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

描述（由申请人提供）：吞咽困难（吞咽障碍）是中风后常见且严重的症状，经常涉及渗透和/或误吸（异物进入气道）。据报道，适度减少与吞咽困难有关的健康问题将导致医疗保健系统节省数百万美元，并将防止每年数千例与吸气有关的死亡。因此，每天监测吞咽的安全性和有效性是很重要的。人们普遍认识到，有必要尽早在有风险的个体中识别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对吞咽水中吞咽困难的明显迹象的观察。然而，与x线吞咽检查相比，即使是最严格的吞咽筛查方案在检测吞咽受损的安全性和有效性方面也具有有限的敏感性和特异性。特别是，明显的临床征象暗示误吸（如咳嗽和清嗓子）往往不存在或依赖于音量。因此，如果一种简单的、非侵入性的技术和方案可以用于监测吞咽的安全性和有效性，将是可取的，可以引入常规的初始临床筛查计划。如果这种方法能够达到与目前表现最好的吞咽筛查方案相似或更好的误吸检测精度，它将有助于同等或改进吞咽风险的检测，同时克服感性临床判断的局限性和工作人员培训和依从性方面的相当大的负担。在过去的4年里，我们的研究团队开发了一种无创的吞咽筛查仪器，Aspirometer，它通过对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个薄液体吞咽记录的训练集，血压计信号显示出90%的灵敏度和77%的特异性。目前的研究旨在进一步提高血压计的准确性，通过获取吞咽加速度测量信号，从更大的样本进行同步视频透视。此外，我们将使用同位麦克风收集吞咽声学信息，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问题。最后，我们将探索气压计的潜力，通过收集花蜜和蜂蜜厚度的液体来检测吞咽问题。这最后一步将使我们能够确定的能力

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.