Development of Novel Methods for Intervention in Chronic Dysphagia

慢性吞咽困难干预新方法的开发

• 批准号: 7594711
• 负责人: Christy Leslie Ludlow
• 金额: $ 91.23万
• 依托单位: NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/7594711
• 关键词: Adult; Affect; Aging; Aspiration Pneumonia; Basal Ganglia; Behavior; Biofeedback; Brain; Brain Injuries; Cerebellum; Cerebral cortex; Chronic; Condition; Deglutition; Deglutition Disorders; Development; Disease; Electric Stimulation; Elevation; Faucial pillar; Feedback; Food; Health; Implant; Intervention; Larynx; Left; Liquid substance; Long-Term Care; Methods; Motor; Movement; Muscle; Neuraxis; Neuronal Plasticity; Oral cavity; Patients; Pattern; Peripheral; Phase II Clinical Trials; Physiological; Quality of life; Risk; Role; Saliva; Secondary to; Sensory; Surface; Techniques; Training; Week; central nervous system injury; cost; day; feeding; healthy volunteer; kinematics; nerve supply; nervous system disorder; neuroimaging; neuroprosthesis; novel; sensory stimulus; stem; trial comparing; vocal cord

During the last year we completed a study examining the central nervous system for swallowing using functional neuroimaging. Volitional swallowing invokes activity in widely distributed regions of the cerebral cortex, basal ganglia and cerebellum. We aimed to determine what portions of this network are elicited either by sensory stimulation alone, or swallowing planning without movement feedback from swallowing. We compared brain activation during volitional swallowing with that produced with sensory stimulation of the faucial pillars, during covert swallowing without execution, and during volitional swallowing of saliva. Very similar patterns of activation were elicited in all three tasks demonstrating the significant role of sensory facilitation in volitional swallowing and that motor planning can also invoke a similar pattern of brain activation. We are also comparing the degree to which different sensory stimuli can increase swallowing behavior as well as the urge to swallow in healthy volunteers in order to develop more potent sensory triggers for reinstituting swallowing following dysphagia after brain injury. We completed our third study of the effects of surface electrical stimulation on vocal tract kinematics. Using nasolaryngoscopy during surface electrical stimulation we demonstrated that neither vocal fold adduction nor abduction occurred with stimulation showing that this technique is not efficacious for airway protection during swallowing. We aim to determine how sensory facilitation or motor augmentation of volitional swallowing can enhance swallowing in patients with chronic pharyngeal dysphagia secondary to neurological diseases or disorders. Two phase II trials are ongoing in chronic pharyngeal dysphagia. The first study is examining neuroplasticity following 2 weeks of swallowing training in different conditions using biofeedback swallowing training while providing sensory facilitation and/or cortical direct current stimulation. The second is a two year trial comparing an implanted neuroprosthesis for augmenting hyo-laryngeal elevation during swallowing with sensory facilitation when both are used during volitional retraining by the patient.

在过去的一年中，我们完成了一项研究，研究了使用功能性神经影像学吞咽中枢神经系统的研究。 自愿吞咽会引起大脑皮层，基底神经节和小脑的广泛分布区域的活动。 我们的目的是确定单独的感觉刺激会引起该网络的哪些部分，或者吞咽计划而没有吞咽的移动反馈。 我们将自愿吞咽期间的大脑激活与辅音柱的感觉刺激，秘密吞咽过程中的感觉刺激而产生的大脑激活，而无需执行，以及在唾液的自愿吞咽过程中。 在所有三个任务中都提出了非常相似的激活模式，证明了感觉促进物在自愿吞咽中的重要作用，并且运动计划还可以引起类似的大脑激活模式。 我们还比较了不同的感觉刺激可以增加吞咽行为以及吞咽健康志愿者的冲动，以便开发出更有效的感觉触发因素，以重新建立脑损伤后吞咽困难后吞咽。 我们完成了第三项关于表面电刺激对声带运动学的影响的研究。 在表面电刺激期间，我们使用鼻腔内镜检查表明，刺激表明该技术在吞咽过程中对气道保护无效。 我们旨在确定感官促进或运动吞咽的增强如何增强继发于神经系统疾病或疾病的慢性咽部吞咽困难的患者的吞咽。 慢性咽吞咽困难正在进行两次II期试验。 第一项研究是在使用生物反馈吞咽训练的情况下进行2周吞咽训练后，在提供感觉促进和/或皮质直流电流刺激的同时，检查了神经可塑性。 第二个试验是一项为期两年的试验，比较了植入的神经假体，用于在患者的自愿性再培训期间使用两者时，在吞咽过程中增加了汉脑升高。