High Resolution Manometry: A Novel Pattern Recognition Method for Dysphagia

描述（由申请人提供）：吞咽是一种关键的生命功能，其失败会导致危及生命的并发症。吞咽相关行为涉及复杂的适应性肌肉收缩的调节，以在整个口腔、咽喉和食管中产生压力和瓣膜活动。然而，我们对产生和调节这些压力的机制的理解仍然不完整。有效的吞咽是压力梯度的结果，该压力梯度最大化了完全药丸转移到食管中的概率。高分辨率测压（HRM）可以直接测量沿着咽部长度的这些压力模式，并提供直接表征每个吞咽事件的可量化的综合数据集。HRM的使用尚处于起步阶段，由于其独特的功能，有可能成为咽部吞咽障碍的诊断和管理中非常有价值的工具。当与视频荧光镜（VF）评估相结合时，HRM/VF可以提供详细的多维评估，定义产生压力的结构和运动，重新定义正常和功能失调的吞咽模型，提高诊断的准确性，并直接测量治疗效果。然而，由于缺乏对压力模式的全面分析，目前无法在循证实践中使用人力资源管理。本研究提案的总体目标是通过优化HRM分析并将结果与VF获得的结果相结合，开发咽部吞咽障碍诊断的新临床能力。然后，这项新技术将用于确定这些组合技术在多大程度上可以优化吞咽障碍人群中吞咽困难的诊断。在这项工作的最后阶段，我们将测试这个新工具的临床接受度。这项工作是非常重要的，因为HRM与VF相结合，当分析适当和优化，将增加吞咽困难患者的临床护理干预。 公共卫生相关性：吞咽是一项重要的生命功能，必须安全进行，以确保充足的营养并避免气道受损;失败可能导致危及生命的并发症。在吞咽过程中产生复杂的压力，并且直接测量这些压力沿着吞咽的X射线视频图像可以为诊断和治疗吞咽问题提供大量信息。这项研究将开发和测试一种新的方法，对吞咽过程中产生的多种压力和图像进行分析、显示和分类，使医生和语言病理学家能够提高吞咽障碍诊断和管理的准确性。

DESCRIPTION (provided by applicant): Swallowing is a critical life function and its failure leads to life threatening complications. Swallow-related behaviors involve the modulation of complex, adaptive muscular contractions to produce pressures and valving events throughout the oral cavity, laryngo-pharynx and esophagus. However, our understanding of the mechanisms that generate and modulate these pressures remains incomplete. Efficient swallow is the result of a pressure gradient that maximizes the probability of complete bolus transfer into the esophagus. High Resolution Manometry (HRM) can directly measure these pressure patterns along the length of the pharynx and provides a quantifiable, comprehensive data set directly characterizing each swallow event. The use of HRM is in its infancy and due to its unique capabilities, has the potential to become an exceptionally valuable tool in the diagnosis and management of pharyngeal swallowing disorders. When coupled with videofluoroscopic (VF) evaluations, HRM/VF could provide the detailed, multi-dimensional assessment that will define the structures and movements which generate pressure, redefine the models of normal and dysfunctional swallow, increase accuracy of diagnosis, and directly measure therapeutic effect. However, the lack of a comprehensive analysis of the pressure patterns currently precludes the use of HRM in evidence- based practice. The overarching goal of this research proposal is to develop new clinical capabilities for the diagnosis of impaired pharyngeal swallowing by optimizing HRM analysis and combining results with those obtained by VF. This new technology will then be used to determine the extent to which these combined technologies can optimize diagnosis of dysphagia in populations with variable swallowing impairment. In the final phase of this work, we will test clinical acceptance of this new tool. This work is highly significant because HRM combined with VF when analyzed appropriate and optimized will augment interventions in the clinical care of patients with dysphagia. PUBLIC HEALTH RELEVANCE: Swallowing is a critical life function that must be performed safely to ensure adequate nutrition and avoid airway compromise; failure can lead to life threatening complications. Complex pressures are generated during the swallow and directly measuring these pressures along with x-ray video images of the swallow can provide a great deal of information for diagnosing and treating swallowing problems. The proposed research will develop and test a new method of analyzing, displaying and classifying multiple pressures and images generated during the swallow to allow physicians and speech language pathologists to improve the accuracy of diagnosis and management of swallowing disorders.