| Summary: | 碩士 === 國立成功大學 === 醫學工程研究所碩博士班 === 97 === Dysphagia, difficulty in eating, especially in stroke survivals has become a severe clinical problem due to the increasing aging population in Taiwan. Although clinical usage of videofluorography provides clinically relevant assessment for all phases of swallowing, its radiation exposure and high cost have hindered it from routine clinical use and for biofeedback application. There is clear evidence that swallowing is a muscular activity that requires the complex sensory-motor integration of mouth and larynx movement. A few of non-invasive systems have been proposed but only lead to limited applications due to unreliable detection of swallowing action. The swallowing movement can be detected from electromyogram (EMG) or from motion detection sensors attached to anatomic markers related to swallowing movement. The aim of this study is to develop an innovative evaluation and treatment system for dysphagia which utilizes surface EMG of submental muscle together with movement of thyroid cartilage for the evaluation and feedback information for the application of biofeedback or electrical stimulation (ES) to assist the swallowing function. In this study, ES system can be performed by the concepts of hybrid activation for potential mechanism of potentiation and triggered swallow reflex.
We first designed an evaluation platform, including sEMG (surface electromyogram) and one miniature tri-axial accelerometer, for assessing the swallowing function. The activity detected by muscle activity from sEMG of submental muscle and the lifting of thyroid cartilage recorded by the accelerator can be used for deriving triggering time. Furthermore, a hybrid activation system which can measure the sEMG before and during ES was established. The sub-threshold ES can be applied at varied phases of swallowing. Novel way of ES was proposed and validated in this study, which ES can be initiated when tongue base is activated followed by a major synchronous stimulation while the lifting of laryngeal perceived. The EMG and acceleration signals acquired can also serve as a biofeedback training protocol. The proposed dysphagia assessment, biofeedback training, and ES-trigger assisted systems have been proven to shorten the triggering time, reduce occurrence of aspiration, and improve swallowing comfort in pilot clinical trials. It is believed this integrated assessment and ES-assisted swallowing induced by hybrid muscle activation would benefit wide ranges of dysphagia due to stroke, Parkinsonism, and other neurological deficits.
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