Effects of Aging on Anticipatory Functional Synergies Activated in Deglutition

描述（由申请人提供）：该项目的总体目标是促进对整个进食过程中发生的与年龄相关的生理和功能变化的理解，从而为患有吞咽问题的个体设计更有效的治疗方法，特别是在老龄化人群中。在许多老年人中常见的认知、身体和感觉障碍的组合，特别是在存在共病神经功能障碍的情况下（例如，痴呆症），往往导致饮食需求得不到满足，导致发病率和过早死亡率增加。这些人中的许多人的功能限制需要大量或全部的帮助来消耗食物和液体。然而，尽管与辅助喂养相关的安全性增加的含义，这种建议导致的线索消除的影响和潜在的风险增加（例如，来自手/手臂的本体感受）对已经负担过重的系统的影响尚不清楚。有限的文献是关于这些口前，或预期，线索和刺激的过程中的“安全进食和吞咽”的贡献。为了解决这个临床相关的问题，本项目旨在：（1）确定涉及手/手臂，嘴唇和下颌的协同肌肉模式，这些肌肉模式存在于年轻人和老年人的吞咽口前阶段;（2）确定非口咽感觉信息和反馈的修改对启动和改变年轻人和老年人这些口腔运动模式的影响。该提案的实验方法利用肌电图和光学运动检测技术来检查在典型的进食和吞咽期间发生的预期反应和纠错模式中与年龄相关的变化。这项工作是重要的，因为吞咽和吞咽前计划的预期阶段的中断不仅在需要喂养辅助的个体亚群中很常见，而且在患有许多神经系统疾病的个体中也很突出，包括痴呆症，右半球障碍，中风和创伤性脑损伤。本研究中获得的知识将有助于将正常衰老的影响与这些疾病的影响分开，这对于设计适当的评估和干预技术非常重要。确定在吞咽的预期阶段期间感觉反馈的中断是否会影响以后吞咽的模式和时间，然后可能导致开发新的方法来有效的喂养实践和吞咽策略，旨在预防老年人和临床人群中的吞咽困难和上呼吸道损害。 公共卫生相关性：吞咽问题导致了与疾病相关的高昂的经济、身体和心理社会成本，特别是在老年人中。尽管与这些个体的喂养辅助相关的安全性增加的含义，对已经征税的系统缺乏口前感觉线索的影响和潜在风险尚不清楚。通过检查这些口前提示和健康老年人在进食和吞咽过程中的预期口腔姿势之间的关系，本研究旨在解决这些建议可能引起的风险增加的可能性，增强吞咽相关的实践和干预措施。

DESCRIPTION (provided by applicant): The overall goal of this project is to contribute to the understanding of the age-related physiological and functional changes that occur across the eating process, leading to the design of more efficacious treatments for individuals with swallowing problems, particularly in the aging population. The combination of cognitive, physical, and sensory impairments commonly seen in many elderly individuals, especially in the presence of co-morbid neurologic impairment (e.g., dementia), often results in eating needs going unmet, leading to increased morbidity and premature mortality. The functional limitations of many of these individuals necessitate extensive or total assistance with consuming foods and liquids. However, despite the implication of increased safety associated with assisted feeding, the influence and potential increased risk of the elimination of cues resulting from this recommendation (e.g., proprioception from the hand/arm) on an already taxed system are unclear. Limited literature is available regarding the contribution of these pre-oral, or anticipatory, cues and stimuli to the process of "safe eating and swallowing". To address this clinically-relevant problem, this project seeks to: (1) identify the synergistic muscle patterns involving the hand/arm, lips, and jaw that are present during the pre-oral stage of deglutition in younger and older adults; and (2) to determine the influence of modifications in non-oropharyngeal sensory information and feedback on initiating and altering these oral motor patterns in younger and older adults. The experimental approach of this proposal capitalizes on the opportunity to utilize electromyography and optical motion detection techniques to examine the age-related changes in anticipatory responses and error correction patterns that occur during typical eating and swallowing. This work is significant as disruptions in the anticipatory stage of swallowing and pre-swallowing planning are common not only in the subpopulation of individuals requiring feeding assistance, but are additionally prominent in individuals with numerous neurological diseases, including dementia, right hemisphere disorder, stroke, and traumatic brain injury. The knowledge gained in this study will help disassociate the effects of normal aging from those due to these diseases, important in the design of appropriate assessment and intervention techniques. Determining whether or not disruptions in sensory feedback during the anticipatory stage of swallowing affect the pattern and timing of later swallowing may then lead to the development of new approaches to effective feeding practices and swallowing strategies aimed at preventing dysphagia and upper airway compromise in the elderly and across clinical populations. PUBLIC HEALTH RELEVANCE: Swallowing problems contribute to the high financial, physical, and psychosocial costs associated with disease, particularly in the elderly. Despite the implication of increased safety associated with feeding assistance for these individuals, the influence and potential risks of absent pre-oral sensory cues on an already taxed system are unclear. By examining the relationship between these pre-oral cues and anticipatory oral posturing during eating and swallowing in healthy elderly individuals, this research is positioned to address the potential for increased risk these recommendations may elicit, enhancing swallowing-related practices and interventions.