VOLITIONAL, BOLUS, AND AGE EFFECTS ON HUMAN SWALLOWING

这一修订后的竞争性更新旨在扩大生物力学的工作， 分析人类咽部吞咽反应以分析决定因素 口咽吞咽困难，以及治疗策略的潜力， 补偿观察到的功能障碍。在第一个五年的工作 这个项目导致了口咽吞咽的概念化 作为一个紧密集成的功能元件组（ 鼻咽，UES开口，喉前庭闭合，舌负荷 （斜坡），舌推进和咽间隙），每一个受试者 时间、运动、协调和可修改性的特定约束。 更新的最初目标是获得关键的正常值， 吞咽的观察、定时、机械和协调措施 从适当的对照组（三个年龄组的男性和女性受试者 年龄组：20-29岁、40-49岁和等于或大于70岁）。第二个目的 将专注于确定这些吞咽措施的最小集合， 区分正常和异常的吞咽功能（误吸， 鼻咽返流、残留或延迟）。吞咽困难的数据 易受特定功能障碍影响的人群将被用于 对确定每个吞咽测量的吞咽测量集合进行统计建模， 功能障碍，并制定一个“风险方程”的功能障碍。的 总的假设是，评估这种极其复杂的机械 行动可以减少到一个相对较小的测量集， 显示出任何严重功能障碍第三个具体目标 项目是衡量补偿的程度可能为每个 确定的正常受试者的关键吞咽指标， 吞咽困难人群，以及被确定为患有最低限度 这个变量的功能储备。补偿方式来自 吞咽治疗师的设备和包括吞咽动作的使用， 姿势技巧和增加口腔感觉刺激。最后， 计算机辅助图像分析和三维重建将是 用于模拟咽内形状的动力学。分析 三维图形工具的程序，可以量化瞬时 咽内容积，其与来自 咽出口，可以产生吞咽功效的有用参数。

This revised competitive renewal seeks to expand work on the biomechanical analysis of the human pharyngeal swallow response to analyze determinants of oropharyngeal dysphagia, and the potential of therapeutic strategies to compensate for observed dysfunction. Work during the first five years of this project has led to the conceptualization of the oropharyngeal swallow as a tightly integrated group of functional elements (closure of the nasopharynx, UES Opening, laryngeal vestibule closure, tongue loading (ramping), tongue pulsion, and pharyngeal clearance), each subject to specific constraints of timing, motion, coordination, and modifiability. An initial aim of the renewal will be to obtain normal values for key observational, timing, mechanical, and coordinative measures of swallowing from appropriate groups of controls (male and female subjects of three age groups: 20-29, 40-49, and equal to or more than 70 yrs). The second aim will focus on determining the minimal set of these swallow measures that discriminates normal from abnormal swallowing function (aspiration, nasopharyngeal regurgitation, residue, or delay). Data from dysphagic populations susceptible to specific dysfunctions will be used to statistically model the set of swallow measures that determine each dysfunction and to develop an "equation of risk" for that dysfunction. The overall hypothesis is that evaluation of this extremely complex mechanical action can be reduced to a relatively small set of measurements that will indicate any significant dysfunction. The third specific aim of the project is to measure the degree of compensation possible for each of the key swallow measures identified for normal subjects, for the relevant dysphagic population, and for individuals identified as having minimal functional reserve for that variable. Means of compensation are drawn from the swallow therapists armamentarium and include use of swallow maneuvers, postural techniques, and increased oral sensory stimulation. Finally, computer-assisted image analysis and 3 dimensional reconstructions will be utilized to model the dynamics of the intrapharyngeal shape. The analysis tool of the 3-dimensional graphics program can quantify instantaneous intrapharyngeal volume, which coupled with pressure data from the pharyngeal outlet, may yield a useful parameter of swallow efficacy.