dysphagia committee panel
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TRANSCRIPT
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