JP2016168092A - Deglutition detection garment and deglutition detector - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a deglutition detection garment usable easily without imparting unpleasant feeling to an examinee, which is a garment capable of detecting deglutition of the examinee at the eating time; and to provide a deglutition detector.SOLUTION: A deglutition detection garment includes a garment body 10 having a collar part, a bridge part 20 bridged over the collar part, and an acceleration sensor 30 fitted to the bridge part 20. A deglutition detector includes the bridge part 20 fitted to the collar part 12 of the garment body 10, and bridged over the front side of a neck part, and the acceleration sensor fitted to the bridge part 20.SELECTED DRAWING: Figure 1

Description

  The present invention relates to a swallowing detection garment and a swallowing detector for determining swallowing during eating and drinking.

  A caregiver engaged in a care facility usually provides care for a plurality of care recipients. Caregivers need to provide meal care for all the care recipients they are responsible for within the prescribed time in the care of the caregivers' meals, and efficiently provide meal care for individual caregivers in a short time. There must be. However, since it is difficult even for a skilled caregiver to visually determine the swallowing (swallowing) of food and drink by the care recipient, the caregiver efficiently provides meal care to each caregiver. I can't. Moreover, since the cared person may cause pneumonia leading to death by aspiration, the carer feels a strong psychological burden in caring for the cared person's meal.

  Therefore, if the care recipient can accurately determine swallowing at the time of eating and drinking, the caregiver can improve the efficiency of the care of the meal, and the psychological burden can be reduced. Furthermore, since the cared person can eat efficiently, an improvement in the “quality of life” related to the meal is also expected.

  As a method of determining whether or not a person is swallowed, there is a swallowing contrast examination. According to the swallowing contrast examination, the presence or absence of swallowing or aspiration of the subject can be safely determined. However, swallowing contrast examination cannot be used in every meal because the size of the contrast device is large, its price is expensive, and it is necessary to take a contrast medium and there is a problem of X-ray exposure. .

  Patent Document 1 describes a method for detecting a dysphagia by arranging electrodes on a plurality of muscle surfaces involved in swallowing and recording a surface electromyogram. However, this method takes time and labor to attach the electrode, and when the electrode is disposable, the cost of the electrode increases. Therefore, this method cannot be used in every meal.

  In addition, each of the above methods also has a problem of giving restraint and discomfort to the care recipient.

JP-A-2005-304890

  The present invention provides a garment that can detect swallowing of a subject during eating and drinking, and that can be easily used without causing discomfort to the subject and a swallowing detector The purpose is to do.

  The swallowing detection garment of the present invention includes a garment main body having a collar portion, a spanning portion spanned over the collar portion, and an acceleration sensor attached to the spanning portion.

  The swallowing detection garment of the present invention preferably includes a position adjusting unit capable of adjusting a position at which the bridge part is bridged on both or one of the collar part and the bridge part.

  A swallowing detector for detecting swallowing by an examiner according to the present invention includes a crossover part that is attached to a collar part of a garment body and is stretched over the front side of a neck part, and an acceleration sensor that is attached to the crossover part.

The swallowing detector and the swallowing detector attached to the clothing body can be easily worn by the subject, so that the subject's judgment data for swallowing can be used without much effort compared to conventional tests. Neck acceleration data can be measured. In addition, the swallowing detector attached to the garment detection clothing and the clothing body measures the acceleration of the subject's anterior cervical muscle using an acceleration sensor. Appropriate data can be acquired.
Furthermore, since the swallowing detector attached to the swallowing detection garment and the garment body is non-invasive and less restrictive, acceleration data can be measured without placing a burden on the subject.

It is a front view which shows the swallowing detection clothes of embodiment of this invention. It is a rear view which shows the swallowing detection clothes of embodiment of this invention. It is a front view which shows a bridge part and an acceleration sensor. It is a front view which shows the state which the subject put on the swallowing detection clothes. It is a figure which shows the outline | summary of the experiment regarding the attachment position of an acceleration sensor. It is a graph which shows the time series of the acceleration data at the time of swallowing obtained by the subject's swallowing experiment. (A) is a graph showing the integrated value iAcc of resting and swallowing at each measurement site, and (B) shows the ratio of the integrated value iAcc of resting and swallowing at each measuring site. It is a graph (* p <0.05, ** p <0.01, Sidak method). (A) And (B) is a graph which shows the ratio of the integral value iAcc of the acceleration at the time of rest in the x-axis, y-axis, and z-axis of a healthy male subject and a female subject, respectively. * p <0.05, ** p <0.01, Sidak method). It is a graph which shows the time series of the acceleration data obtained by the swallowing experiment of the elderly person, and myoelectric value. (A) is a graph showing the integrated value iEMG of resting and swallowing myoelectric values based on the average value of the integrated value iEMG of resting myoelectric values of each elderly person, (B) It is a graph which shows the integrated value iAcc of the acceleration at the time of rest and swallowing on the basis of the average value of the integrated value iAcc of the acceleration of each elderly person (* p <0.05, ** p <0.01, *** p <0.001, t test). (A) is a graph which shows the integrated value iEMG of the myoelectric value at the time of swallowing on the basis of the average value of the integrated value iEMG of the myoelectric value at the rest of all elderly people, (B) is all elderly people 3 is a graph showing the integral value iAcc of swallowing acceleration based on the average value of the integral value iAcc of resting acceleration (** p <0.01, t test).

In the following, a swallowing detection garment according to an embodiment of the present invention will be described first, and then a swallowing detector according to an embodiment of the present invention will be described.
In the following description, a person wearing a swallowing detection garment such as a cared person or a patient is referred to as a subject A. A person who cares, nursing or inspects the subject A such as a cared person or a patient is called an examiner. In addition, swallowing may be referred to as swallowing.

  As shown in FIGS. 1 and 2, the swallowing detection garment includes a garment main body 10, a crossover unit 20, and an acceleration sensor 30.

The garment body 10 is formed in a substantially trapezoidal shape from a plan view of a material such as cloth or woven fabric. In the upper part of the garment body 10, an opening 11 for passing the neck is provided, and the periphery of the opening 11 is a collar 12. Further, the opening 11 is provided with a notch 14 that is notched upward from the upper part thereof. The portions located on the left and right of the notch portion 14 are mounting portions 16 and 16 for mounting the swallowing detection clothes on the neck. Of the left and right mounting portions 16, 16, on one front surface and the other rear surface are provided surface fasteners 18, 19 that can be detachably connected to each other.
The form of the garment body 10 is not limited to the above form, and may be any form as long as it has a collar portion 12. Moreover, the form of the collar part 12 is not limited to the said form, What kind of form may be sufficient if it surrounds the circumference | surroundings of a neck. The material of the garment main body 10 may be a sheet made of synthetic resin such as polyester that easily removes dirt such as spilled food.

The crossover part 20 has a belt-like shape, and both surfaces thereof are substantially orthogonal to the front-rear direction, and when the subject A wears a swallowing detection garment, it is positioned on the front side of the neck of the subject A. , Is stretched over the collar 12.
Any material may be used for the bridge portion 20, but a stretchable material is preferable. When a stretchable material such as a knitted fabric knitted with stretchable yarn or the like is used as the material of the bridge part 20, the bridge part 20 or the acceleration sensor 30 can be easily and reliably applied to the neck.
In addition, when the subject A wears the swallowing detection clothes, the crossing unit 20 is crossed in front of the neck and the acceleration sensor 30 performs a predetermined measurement. Anything may be used as long as it is located on the part.

As the acceleration sensor 30, a sensor capable of measuring the acceleration of at least one axis is used. The acceleration sensor 30 is attached to the periphery of the center portion of the rear surface of the bridge portion 20 by fixing means such as an adhesive or an adhesive tape so that one of the acceleration measurement axes is substantially parallel to the front-rear direction. . Although the acceleration sensor 30 may be attached to the front surface of the crossover portion 20, the acceleration sensor 30 can be directly applied to the skin of the neck of the subject A when attached to the rear surface. Detection accuracy is improved.
The acceleration sensor 30 may include a wired or wireless communication unit in order to transmit acceleration data to a computer 74 such as a personal computer.

The swallowing-detecting garment may be one in which the crossover portion 20 is crossed over a predetermined position on the collar portion 12 of the garment main body 10 and is fixed to the garment main body 10 by fixing means such as sewing or adhesion. Moreover, the position adjustment parts 40 and 42 which can adjust the bridge position of the bridge part 20 in the collar part 12 may be provided. In the present embodiment, the surface fasteners 40 and 42 are provided on the garment main body 10 and the crossover part 20 as the position adjusting parts 40 and 42, respectively. More specifically, as shown in FIG. 2, belt-like surface fasteners 40, 40 extending substantially in the vertical direction are provided on the left side and the right side of the collar portion 12 of the rear surface of the garment body 10, respectively. It has been. Further, as shown in FIG. 3, the left and right end portions of the front surface of the crossover portion 20 can be detachably connected to the surface fasteners 40 and 40 and extend in the longitudinal direction of the crossover portion 20. Band-shaped surface fasteners 42 and 42 are provided, respectively.
According to the position adjusting portions 40, 42, the hook and loop fasteners 40, 40 of the garment body 10 are provided in a manner extending substantially in the vertical direction, so that the spanning position of the spanning portion 20 in the collar portion 12 is changed in the vertical direction, The span 20 can be attached to the garment body 10. Moreover, since the strip | belt-shaped surface fasteners 42 and 42 extended in the longitudinal direction of the crossover part 20 are provided in the right-and-left end part side of the crossover part 20, the crossover part 20 can be shifted to the left-right direction and can be attached to the clothing main body 10. it can. Therefore, the swallowing detection clothes can change the position of the acceleration sensor 30 up, down, left, and right by the position adjustment units 40 and 42.
The surface fasteners 40, 40 of the garment body 10 may be provided on the front surface of the garment body 10. In this case, the surface fasteners 42, 42 of the transfer unit 20 are provided on the rear surface of the transfer unit 20. .
Further, the position adjusting units 40 and 42 may be other than the hook-and-loop fasteners 40 and 42. In order to change the position of the acceleration sensor 30 up, down, left and right, the position of the bridge 20 in the collar 12 is changed. As long as it can do, it may be anything. For example, instead of the hook and loop fasteners 40 and 40 of the garment main body 10, a plurality of recesses or convex portions of the snap button are provided substantially in the vertical direction, and the snap buttons of the garment main body 10 can be used instead of the hook and loop fasteners 42 and 42 of the transfer part 20 You may provide the convex part or recessed part of a snap button. Further, the position adjusting units 40 and 42 may be a combination of a button and a buttonhole instead of the snap button.

  The swallowing detection clothes may further include a control unit and a notification unit. A control part and a notification part can be provided in the acceleration sensor 30, for example. When the swallowing detection garment includes a control unit and a notification unit, the control unit compares the measured acceleration with a threshold value, and performs a swallowing determination process to determine that the swallowing has occurred if the acceleration is greater than the threshold value. If it is determined that there has been a swallow, the notification unit can notify the user. As the control unit, for example, a control unit having a CPU (Central Processing Unit), a ROM (Read Only Memory), and a RAM (Random Access Memory) can be used. As the notification unit, for example, a lamp, a buzzer, a monitor, or the like can be used. In particular, a lamp that does not get in the way during a meal or conversation is desirable. The control unit and the notification unit are not necessarily provided in the acceleration sensor 30. For example, a computer 74 such as a personal computer may be used as the control unit, and a monitor or the like may be used as the notification unit. In this case, the acceleration sensor 30 and the computer 74 are provided with a wired or wireless communication unit for transmitting and receiving acceleration data.

Next, a method for using the swallowing detection garment will be described. FIG. 4 shows a state where the subject A wears the swallowing detection clothes. The swallowing detection garment is worn by passing the neck of the subject A through the collar portion 12 and connecting the left and right attachment portions 16, 16 with the respective surface fasteners 18, 19. At this time, the bridge 20 is bridged on the front side of the neck, and the position adjusters 40 and 42 are used to bridge the collar 12 with the acceleration sensor 30 so that the acceleration sensor 30 is positioned on the front neck muscle. The bridge position of the transfer part 20 is adjusted. Thus, by spanning the bridge part 20 on the collar part 12, one of the measurement axes of the acceleration sensor 30 is substantially orthogonal to the running direction of the muscle fibers of the muscle.
Here, the anterior cervical muscle is a general term for the upper hyoid and subhyoid muscles. The suprahyoid muscle is a general term for the digastric muscle, the stylohyoid muscle, the maxillohyoid muscle, and the geniohyoid muscle. It is a general term for thyroid muscle and thyroid hyoid muscle.
As for the measurement site by the acceleration sensor 30, the subhyoid muscle is more preferable among the front neck muscles, and particularly the sternohyoid muscle is more preferable among the subhyoid muscles. When the acceleration sensor 30 is arranged on these parts, the measured acceleration value is larger than that of other parts, so that the determination accuracy is improved in swallowing determination.

Since the swallowing detection garment of the present invention can be easily worn by the subject A, the acceleration data of the neck of the subject A, which becomes a judgment material for swallowing without taking time compared with the conventional examination or the like. Can be measured. In addition, since the swallowing detection garment of the present invention measures the acceleration of the anterior cervical muscle of the subject A by the acceleration sensor 30, data that is very suitable for swallowing determination is obtained compared to the case of measuring with an electromyograph or the like. can do.
Moreover, since the swallowing detection garment is non-invasive and weak in restraint, acceleration data can be measured without imposing a burden on the subject A. Moreover, by attaching it to clothes worn during meals, such as an apron or apron, it can be worn in a natural manner during meals, and the sense that swallowing is detected can be diminished.

  Moreover, since the swallowing detection garment includes the position adjustment units 40 and 42, the attachment position of the acceleration sensor 30 can be adjusted. Therefore, the acceleration sensor 30 is disposed on a portion of the neck that is suitable for data acquisition. can do.

  In the swallowing detection garment, the control unit performs swallowing determination processing based on the acceleration data measured by the acceleration sensor 30, and the notifying unit notifies the swallowing of the subject A by the notifying unit. Since the presence or absence can be ascertained reliably, the meal care time per person can be shortened, and the efficiency of meal care can be improved.

Next, an experiment performed on swallowing detection clothes will be described. In the experiment, an experiment for examining a suitable mounting position of the acceleration sensor 30 in the neck and an experiment in which the subject A wearing the swallowing detection clothes swallows were performed. Hereinafter, the former will be described in the order of the latter. FIG. 5 shows an outline of the former experiment.
The acceleration was measured at three sites: the digastric muscle, the sternohyoid muscle, and the sternothyroid muscle.
For the measurement of acceleration, a multi-telemeter system 70 having an acceleration sensor 30 (ZB-155H, ZB-156H: manufactured by Nihon Kohden Co., Ltd.) capable of transmitting acceleration data, a receiver 72 and a computer 74 for receiving acceleration data. (WEB1000: manufactured by Nihon Kohden Co., Ltd.). The acceleration sensor 30 uses ZB-155H that can measure acceleration of one axis (x axis) for the digastric muscle, and three axes (x axis, y axis, z axis) for the sternohyoid muscle and the sternum thyroid muscle. ZB-156H capable of measuring acceleration was used. The acceleration sensor 30 was attached to the surface of the skin on each measurement site with double-sided tape. The acceleration sensor 30 (ZB-155H) for the bigastric muscle was attached so that the x-axis, which is the acceleration detection axis, was substantially orthogonal to the running direction of the muscle fibers. The sternohyoid muscle and sternum thyroid muscle acceleration sensor 30 (ZB-156H) makes the x-axis, which is the acceleration detection axis, substantially parallel to the running direction of each muscle fiber, and the acceleration detection axis. A certain z axis was attached so as to be substantially orthogonal to the running direction of each muscle fiber. The acceleration data measured by each acceleration sensor 30 is wirelessly transmitted to the receiver 72, and the acceleration data is transmitted to the computer 74 and stored in the storage device of the computer 74. The sampling frequency of acceleration data was 1 kHz.
Subject A was 6 healthy adult males (22.3 ± 0.9 years). Subject A kept resting in the sitting position, and after swallowing 10 ml of drinking water in his mouth, swallowed it at the time indicated by the examiner. Such swallowing was performed 5 times for each subject A.

  FIG. 6 is a graph showing a time series of acceleration data for 1.5 seconds before and after the swallowing time obtained by the swallowing experiment of the subject A. FIG. 6 shows, in order from the top, (A) raw data, (B) data obtained by subjecting the raw data to a bandpass filter, and (C) data obtained by performing full-wave rectification. A black belt line in the figure indicates a time range in which the examiner determines that the subject A is swallowing. According to FIG. 6, it can be seen that the acceleration changes greatly when swallowed.

Next, a method for analyzing acceleration data will be described. According to the time series of acceleration data obtained by experiments, periodic peaks were observed before and after swallowing time. Therefore, it was determined that these peak intervals (912 ± 14 ms) were the heart rate of the subject A, and the maximum value was used as a threshold value. The time at which the acceleration data first exceeds the threshold is defined as the swallow start time, and the time at which the acceleration data finally falls below the threshold is defined as the swallow end time. In addition, -1 s from 1 ms before swallowing start time was regarded as resting.
Then, an integral value per unit time was obtained from the raw acceleration data xt from the resting data and the swallowing data defined as described above by the following equation (1).

  Further, as statistical processing, the integral value iAcc per unit time (hereinafter referred to as the acceleration integral value iAcc) of the acceleration data obtained from the equation (1) is used by the t test or the Sidak method of one-way analysis. Analysis was performed.

FIG. 7 (A) shows the integrated value iAcc of acceleration data at rest and swallowing at each measurement site measured by 6 subjects. According to this, the integrated value iAcc of acceleration at each measurement site is significantly larger when swallowed than when rested. Further, the integrated value iAcc of acceleration when swallowing the sternohyoid muscle is significantly larger than that of other parts.
FIG. 7B shows the ratio of the integrated value iAcc of acceleration at rest and swallowing at each measurement site. Similarly to FIG. 7A, the value of the sternohyoid muscle is the largest, and is significantly larger than other parts.

Next, an experiment in which the subject A wearing the swallowing detection clothes swallows will be described. The swallowing detection garment used in the experiment is that of the above embodiment.
Subject A was a young person and an elderly person. The young were 10 healthy adult men (22.1 ± 0.9 years) and 10 healthy adult women (21.2 ± 0.4 years). Elderly persons were elderly persons requiring nursing care (one male, three females, 83.0 ± 5.6 years old, 4.8 ± 0.5 requiring nursing care).
In the swallowing detection garment, the acceleration sensor 30 causes the x-axis, which is the acceleration detection axis, to be substantially parallel to the running direction of each muscle fiber on the surface of the skin on the sternohyoid muscle, and detects the acceleration. The subject A was attached so that the z-axis, which is the axis, was substantially orthogonal to the running direction of each muscle fiber.
For the elderly, in addition to measurement by swallowing detection clothes, measurement by an electromyograph (ZB-150H, manufactured by Nihon Kohden Co., Ltd.) was also performed. The electromyograph was mounted on the surface of the skin on the bigastric muscle so as to be substantially perpendicular to the running direction of the muscle fibers.
The subject A swallowed it as a jelly-like tea instead of drinking water, and the examiner carried it to the mouth of the subject A. When the examiner determines that the subject A has swallowed, the examiner inputs a time stamp to the computer 74 by the foot switch 76. A video was taken to observe the swallowing of the subject A.

  The determination of when the young person was resting and swallowing was determined by the same method as the experiment regarding the mounting position of the acceleration sensor 30. Regarding the judgment of resting and swallowing for the elderly, the acceleration data measured from the elderly does not show the above heartbeat, so less than half the amplitude of the acceleration data measured when drinking tea The range of the amplitude of the rest was defined as resting, and the time when the examiner entered the time stamp and the swallowing time range estimated by the examiner from the video image were redefined as swallowing.

The integrated value iAcc of the acceleration data of the young person is obtained from the equation (1) by the same method as the experiment relating to the mounting position of the acceleration sensor 30.
The integrated value iAcc of the acceleration data of the elderly is obtained by the equation (1) from the resting data and the swallowing data of the elderly redefined as described above.
In addition, from the raw data Et obtained by the electromyograph, the integrated values per unit time are obtained from the following formula (2) from the resting data and swallowing data of the elderly redefined as above. Ask for.

  8 (A) and 8 (B) show the ratios of integral values iAcc of acceleration on the x-axis, y-axis, and z-axis of a healthy male subject and a female subject when resting and swallowing, respectively. . According to this, the ratio of the integrated value iAcc of acceleration is significantly greater when swallowing than when resting for both men and women. In addition, the ratio of the acceleration integral value iAcc is such that the z-axis acceleration is significantly greater than the other axes regardless of gender.

  FIG. 9 shows a time series of acceleration data and myoelectric values during typical swallowing of an elderly person. In the legend in the figure, swallowing represents the time when the time stamp is input by the foot switch 76. According to this, the EMG value is measured not only at the time when the time stamp was input (during swallowing) but also at other times, and it is difficult to determine the presence or absence of swallowing from the EMG value. It can be seen that it is. In contrast, the acceleration data has a large amplitude corresponding to the time when the time stamp is input, and it can be seen that swallowing can be determined from the acceleration data.

  FIG. 10A shows the integrated value iEMG of the myoelectric value at the time of swallowing with the average value of the integrated value iEMG of the myoelectric value at rest of each elderly person as a reference. FIG. 10 (B) shows the integral value iAcc of the swallowed acceleration based on the average value of the integral value iAcc of the resting acceleration of each elderly person. According to the integrated value EEMG of the myoelectric value, only two of the four subjects are significantly larger when swallowed than at rest. On the other hand, according to the integrated value iAcc of acceleration, the value is significantly larger when all the four subjects are swallowed than when they are resting.

  FIG. 11A shows the integrated value iEMG of the myoelectric value at the time of swallowing based on the average value of the integrated value iEMG of the myoelectric value at rest for all elderly people. FIG. 11B shows the integral value iAcc of the swallowing acceleration with the average value of the integral value iAcc of the resting acceleration of all elderly people as a reference. According to these, the integrated value iEMG of the myoelectric value was not significantly different between the resting and the swallowing, but the integrated value iAcc of the acceleration was significantly larger when swallowing than the resting. Become.

Next, a swallowing detector according to an embodiment of the present invention will be described. As shown in FIGS. 1 to 3, the swallowing detector is attached to a collar portion 12 of a garment (clothing body 10), spanned across the front side of the neck, and an acceleration sensor attached to the spanner 20. 30.
Since the transfer part 20 is the same as that of the swallowing detection clothes, a specific description is omitted here. The bridge section 20 is provided with a position adjusting section 42 such as a hook-and-loop fastener 42 as necessary.
Since the acceleration sensor 30 is the same as that of the swallowing detection garment, a specific description is omitted here. The acceleration sensor 30 is located on the front neck muscle of the subject's neck when the subject wears the clothes that the bridging portion 20 is spanned on the collar portion 12, and the measurement sensor of the acceleration sensor 30 It is attached to the bridge part 20 by fixing means such as an adhesive or an adhesive tape so that one is substantially parallel to the front-rear direction.
The bridge portion 20 may be used by being fixed to the garment by a fixing means such as sewing or bonding in a state where the hangover section 20 is hanged at a predetermined position on the collar portion 12 of the garment body 10 or the like. You may fix and use by the position adjustment parts 40 and 42 with which the delivery part 20 and clothes were equipped.
Since the usage method and effect of the swallowing detector laid over the collar 12 of the garment are the same as the usage method of the swallowing detection garment, description thereof is omitted here.

The swallowing detection garment and swallowing detector of the present invention described above are not particularly limited to the configuration of the above embodiment, and can be appropriately changed within the scope of the gist of the present invention.
The swallowing detection garment and swallowing detector of the present invention can be applied not only to humans but also to other animals.

DESCRIPTION OF SYMBOLS 10 Clothing body 11 Opening part 12 Collar part 14 Notch part 16 Mounting part 18, 19 Surface fastener 20 Overhead part 30 Acceleration sensor 40, 42 Surface fastener (position adjustment part)
70 Multi-telemeter system 72 Receiver 74 Computer 76 Foot switch A Subject

Claims (3)

A garment body having a collar,
A crossover section that spans the collar,
An acceleration sensor attached to the bridge,
A swallowing detection garment characterized by comprising:   The swallowing detection garment according to claim 1, further comprising a position adjusting unit capable of adjusting a position at which the bridge part is bridged on both or one of the collar part and the bridge part. A crossover attached to the collar of the garment body and spanned to the front of the neck;
A swallowing detector comprising: an acceleration sensor attached to the crossover portion.

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