Applying motor learning principles to dysphagia rehabilitation

描述(由申请人提供)：总体目标是以一种新的方式利用运动学习原理来促进中风吞咽困难患者的康复。吞咽困难是吞咽障碍，由于吸入的物质进入气管(吸入)，可能导致严重疾病或死亡。这项研究阐述了该机构的使命，因为它促进了提高肢体残疾人的健康、生产力、独立性和生活质量所需的科学知识的发展。具体来说， 这项研究将确定吞咽训练后持久的行为改变是否发生在运动学习原则与标准护理之间。运动学习原则强调在训练过程中通过生物反馈进行持续的运动学评估。然而，在标准的吞咽困难护理中，持续的运动学评估是罕见的，因为吞咽运动学需要视频透视(VF)等仪器才能看到。由于室颤涉及辐射暴露和较高的成本，金属下肌电(SEMG)被广泛用作生物反馈，尽管它不成像吞咽运动学或确认治疗性运动正在接受训练。在这个最初的第一阶段临床试验中，我们将比较三种形式的生物反馈训练吞咽动作，称为意志性喉前庭关闭(VLVC)，强调吞咽呼吸道保护。VF生物反馈训练将提供有关vLVC性能的运动学信息，并纳入运动学习原则。表面肌电信号生物反馈训练将提供有关vLVC表现的非运动学信息，因此不包含运动学习原理。我们还将研究混合生物反馈训练，其中包括早期的VF生物反馈，以建立vLVC动作的目标运动学，然后强化从sEMG学到的内容。正在研究混合生物反馈训练，因为它在临床上比VF生物反馈训练更可行，同时在vLVC训练的一部分中仍纳入了运动学习原则。我们假设VF训练比混合训练更能减少吞咽障碍，但混合训练比表面肌电信号训练更能减少吞咽障碍。此外，这项研究将调查已知的增强运动训练的辅助技术(非侵入性神经刺激和显性奖励独立测试)是否会增强每一种拟议训练的结果。我们创新的实验设计具有重要意义，因为它在理想训练(VF生物反馈)以及临床可行选项(混合生物反馈)中研究运动学习原理，以将它们与标准吞咽困难训练(SEMG)区分开来，后者在高强度运动训练后几乎没有改善。我们的建议的结果可能会改变治疗吞咽和其他内部功能，如语言和声音障碍的范例。

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.