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。我们口渴的时候喝水，早晨喝咖啡的时候不加思索地咽下去。然而，吞咽困难（吞咽困难）是一个严重的、昂贵的和重要的健康问题，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。患有吞咽困难的人尤其难以安全地吞咽稀液体；液体的快速流动使它们难以控制。舌头在容纳口腔中的液体，以及指导和控制咽（喉）的流动方面起着至关重要的作用。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。这项研究指导了旨在恢复舌头功能的干预措施的开发和测试，从而使患有吞咽困难的人能够安全地吞咽稀液体。到目前为止，我们已经了解到舌压应用的时间尺度调节（舌压定时）是液体吞咽的关键因素。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，以检查健康成人（年轻人和老年人）和吞咽困难患者的舌压时间。提出的研究是基于这样一种想法，即舌压应用于液体刺激的主要目的是测量和控制液体的流动特性。我们假设，与健康的年轻人相比，健康的老年人和有吞咽困难的人在舌压时间上会表现出差异。我们预计舌压定时异常的人（与健康的年轻对照者相比）将不太能够察觉液体粘度的差异，并且在吞咽时跨粘度的舌压定时调节将会减少。我们特别寻求证实舌压定时的损伤与粘度差异检测的损伤同时发生。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的年轻人；B)便于改进粘度检测；c)改善液丸控制。本研究将回答临床处理吞咽困难的一个关键问题，即粘度差必须多大才能影响吞咽功能？这将有助于制定针对吞咽困难的增稠液体配方的行业标准。这项研究的结果将支持以证据为基础的舌压评估临床方案的发展。最后，本研究将提供初步证据，证明舌压定时训练在改善吞咽困难患者服药控制困难方面的有效性。

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.