Corinna Schultheiss

Die Bewertung der pharyngalen Schluckphase mittels Bioimpedanz

Evaluation eines Mess- und Diagnostikverfahrens



ISBN: 978-3-86956-284-1
108 pages
Release year 2014

Series: Spektrum Patholinguistik - Schriften , 7

12,00 

Swallowing is a vital process. Its diagnosis and therapy represent enourmous medical challenges. The detection and assessment of swallows and swallowing disorders require elaborate techniques such as videofluoroscopy (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES), which entail a high burden for the patient. Both methods are currently used as a goldstandard in the diagnosis and therapy of swallowing disorders. The measurements must, in general, be performed and evaluated by experienced medical personnel. In therapy, dietary modifications and swallowing maneuvers are common methods. But also functional electrical stimulation (FES) is increasingly used. The goal of this doctoral thesis was the evaluation of the combined bioimpedance (BI) and electromyography (EMG) measurement system that was developed within the research project BigDysPro. In particular, it should be examined whether the system can be used in the diagnosis and therapy of swallowing disorders as an independent measurement system and in the context of a swallowing neuroprosthesis. Several studies were conducted with healthy subjects to assess the reproducibility of the measurements, the distinction of swallowing from head movements, and the influence of different factors (i.e. the subject’s gender as well as amount, consistency, and conductivity of the food) on the bioimpedance and electromyography. In additional experiments with patients, the influence of the electrode type, i.e. surface vs. needle electrodes, was examined. Furthermore, patients were examined with FEES and VFSS in parallel measurements with the new system. Thereby, the correlation of the BI and EMG signals with movements of anatomical structures (VFSS) and with the swallowing quality (FEES) was assessed. In these studies, 31 healthy subjects with 1819 swallows and 60 patients with 715 swallows were examined. The measured signals show a typical, reproducable run of the curve, that correlates with the anatomical and functional alterations observed by videofluoroscopy during the pharyngeal phase of swallowing (r > 0, 7). From the curve of the bioimpedance, features were extracted to assess the quality of swallowing. These features were demonstrated to correlate with physiological phenomena, such as delayed laryngeal closure and larynx elevation. Therefore, they were used to assess the swallow quality in accordance with fiberoptic endoscopic examination of swallowing. Significant differences were found in the measurement signals of swallows and head movements, as well as in the signals from different food amounts and consistencies. In contrast, the conductivity of the food, the gender of the subjects, and the type of electrodes had no significant effect on the curve of the bioimpedance and the electromyography. From the results of the evaluation, it is concluded that the combined bioimpedance and electromyography measurement system represents a novel, non-invasive tool. It enables the reproducible assessment of the pharyngeal phase of swallowing. In diagnosis, the system might be used, e.g., in long-time measurements for the assessment of swallowing frequency and quality. In therapy, the method can be implemented in a swallowing neuroprosthesis or might be used in a biofeedback system.

Swallowing is a vital process. Its diagnosis and therapy represent enourmous medical challenges. The detection and assessment of swallows and swallowing disorders require elaborate techniques such as videofluoroscopy (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES), which entail a high burden for the patient. Both methods are currently used as a goldstandard in the diagnosis and therapy of swallowing disorders. The measurements must, in general, be performed and evaluated by experienced medical personnel. In therapy, dietary modifications and swallowing maneuvers are common methods. But also functional electrical stimulation (FES) is increasingly used. The goal of this doctoral thesis was the evaluation of the combined bioimpedance (BI) and electromyography (EMG) measurement system that was developed within the research project BigDysPro. In particular, it should be examined whether the system can be used in the diagnosis and therapy of swallowing disorders as an independent measurement system and in the context of a swallowing neuroprosthesis. Several studies were conducted with healthy subjects to assess the reproducibility of the measurements, the distinction of swallowing from head movements, and the influence of different factors (i.e. the subject’s gender as well as amount, consistency, and conductivity of the food) on the bioimpedance and electromyography. In additional experiments with patients, the influence of the electrode type, i.e. surface vs. needle electrodes, was examined. Furthermore, patients were examined with FEES and VFSS in parallel measurements with the new system. Thereby, the correlation of the BI and EMG signals with movements of anatomical structures (VFSS) and with the swallowing quality (FEES) was assessed. In these studies, 31 healthy subjects with 1819 swallows and 60 patients with 715 swallows were examined. The measured signals show a typical, reproducable run of the curve, that correlates with the anatomical and functional alterations observed by videofluoroscopy during the pharyngeal phase of swallowing (r > 0, 7). From the curve of the bioimpedance, features were extracted to assess the quality of swallowing. These features were demonstrated to correlate with physiological phenomena, such as delayed laryngeal closure and larynx elevation. Therefore, they were used to assess the swallow quality in accordance with fiberoptic endoscopic examination of swallowing. Significant differences were found in the measurement signals of swallows and head movements, as well as in the signals from different food amounts and consistencies. In contrast, the conductivity of the food, the gender of the subjects, and the type of electrodes had no significant effect on the curve of the bioimpedance and the electromyography. From the results of the evaluation, it is concluded that the combined bioimpedance and electromyography measurement system represents a novel, non-invasive tool. It enables the reproducible assessment of the pharyngeal phase of swallowing. In diagnosis, the system might be used, e.g., in long-time measurements for the assessment of swallowing frequency and quality. In therapy, the method can be implemented in a swallowing neuroprosthesis or might be used in a biofeedback system.