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

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。当我们口渴的时候，我们喝水，并且毫不犹豫地吞下我们早上的咖啡。然而，吞咽困难（吞咽困难）是一个严重的，昂贵的和重大的健康问题，特别是对老年人和神经损伤的人。 吞咽困难使个体面临营养不良、脱水和肺炎的风险，并对生活质量产生不利影响。 患有吞咽困难的人特别难以安全地吞咽稀薄的液体;液体的快速流动使他们难以控制。舌头在容纳口腔中的液体以及引导和控制通过咽（喉咙）的流动方面起着关键作用。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，目标是恢复舌头功能，使吞咽困难的人可以安全地吞咽稀薄的液体。到目前为止，我们已经了解到，调节舌压应用的时间尺度（舌压定时）是吞咽液体的关键因素。健康的年轻人在不同粘度的液体中调节舌压时间。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）和吞咽困难患者的舌压时间。 所提出的研究是基于这样的想法，即舌压应用于液体刺激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将表现出舌压时间的差异。我们预计，具有异常舌压定时的人（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，并且在吞咽粘度时会显示出减少的舌压定时调制。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共同发生。我们还想对我们开发的干预方案进行初步测试，强调舌压定时的调节。我们假设这种干预将：a）使舌压计时值更接近健康年轻人; B）促进改善粘度检测; c）改善液体推注控制。这项研究将回答吞咽困难的临床管理的一个关键问题，即多大的粘度差必须影响吞咽功能？这将为用于吞咽困难的增稠液体的配制提供行业标准。本研究的结果将支持发展循证临床协议的舌压评估。最后，本研究将提供初步证据，证明舌压定时训练对改善吞咽困难患者的食团控制困难的有效性。 公共卫生相关性：吞咽困难（吞咽困难）是老年人和中风或其他神经系统疾病患者的严重健康问题。这项研究将促进我们对舌压应用在吞咽中的作用的理解，并将为吞咽困难评估和干预的未来最佳实践指南提供建议。这些结果将指导治疗上有用的，刚刚足够稠的液体的配方，并将提高我们解决液体丸剂控制困难的能力，这是吞咽障碍的主要组成部分。

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.