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）是卒中后常见的严重症状，通常涉及渗透和/或吸入（异物进入气道）。据报道，与吞咽困难有关的健康问题的适度减少将导致卫生保健系统节省数百万美元，并将防止每年数千例与吸入有关的死亡。因此，每天监测吞咽安全性和效率非常重要。人们普遍认识到，有必要尽早识别处于风险中的个体的吞咽安全性和效率受损。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咽水任务期间观察吞咽困难的明显迹象。然而，与放射性吞咽检查相比，即使是最严格开发的吞咽筛查方案也具有有限的灵敏度和特异性来检测受损的吞咽安全性和效率。特别是，暗示吸入的明显临床体征（如咳嗽和清咽）通常不存在或依赖于容量。因此，如果可以将用于监测吞咽安全性和效率的简单的非侵入性技术和方案引入常规的初始临床筛选程序中，则将是期望的。如果这样的方法可以实现与当前最佳执行的吞咽筛查协议相似或上级的抽吸检测准确度，则它将有助于吞咽风险的等同或改进的检测，同时克服感知临床判断的限制以及关于人员培训和依从性的相当大的负担。在过去的4年里，我们的研究团队开发了一种非侵入性吞咽筛查仪器，Aspirometer，它可以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，使用同步视频荧光检查验证，基于154个稀液体吞咽记录的训练集，Aspirometer信号显示出90%的灵敏度和77%的特异性。目前的研究旨在通过从接受同时视频透视的更大样本个体中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学信息，以提高信号处理分类算法的准确性，从而检测吞咽安全性和效率方面的问题。最后，我们将探索肺活量计的潜力，以检测吞咽问题超出了薄液体吞咽的背景下，通过收集吞咽花蜜厚和蜂蜜厚的液体。这最后一步将使我们能够确定 在患者等待全面评估期间，使用肺活量计确定口服质构改良饮食的安全性。这项研究是将我们以前关于吞咽加速度的基础研究结果转化为临床有用的工具，用于监测疑似吞咽困难患者的吞咽安全性和效率的必要步骤。

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.