Establishing Reference Values and Clinical Decision Points for Quantitative Videofluoroscopic Measures of Swallowing

项目总结/摘要 吞咽困难（吞咽障碍）是一种严重的健康状况，见于许多与年龄有关的疾病和损伤 流程.虽然视频透视（VF）是国际“金标准”吞咽困难诊断检查， 在不同年龄段的健康成人中，缺乏可用的标准生理VF参考值 以指导对该检查的解释。这种知识上的根本差距导致了协议的不一致 吞咽障碍及其潜在机制的识别。为了改善吞咽困难 诊断中，迫切需要在健康人群中建立VF吞咽测量的参考值 年龄跨度在我们之前的R 01（DC 011020）中，我们开发了一种严格的吞咽测量方法 VF生理学：吞咽生理学分析：事件、运动和时间（ASPEKT 方法）。我们发表了40名年轻健康成人（<60岁）的初始ASPEKT参考值， 进行了初步分析，以比较健康老年人和患有糖尿病的成年人小队列的数据。 这些参考数据。通过此次更新申请，我们将验证ASPEKT方法 在整个成人寿命期间吞咽的健康参考值，证明了ASPEKT的可扩展性 临床VF测试方案中常用变化的方法和轮廓吞咽 吞咽困难是发病原因的临床组的病理生理学，以确定临床决策点 可用于诊断和结果测量。我们的愿景是，ASPEKT方法将使 临床医生将患者测量值与健康参考值进行比较，促进量化和证据- 基于对吞咽障碍的存在、性质和严重程度的解释。最终，我们寻求 生成数据，将主观吞咽困难诊断实践转向定量，循证 诊断框架，将改善资源利用，治疗计划和病人的结果。

Project Summary/Abstract Dysphagia (swallowing impairment) is a serious health condition seen in many age-related disease and injury processes. Although videofluoroscopy (VF) is an international “gold standard” dysphagia diagnostic exam, there is a paucity of available normative physiologic VF reference values in healthy adults across the age span to guide interpretation of this examination. This fundamental gap in knowledge contributes to poor agreement in the identification of swallowing impairment and its underlying mechanisms. To enable better dysphagia diagnostics, there is a critical need to establish reference values for VF swallowing measures across the healthy age span. In our previous R01 (DC011020), we developed a rigorous method for measuring swallowing physiology from VF: the Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT Method). We published initial ASPEKT reference values from 40 young healthy adults (<60 years) and performed preliminary analyses to compare data from healthy older adults and small cohorts of adults with dysphagia to these reference data. Through this renewal application, we will validate the ASPEKT Method healthy reference values for swallowing across the adult life span, demonstrate scalability of the ASPEKT Method across commonly used variations in clinical VF testing protocols, and profile swallowing pathophysiology in clinical groups where dysphagia is a cause of morbidity to identify clinical decision points that can be used for diagnosis and outcome measurement. Our vision is that the ASPEKT Method will enable clinicians to compare patient measures to healthy reference values, facilitating quantification and evidence- based interpretation of the presence, nature and severity of swallowing impairment. Ultimately, we seek to generate data that will shift subjective dysphagia diagnostic practices toward a quantitative, evidence-based diagnostic framework that will improve resource utilization, treatment planning and patient outcomes.