VOLITIONAL, BOLUS, AND AGE EFFECTS ON HUMAN SWALLOWING

描述(摘自申请者的摘要)：本项目的目的 就是量化吞咽反应的改变程度 可由推注体积、粘度和 温度以及吞咽前的热刺激和意志 吞咽对吞咽行为的操纵数据将在以下几组中收集 志愿者年龄在20-29岁，40-49岁，70-79岁，年龄段。两个人 选择较老的组为计划中的 与几十年来聚集在一起的中风患者相比。较年轻的 小组完成年龄谱，协助分析年龄对 燕子的反应，也是一组自愿的受试者 进行意志控制的实验。描述了几种协议 电视透视与咽部测压同时应用为研究对象 吞下一系列体积、粘度和药丸。意志力 需要研究的动作包括那些建议用于吞咽困难的动作。 患者：吸气高峰屏气，喉部延长 抬高，用力吞咽。 此外，吞咽前热刺激的效果将是 推拿手法的系统评价与比较 温度。测压和视频透视数据将同步 并被记录下来。数据分析将利用计算机的新技术 辅助视频和测压分析。透视技术的一个主要推动力 分析将结合动作分析以及时间分析。 每个燕子的每个参数的数据将以数字形式表示 以0.03秒的时间间隔作为列标题组织的电子表格 和用于数据参数的行。这种分析方法允许关键的 比较并发事件以及建立全面的 用于评估吞咽困难患者的数据集进行比较。 此外，治疗手法和吞咽前的机制 刺激可能有益于吞咽困难将被描述。因此，可塑性 咽部吞咽的运动范围和时间 口咽结构的运动受推注相关变量的影响， 年龄和意志力的控制是咽咽可以 概念化为由几个紧密协调的、但 潜在地可修改的组件，而不是作为单个构造型 事件。所描述的方案检查了正常受试者 能够改变环咽开口，喉部闭合， 蠕动力和推进力。这些因素的意义 研究结果与吞咽困难的治疗策略有关 个人。一个受损的病人可能会有一个方面的问题 咽喉闭合或上食道括约肌开口等吞咽现象， 但如果该缺陷可以选择性地进行口腔喂养 作为补偿。

DESCRIPTION (Adapted from applicant's abstract): The aim of this project is to quantify the extent to which modifications of the swallow response can be provoked by the systematic variation of bolus volume, viscosity, and temperature as well as by pre-swallow thermal stimulation and volitional manipulation of the act of swallowing. Data will be collected on groups of volunteer subjects in the 20-29, 40-49, 70-79, yr age brackets. The two older groups were selected to provide a normal data base for a planned comparison with stroke victims who cluster in these decades. The younger group completes the age spectrum facilitating analysis of age effects on the swallow response and also serves as a willing group of subjects on whom to experiment with volitional control. Several protocols are described using videofluoroscopy concurrently with pharyngeal manometry as subjects swallow a spectrum of volumes, viscosities, and pills. Volitional maneuvers to be studied include those suggested to be of use in dysphagic patients: breath holding at peak inhalation, prolonged laryngeal elevation, and forceful swallowing. Furthermore, the effect of pre-swallow thermal stimulation will be systematically evaluated and compared to manipulations of bolus temperature. Manometric and videofluoroscopic data will be synchronized and recorded. Data analysis will utilize new techniques of computer assisted video and manometric analysis. A major thrust of the fluoroscopy analysis will be to incorporate motion analysis as well as timing analysis. Data on each parameter for each swallow will be numerically expressed in spreadsheets organized with 0.03 sec time intervals as the column headings and rows for data parameters. This analytic method allows for critical comparisons of concurrent events as well as establishing a comprehensive data set for comparison in the evaluation of dysphagic patients. Furthermore, mechanisms whereby therapeutic maneuvers and pre-swallow stimulation may benefit dysphagia will be described. Thus, the plasticity of the pharyngeal swallow in terms of the range of motion and timing of motion of oropharyngeal structures as affected by bolus-related variables, age, and volitional control is that the pharyngeal swallow can be conceptualized as being composed of several closely coordinated, but potentially modifiable components, rather than as a single stereotyped event. The protocols described examine the extent to which normal subjects are capable of varying cricopharyngeal opening, laryngeal closure, peristaltic force, and bolus propulsion. The significance of these findings relates to therapeutic strategies applied to dysphagic individuals. An impaired patient may have trouble with one aspect of the swallow such as laryngeal closure or upper esophageal sphincter opening, but still be capable of oral feeding if that defect can be selectively compensated for.