The Aspirometer: A noninvasive tool to detect swallowing safety and efficiency

描述(申请人提供)：吞咽困难(吞咽障碍)是中风后常见和严重的组成部分，经常涉及穿透和/或吸入(异物进入呼吸道)。据报道，吞咽困难相关健康问题的适度减少将在医疗保健系统中节省数百万美元，并将每年防止数千人因吸入而死亡。因此，每天监测吞咽的安全性和效率是很重要的。人们普遍认识到，有必要尽早确定有风险的人吞咽受损的安全性和有效性。这导致了许多不同的吞咽筛查方案的发展，这些方案在很大程度上依赖于在吞水任务中观察到吞咽困难的明显迹象。然而，即使是最严格开发的吞咽筛查方案，与放射学吞咽检查相比，检测吞咽受损的安全性和有效性的敏感性和特异性也是有限的。特别是，暗示吸入的明显临床体征(如咳嗽和清喉)通常不存在或依赖于容量。因此，如果一种简单的、非侵入性的监测吞咽安全性和有效性的技术和方案能够被引入到常规的初始临床筛查计划中，那将是可取的。如果这种方法能够达到与目前表现最好的吞咽筛查方案类似或更高的吸入检测准确度，它将有助于同等或改进吞咽风险的检测，同时克服感知临床判断的限制和工作人员培训和遵从性方面的相当负担。在过去的4年里，我们的研究团队开发了一种非侵入性的燕子筛查仪器-肺活量计，它根据吞咽振动的处理和分析来检测问题。在最近的一项概念验证研究中，使用同步视频透视验证，基于154个稀液吞咽记录的训练集，肺活量计信号显示出90%的灵敏度和77%的特异度。目前的研究旨在通过从同时接受视频透视检查的更大样本个体获取吞咽加速度计信号来进一步提高肺活量计的准确性。此外，我们还将使用同一位置的麦克风收集吞咽声信息，以提高信号处理分类算法的准确性，以检测吞咽安全和效率方面的问题。最后，我们将通过收集花蜜般浓稠的液体和蜂蜜般稠密的液体的燕子，来探索肺活量计检测吞咽问题的潜力，而不仅仅是稀薄的液体。这最后一步将使我们能够确定 在患者等待全面评估的同时，使用肺活量计来确定口服质地改良饮食的安全性。这项研究是将我们之前关于吞咽加速度法的基础研究成果转化为临床上有用的工具，用于监测疑似吞咽困难患者的吞咽安全性和有效性的必要步骤。

DESCRIPTION (provided by applicant): Dysphagia (swallowing impairment) is a common and serious component following stroke and frequently involves penetration and/or aspiration (the entry of foreign material into the airway). It has been reported that a modest reduction in dysphagia-related health problems would result in multi-million dollar savings in the health care system and would prevent thousands of aspiration-related deaths annually. Therefore, it is important to monitor swallowing safety and efficiency on a daily basis. There is widespread recognition of the need to identify impaired swallowing safety and efficiency as early as possible in individuals at risk. This has led to the development of many different swallow screening protocols, which rely heavily on observation of overt signs of swallowing difficulty during water swallowing tasks. Nevertheless, even the most rigorously-developed swallow screening protocols have limited sensitivity and specificity detecting impaired swallowing safety and efficiency, compared to radiographic swallowing examinations. In particular, overt clinical signs implying aspiration (such as coughing and throat clearing) are frequently absent or volume-dependent. Therefore, it would be desirable if a simple, non-invasive technology and protocol for monitoring swallowing safety and efficiency could be introduced into routine initial clinical screening programs. If such a method could achieve similar or superior aspiration detection accuracy to the current best-performing swallow screening protocols, it would facilitate equivalent or improved detection of swallowing risk, while overcoming the limitations of perceptual clinical judgments and considerable burdens with respect to staff training and compliance. Over the past 4 years, our research team has developed a non-invasive swallow screening instrument, the Aspirometer, which detects problems based on the processing and analysis of swallowing vibrations. In a recent proof-of-concept study, using concurrent videofluoroscopic validation, the Aspirometer signals demonstrated with 90% sensitivity and 77% specificity, based on a training set of 154 thin liquid swallow recordings. The current study aims to further enhance the accuracy of the Aspirometer by acquiring swallowing accelerometry signals from a larger sample of individuals undergoing concurrent videofluoroscopy. Additionally, we will collect swallowing acoustic information with a co-located microphone in order to enhance the accuracy of signal processing classification algorithms to detect problems in swallowing safety and efficiency. Lastly, we will explore the potential of the Aspirometer to detect swallowing problems beyond the context of thin liquid swallows by collecting swallows of nectar-thick and honey-thick liquids. This last step will enable us to determine the ability of the Aspirometer to determine the safety of oral intake with texture-modified diets while patients are waiting for comprehensive assessment. This study is a necessary step in translating the findings of our previous basic research regarding swallowing accelerometry into a clinically useful tool for monitoring of swallowing safety and efficiency in patients with suspected dysphagia.