Dysphagia Committee Symposium

Current Topics in Dysphagia Diagnostics and Management

Ypsilon 1,2,324/8/2010

11:30 – 13:00

Dysphagia Committee

• Kenneth Watkin (Canada/United States) – Chair• Sandy Ettema (United States)

• Jeri Logemann (United States)

• Takahiro Ono (Japan)

• Alison Perry (Australia)

• Antonio Schindler (Italy)

• Irma Verdonck-DeLeeuw (Netherlands)

Presentations

11:30 Watkin, KL Recent Advances in Dysphagia Diagnostics and Intervention

11:45 Logemann, JA The Critical Nature of 30 Frames Per Second for Videofluoroscopic Studies of Swallow

12:00 Ono, T Diagnostics of Lingual Mechanics During Swallowing

12:15 Verdonck-DeLeeuw, IM Patient Reported Swallowing Outcome in Head and Neck Cancer

12:30 Schindler, A Applicability of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in Paediatric Population

Recent Advances in Dysphagia Diagnostics and Intervention

Kenneth L WatkinUniversity of IllinoisChampaign, Illinois

Outline

• Advances in Diagnostic Imaging for Swallowing– Cine MRI

• New Diagnostic and Rehabilitation Techniques– DASI

• Pervasive Monitoring– Small EEG/EMG

Advances in Diagnostic Imaging for Swallowing

– Cine-MRI• T2-weighted, “single-shot fast

spin echo” (SSFSE) cine-MRI• 1.5 T MRI unit (Signa GE)• The acquisition rate was 700ms per

acquisition (slice), with the following parameters:

– field of view 220mm, repetition time 4900ms, echo time 90 ms, flip angle 90◦, rephasing impulse 160◦, 256×128 matrix, excitation number 1, and bandwidth 62.5

• Hartl, D. M., Kolb, F., Bretagne, E., Bidault, F., & Sigal, R. (2010). Cine-MRI swallowing evaluation after tongue reconstruction. European Journal of Radiology, 73(1), 108-113.

• Hartl, D. M., Kolb, F., Bretagne, E., Marandas, P., & Sigal,

R. (2006). Cine magnetic resonance imaging with single-shot fast spin echo for evaluation of dysphagia and aspiration. Dysphagia, 21(3), 156-162.

Cine MRI >

Videofluoroscopic MBS

A Clinical Perspective

Diagnostics Intervention

MBSFEESCine-MRI

Diagnostics Intervention‘and’

‘then’TODAY :

FUTURE :

Laryngeal Accelerometery & Dysphagia

• Underdevelopment for many years– Reddy et al. (1991 – 1995)

• Small accelerometer taped to the midline surface of the thyroid cartilage)• Spectral analysis, fuzzy logic• Can discern patterns of movement associated with swallowing event.

– Eretkin (1996 – 2008), Ludlow(2006 – 20008)• Explored the application of the technology

accelerometer PVDF strip Nano accelerometer

Application - Swallowing Diagnostics and Intervention

• Sensing Laryngeal Movement

Images provided by Elixir Research: DASI

From Reddy, et al.(1996)

Images from : www.strainsense.co.uk

COLLAR Pressure

PROCESSOR

SOFTWARE dynamics of swallowing

and calculations

SENSOR Piezoelectr

ic

10

Portable non-invasive technology

Digital Accelerometry Swallow Imaging is patented and

cleared by the FDA Slide courtesy of Elixir Research

Diagnostics: Normal Swallow Profile Example

ORAL

Hyo Laryngeal

POST Laryngeal

Slide courtesy of Elixir Research 2010

12

Normal Vs. Abnormal Swallow Examples

Stroke

TBI COPD

Intervention: Repetitive Task Training Directed at Correcting the Swallow Pattern

No Swallow

Three Swallows

With Accelerometry visualization and with clinician guidance , patient can correct the shape or pattern of swallow movement , improve the timing and coordination of the swallow movement

Swallow

Slide courtesy of Elixir Research 2010

Personalized Task training – example

Procedure # 19 29 35

Mean amplitude 25 52 100

First Onset 0.2 1.0 1.0Mean duration 2.8 1.3 1.2

DASI™ outcome measurements document any treatment progress and efficacy of any intervention

DASI™ automatic outcome measurements are used to enhance patient’s motivation and collaboration in therapy

Slide courtesy of Elixir Research 2010

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Pervasive Monitoring

• EEG/EMG --- TBI and swallowing• Helmet Based Telemetry Systems

Server- Data Collection- Multiple Sources- Multi-level andlongitudinal analysis

Analysis Software- Local data processing- Real-time feedback- Data forwarding

to the remote serve

• Small footprint, light-weight,low power consumption, real time data monitoringand diagnostics

• Wireless or satellite datauplinking

Watkin, KL, et al. (2010) Research supported by Office of the Congressionally Directed Medical Research Programs (CDMRP), Post-Traumatic Stress Disorder/Traumatic Brain Injury Research Program, Concept Award No. W81XWH-08-1-0208

The Future

Hospitals

RehabFacilities

MobileVehicles

Home

Clinics

RuralRemote Areas

CloudComputing

Systems

((((

Care Provider

Summary

• Newer imaging devices to support swallowing studies – MBS

• Having instruments that can help support both diagnostics and intervention is important– Especially if the are portable

• There is an acute need for clinical trials of newer instruments