Applying motor learning principles to dysphagia rehabilitation

将运动学习原理应用于吞咽困难康复

• 批准号: 8759098
• 负责人: Ianessa A. Humbert
• 金额: $ 40.5万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-06-04 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8759098
• 关键词: Address; Adjuvant; Affect; Behavior Therapy; Biofeedback; Caring; Cessation of life; Clinical Treatment; Data; Deglutition; Deglutition Disorders; Development; Discipline; Electromyography; Experimental Designs; Food; Fostering; Frequencies; Goals; Health; Hyoid bone structure; Image; Impairment; Intervention; Knowledge; Larynx; Lead; Learning; Mission; Morbidity - disease rate; Motor; Movement; Outcome; Patient Education; Patients; Penetration; Performance; Phase I Clinical Trials; Productivity; Protocols documentation; Quality of life; Radiation; Rehabilitation Outcome; Rehabilitation therapy; Reporting; Rewards; Risk; Severities; Speech Disorders; Stroke; Techniques; Testing; Therapeutic; Time; Trachea; Training; Vestibule; Voice Disorders; clinical practice; cost; disability; improved; innovation; instrumentation; kinematics; motor learning; neural stimulation; novel; post stroke; public health relevance; skills; standard care

DESCRIPTION (provided by applicant): The overall goal is to exploit motor learning principles in a novel way to enhance dysphagia rehabilitation in patients with dysphagia due to stroke. Dysphagia is swallowing impairment that can lead to serious illness or death due to ingested material entering the trachea (aspiration). This study addresses the mission of the agency, because it fosters development of scientific knowledge needed to enhance the health, productivity, independence, and quality-of-life of people with physical disabilities. Specifically, this study will determine whether lasting behavioral modifications after swallowing training occur with motor learning principles versus standard care. Motor learning principles emphasize continual kinematic assessment through biofeedback during training. However, continual kinematic assessment is rare in standard dysphagia care because swallowing kinematics require instrumentation such as videofluoroscopy (VF) to be seen. Since VF involves radiation exposure and higher costs, submental electromyography (sEMG) is widely used as biofeedback, although it does not image swallowing kinematics or confirm that a therapeutic movement is being trained. In this initial phase 1 clinical trial, we will compare three forms of biofeedback on training a swallowing maneuver called volitional laryngeal vestibule closure (vLVC), which emphasizes swallowing airway protection. VF biofeedback training will provide kinematic information about vLVC performance, incorporating motor learning principles. sEMG biofeedback training will provide non-kinematic information about vLVC performance and, thus, does not incorporate motor learning principles. We will also investigate a mixed biofeedback training, which involves VF biofeedback early on to establish the target kinematics of the vLVC maneuver, then reinforces what was learned with sEMG. Mixed biofeedback training is being examined because it is more clinically feasible than VF biofeedback training, while still incorporating motor learning principles during part of the vLVC training. We hypothesize that VF training will reduce swallowing impairment more than mixed training, but mixed training will reduce swallowing impairment more than sEMG training. Additionally, this study will investigate whether adjuvant techniques known to augment motor training (non-invasive neural stimulation and explicit reward tested independently), will augment outcomes of each of the proposed trainings. Our innovative experimental design is significant because it investigates motor learning principles within an ideal training (VF biofeedback) as well as within a clinically feasibe option (mixed biofeedback) to differentiate them from standard dysphagia training (sEMG), which has reported little to no improvements after intense motor training. Outcomes from our proposal may change the paradigm for treating swallowing and other internal functions such as speech and voice disorders.

描述（由申请人提供）：总体目标是利用运动学习原理以一种新颖的方式来增强中风所致吞咽困难患者的吞咽困难康复。吞咽困难是一种吞咽障碍，由于摄入的物质进入气管（误吸），可导致严重疾病或死亡。这项研究涉及该机构的使命，因为它促进了提高身体残疾者的健康、生产力、独立性和生活质量所需的科学知识的发展。具体地说,