Dysphagia and Recovery After Vagal or Laryngeal Nerve Injury

描述(申请人提供)：吞咽是一种重要的人类活动；失败严重损害健康和福祉。正常的吞咽功能依赖于双侧周围神经通路的完整性，以便安全有效地将药丸通过口腔和咽部传输。由于其广泛的解剖过程以及对疾病和创伤的易感性，迷走神经及其喉支的损伤在一生中并不少见。这些损伤的具体影响和导致相关吞咽困难的机制尚有争议，而这些神经损伤的对侧影响尚不清楚。本项目的主要目标是了解神经损伤后病理生理吞咽过程中肌电活动模式和口咽运动学的变化。具体目的包括确定三种独立的单侧神经损伤，即喉上神经(SA1)、喉返神经(SA2)和近端迷走神经(SA3)对仔猪吞咽的影响。响应变量包括口咽和喉部结构的运动学和团注传输的同步测量，以及舌骨、软腭部和咽部肌肉系统的肌电活动模式。我们预测，这些感觉和运动损伤后的口咽行为将以特定的方式紊乱，以便这些结果可以用来预测特定的功能障碍，由于伦理原因，这些功能障碍只能在人类身上不完全测量。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。尤其是在这个复杂的系统中，一个受损的结构可能会严重扰乱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。

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.