神经及其喉部分支的损伤在整个生命周期中并不是罕见的医学发现。确定此类损伤的功能后果将阐明口咽系统生物力学完整性的破坏如何导致吞咽困难。建立吞咽困难的病理生理学基础是针对这种情况制定有效康复策略的第一步。