Effects of Aging on Anticipatory Functional Synergies Activated in Deglutition

描述（由申请人提供）：该项目的总体目标是促进对饮食过程中与年龄相关的生理和功能变化的理解，从而为患有吞咽问题的个体设计更有效的治疗方法，特别是在老龄化人口中。在许多老年人中常见的认知、身体和感觉障碍的组合，特别是在同时存在神经功能障碍（如痴呆）的情况下，往往导致饮食需求得不到满足，从而导致发病率和过早死亡增加。这些人中的许多人的功能限制需要大量或全部的帮助来进食和喝水。然而，尽管与辅助喂养相关的安全性增加的含义，但这一建议（例如，来自手/手臂的本体感觉）对已经征税的系统的影响和潜在的风险增加尚不清楚。关于这些口前或预期提示和刺激对“安全进食和吞咽”过程的贡献的文献有限。为了解决这个与临床相关的问题，本项目旨在：(1)确定年轻人和老年人在吞咽前口腔阶段存在的涉及手/手臂、嘴唇和下巴的协同肌肉模式；(2)确定年轻人和老年人非口咽感觉信息和反馈的改变对启动和改变这些口腔运动模式的影响。本提案的实验方法利用肌电图和光学运动检测技术来检查在典型进食和吞咽过程中发生的预期反应和错误纠正模式的年龄相关变化。这项工作意义重大，因为吞咽预期阶段和吞咽前计划的中断不仅在需要进食辅助的个体亚群中很常见，而且在患有多种神经疾病的个体中也很突出，包括痴呆、右半球障碍、中风和创伤性脑损伤。在这项研究中获得的知识将有助于将正常衰老的影响与这些疾病引起的影响分离开来，这对设计适当的评估和干预技术很重要。确定在吞咽预期阶段感觉反馈的中断是否会影响后来吞咽的模式和时间，可能会导致开发新的方法来有效地喂养实践和吞咽策略，旨在预防老年人和临床人群的吞咽困难和上呼吸道损害。

DESCRIPTION (provided by applicant): The overall goal of this project is to contribute to the understanding of the age-related physiological and functional changes that occur across the eating process, leading to the design of more efficacious treatments for individuals with swallowing problems, particularly in the aging population. The combination of cognitive, physical, and sensory impairments commonly seen in many elderly individuals, especially in the presence of co-morbid neurologic impairment (e.g., dementia), often results in eating needs going unmet, leading to increased morbidity and premature mortality. The functional limitations of many of these individuals necessitate extensive or total assistance with consuming foods and liquids. However, despite the implication of increased safety associated with assisted feeding, the influence and potential increased risk of the elimination of cues resulting from this recommendation (e.g., proprioception from the hand/arm) on an already taxed system are unclear. Limited literature is available regarding the contribution of these pre-oral, or anticipatory, cues and stimuli to the process of "safe eating and swallowing". To address this clinically-relevant problem, this project seeks to: (1) identify the synergistic muscle patterns involving the hand/arm, lips, and jaw that are present during the pre-oral stage of deglutition in younger and older adults; and (2) to determine the influence of modifications in non-oropharyngeal sensory information and feedback on initiating and altering these oral motor patterns in younger and older adults. The experimental approach of this proposal capitalizes on the opportunity to utilize electromyography and optical motion detection techniques to examine the age-related changes in anticipatory responses and error correction patterns that occur during typical eating and swallowing. This work is significant as disruptions in the anticipatory stage of swallowing and pre-swallowing planning are common not only in the subpopulation of individuals requiring feeding assistance, but are additionally prominent in individuals with numerous neurological diseases, including dementia, right hemisphere disorder, stroke, and traumatic brain injury. The knowledge gained in this study will help disassociate the effects of normal aging from those due to these diseases, important in the design of appropriate assessment and intervention techniques. Determining whether or not disruptions in sensory feedback during the anticipatory stage of swallowing affect the pattern and timing of later swallowing may then lead to the development of new approaches to effective feeding practices and swallowing strategies aimed at preventing dysphagia and upper airway compromise in the elderly and across clinical populations. PUBLIC HEALTH RELEVANCE: Swallowing problems contribute to the high financial, physical, and psychosocial costs associated with disease, particularly in the elderly. Despite the implication of increased safety associated with feeding assistance for these individuals, the influence and potential risks of absent pre-oral sensory cues on an already taxed system are unclear. By examining the relationship between these pre-oral cues and anticipatory oral posturing during eating and swallowing in healthy elderly individuals, this research is positioned to address the potential for increased risk these recommendations may elicit, enhancing swallowing-related practices and interventions.