Applying motor learning principles to dysphagia rehabilitation

描述（由申请人提供）：总体目标是以一种新的方式利用运动学习原理来增强卒中所致吞咽困难患者的吞咽困难康复。吞咽困难是吞咽障碍，由于摄入的物质进入气管（误吸），可能导致严重疾病或死亡。这项研究解决了该机构的使命，因为它促进了提高身体残疾人的健康、生产力、独立性和生活质量所需的科学知识的发展。具体地说， 这项研究将确定吞咽训练后，运动学习原则与标准护理是否会发生持久的行为改变。运动学习原则强调在训练过程中通过生物反馈进行持续的运动学评估。然而，在标准吞咽困难护理中，连续的运动学评估是罕见的，因为吞咽运动学需要诸如视频荧光透视（VF）等仪器来观察。由于VF涉及辐射暴露和更高的成本，颏下肌电图（sEMG）被广泛用作生物反馈，尽管它不能成像吞咽运动学或确认正在训练治疗运动。在这个最初的1期临床试验中，我们将比较三种形式的生物反馈训练吞咽动作称为自主喉前庭关闭（vLVC），它强调吞咽气道保护。VF生物反馈训练将提供有关vLVC表现的运动学信息，并结合运动学习原则。sEMG生物反馈训练将提供关于vLVC表现的非运动学信息，因此不包括运动学习原理。我们还将研究混合生物反馈训练，其中包括VF生物反馈早期建立vLVC动作的目标运动学，然后加强与sEMG学习。正在研究混合生物反馈训练，因为它比VF生物反馈训练在临床上更可行，同时在vLVC训练的一部分期间仍然结合运动学习原理。我们假设VF训练比混合训练更能减少吞咽障碍，但混合训练比sEMG训练更能减少吞咽障碍。此外，本研究将调查已知可增强运动训练的辅助技术（独立测试的非侵入性神经刺激和明确奖励）是否会增强每种拟议训练的结果。我们的创新实验设计是重要的，因为它调查了理想训练（VF生物反馈）中的运动学习原理以及临床可行的选择（混合生物反馈），以将其与标准吞咽困难训练（sEMG）区分开来，后者在强烈的运动训练后几乎没有改善。我们提案的结果可能会改变治疗吞咽和其他内部功能（如言语和声音障碍）的范式。

DESCRIPTION (provided by applicant): The overall goal is to exploit motor learning principles in a novel way to enhance dysphagia rehabilitation in patients with dysphagia due to stroke. Dysphagia is swallowing impairment that can lead to serious illness or death due to ingested material entering the trachea (aspiration). This study addresses the mission of the agency, because it fosters development of scientific knowledge needed to enhance the health, productivity, independence, and quality-of-life of people with physical disabilities. Specifically, this study will determine whether lasting behavioral modifications after swallowing training occur with motor learning principles versus standard care. Motor learning principles emphasize continual kinematic assessment through biofeedback during training. However, continual kinematic assessment is rare in standard dysphagia care because swallowing kinematics require instrumentation such as videofluoroscopy (VF) to be seen. Since VF involves radiation exposure and higher costs, submental electromyography (sEMG) is widely used as biofeedback, although it does not image swallowing kinematics or confirm that a therapeutic movement is being trained. In this initial phase 1 clinical trial, we will compare three forms of biofeedback on training a swallowing maneuver called volitional laryngeal vestibule closure (vLVC), which emphasizes swallowing airway protection. VF biofeedback training will provide kinematic information about vLVC performance, incorporating motor learning principles. sEMG biofeedback training will provide non-kinematic information about vLVC performance and, thus, does not incorporate motor learning principles. We will also investigate a mixed biofeedback training, which involves VF biofeedback early on to establish the target kinematics of the vLVC maneuver, then reinforces what was learned with sEMG. Mixed biofeedback training is being examined because it is more clinically feasible than VF biofeedback training, while still incorporating motor learning principles during part of the vLVC training. We hypothesize that VF training will reduce swallowing impairment more than mixed training, but mixed training will reduce swallowing impairment more than sEMG training. Additionally, this study will investigate whether adjuvant techniques known to augment motor training (non-invasive neural stimulation and explicit reward tested independently), will augment outcomes of each of the proposed trainings. Our innovative experimental design is significant because it investigates motor learning principles within an ideal training (VF biofeedback) as well as within a clinically feasibe option (mixed biofeedback) to differentiate them from standard dysphagia training (sEMG), which has reported little to no improvements after intense motor training. Outcomes from our proposal may change the paradigm for treating swallowing and other internal functions such as speech and voice disorders.