Establishing Reference Values and Clinical Decision Points for Quantitative Videofluoroscopic Measures of Swallowing

项目摘要/摘要 吞咽困难(吞咽障碍)是一种严重的健康状况，见于许多与年龄相关的疾病和损伤。 流程。虽然视频透视(VF)是国际上的吞咽困难诊断检查的黄金标准， 在不同年龄段的健康成年人中，可用的标准生理学VF参考值很少。 指导对本次考试的解读。这种知识上的根本差距导致了不太一致的看法 在确定吞咽损害及其潜在机制方面。为了改善吞咽困难 诊断方面，迫切需要为健康人群中的VF吞咽测量建立参考值 年龄跨度。在我们之前的R01(DC011020)中，我们开发了一种严格的吞咽测量方法 来自VF的生理学：吞咽生理学：事件、运动学和计时(ASPEKT 方法)。我们公布了40名年轻健康成年人(60岁)的初步ASPEKT参考值。 执行了初步分析，以比较来自健康的老年人和少数成年人的数据 对这些参考数据有吞咽困难。通过此续订申请，我们将验证ASPEKT方法 成人吞咽的健康参考值，展示了ASPEKT的可扩展性 跨越临床VF测试方案的常用变体的方法，以及轮廓吞噬 吞咽困难是发病原因的临床组的病理生理学，以确定临床决策点 可用于诊断和结果测量。我们的愿景是ASPEKT方法将使 临床医生将患者的测量结果与健康参考值进行比较，便于量化和证据- 基于对吞咽障碍的存在、性质和严重程度的解释。最终，我们寻求 生成数据，将主观吞咽困难诊断实践转向基于证据的量化诊断实践 将改善资源利用、治疗计划和患者结局的诊断框架。

Project Summary/Abstract Dysphagia (swallowing impairment) is a serious health condition seen in many age-related disease and injury processes. Although videofluoroscopy (VF) is an international “gold standard” dysphagia diagnostic exam, there is a paucity of available normative physiologic VF reference values in healthy adults across the age span to guide interpretation of this examination. This fundamental gap in knowledge contributes to poor agreement in the identification of swallowing impairment and its underlying mechanisms. To enable better dysphagia diagnostics, there is a critical need to establish reference values for VF swallowing measures across the healthy age span. In our previous R01 (DC011020), we developed a rigorous method for measuring swallowing physiology from VF: the Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT Method). We published initial ASPEKT reference values from 40 young healthy adults (<60 years) and performed preliminary analyses to compare data from healthy older adults and small cohorts of adults with dysphagia to these reference data. Through this renewal application, we will validate the ASPEKT Method healthy reference values for swallowing across the adult life span, demonstrate scalability of the ASPEKT Method across commonly used variations in clinical VF testing protocols, and profile swallowing pathophysiology in clinical groups where dysphagia is a cause of morbidity to identify clinical decision points that can be used for diagnosis and outcome measurement. Our vision is that the ASPEKT Method will enable clinicians to compare patient measures to healthy reference values, facilitating quantification and evidence- based interpretation of the presence, nature and severity of swallowing impairment. Ultimately, we seek to generate data that will shift subjective dysphagia diagnostic practices toward a quantitative, evidence-based diagnostic framework that will improve resource utilization, treatment planning and patient outcomes.