JP5952536B2 - Swallowing function data measuring device, swallowing function data measuring system, and swallowing function data measuring method - Google Patents

Description

  The present invention relates to a swallowing function data measuring device, a swallowing function data measuring system, and a swallowing function data measuring method for assisting diagnosis of a patient whose swallowing function measurement is reduced.

  For example, in the case of an elderly person, the ability to swallow food (hereinafter referred to as “swallowing function”) decreases with age, which hinders eating. In addition, dysphagia may be manifested by non-elderly people due to stroke and other disorders. In such patients with dysphagia, the risk of aspiration is high, which increases the risk of suffocation and causes aspiration pneumonia that occurs when bacteria in the oral cavity enter the lungs.

  In addition, in order to prevent dysphagia, it is important to perform treatment and rehabilitation to restore swallowing function, but before that, it is necessary to check how each patient has swallowing function .

  As a conventional method for determining swallowing function, (A) the patient's neck is palpated to determine the movement of the throat, and RSST (Repetitive Saliva Swallowing Test) method is used. (B) There are a VF (Video Fluorography) method in which changes are observed and evaluated, and (C) an auscultation method in which diagnosis is performed based on an acoustic signal of a neck using a stethoscope. Furthermore, as a method for detecting an electrical signal corresponding to the swallowing motion, for example, (D) a detection signal corresponding to the movement of the neck of the patient is detected by an acceleration sensor, and a waveform of the detection signal is analyzed by time-frequency analysis. There is a determination method using a biopsy device that determines the movement of the epiglottis (see, for example, Patent Document 1).

JP 2009-213592 A

  In the above-mentioned RSST method, a doctor makes a direct diagnosis, and it is difficult to confirm the inducing property of swallowing reflex by voluntary swallowing exercise, and it is not suitable for detailed diagnosis of swallowing exercise.

  Further, in the VF method, since the patient swallows the contrast medium, there is a risk of aspiration due to the contrast medium, and since the apparatus is large, the swallowing function cannot be diagnosed easily.

  Moreover, in the auscultation method, since the swallowing function is diagnosed by the swallowing operation sound, skill is required to obtain a diagnostic technique with high diagnostic accuracy.

  Further, in the determination method in which the movement of the patient's neck is detected by the acceleration sensor, although the movement of the throat is known, it is difficult to accurately determine whether or not the aspiration is made from the detected signal waveform.

  The above four methods are all effective when a doctor diagnoses a patient in a hospital. For example, a care helper or a family member who cares for a nurse or a home patient can easily swallow a patient. Since the function could not be confirmed, there was a problem that it was difficult to always observe the swallowing state of the patient whose swallowing function was lowered and the convenience was low.

  Therefore, in view of the above circumstances, the present invention aims to provide a swallowing function data measuring device, a swallowing function data measuring system, and a swallowing function data measuring method that are configured so that the swallowing function can be easily confirmed. And

In order to solve the above problems, the present invention has the following means.
(1) The present invention provides a wearing frame to be worn on the neck of a measurement subject;
A sound measuring unit that is provided inside the wearing frame and measures a laryngeal motion sound associated with the swallowing motion of the measurement subject;
A presentation unit for presenting a measurement result based on the laryngeal motion sound measured by the sound measurement unit;
Sound data analyzing means for analyzing each sound data of the epiglottis closing sound, the bolus passing sound, the epiglottis opening sound from the measurement data of the laryngeal motion sound measured by the sound measuring unit;
Determining means for determining whether or not the bolus has passed through the esophagus due to the epiglottis closing sound, the bolus passing sound, and the epiglottis opening sound analyzed by the sound data analyzing means;
Control means for causing the presenting unit to present the determination result of the determination means;
It is provided with.
(2) The present invention includes a storage unit that stores measurement data measured by the sound measurement unit, each sound data analyzed by the sound data analysis unit, and a determination result of the determination unit;
An output unit for outputting each data stored in the storage unit to the outside;
Is further provided.
(3) The sound data analyzing means of the present invention extracts the epiglottis closing sound, the bolus passing sound, the epiglottis opening sound, and the abnormal swallowing sound included in the measurement data based on the frequency characteristics of the measurement data It is characterized by doing.
(4) The sound data analyzing means of the present invention classifies into significant sound data and silence data included in the measurement data, and from the significant sound data when the silence data has passed a predetermined time. The epiglottis closing sound, the bolus passing sound, the epiglottis opening sound, and the abnormal swallowing sound are analyzed.
(5) The sound data analysis means of the present invention is characterized by having a swallowing function calculating means for extracting swallowing operation sound from the significant sound data and calculating swallowing time.
(6) The sound data analyzing means of the present invention converts the waveform data of the significant sound data into frequency analysis data, and based on the spectrum intensity at a specific frequency of the frequency analysis data, It has a sound discriminating means for discriminating either one.
(7) The mounting frame according to the present invention is characterized in that the sound measuring unit is formed in close contact with the outer circumference of the neck near the larynx of the measurement subject.
(8) The presenting unit of the present invention is a light emitting member disposed outside the mounting frame,
The control unit causes the light emitting member to emit light in an arbitrary emission color based on a determination result of the determination unit.
(9) The present invention relates to a plurality of swallowing function data measuring devices described in any one of (1) to (8), and each sound data output from the output units of the plurality of swallowing function data measuring devices and determination A swallowing function data measurement system having an external control device for storing results in time series,
Forming a communication network between the plurality of swallowing function data measuring devices and the external control device;
The external control device is:
A database for storing each sound data and determination results measured by the plurality of swallowing function measuring devices in time series;
A display unit for displaying the determination result transmitted from the plurality of swallowing function measuring devices;
It is characterized by having.
(10) The present invention provides a sound measuring unit that measures a laryngeal motion sound associated with a swallowing motion of a measurement subject;
Sound data analysis means for analyzing measurement data of the laryngeal motion sound measured by the sound measurement unit;
A swallowing function data measuring method using a swallowing function data measuring device having:
Analyzing the sound data of the epiglottis closing sound, the buccal passage sound, the laryngeal opening sound, the swallowing abnormal sound from the measurement data of the laryngeal motion sound measured by the sound measuring unit, the analyzed epiglottis closing sound, It is determined whether or not the bolus has passed through the esophagus based on the bolus passing sound, the epiglottis opening sound, and the abnormal swallowing sound.
(11) The present invention extracts the sound of the epiglottis, the sound of passing through the bolus, and the sound of the epiglottis included in the measurement data, and sets the swallowing time of the entire swallowing operation of the measurement data as T _1. If the time until the intermediate time of the sound was T _2, and judging the presence or absence of dysphagia based on evaluation function T _{2 /} T _1.
(12) The present invention is classified into significant sound data and silence data included in the measurement data, and when the silence data has passed a predetermined time, the laryngeal sound is closed from the significant sound data, It is characterized by analyzing the bolus passing sound, the epiglottis sound, and the abnormal swallowing sound.
(13) The present invention converts the waveform data of the significant sound data into frequency analysis data, and discriminates any of swallowing function sound, cough, and voice based on the spectrum intensity at a specific frequency of the frequency analysis data. It is characterized by.

  According to the present invention, the laryngeal motion sound of the measurement subject is measured by the sound measurement unit, the measurement result based on the laryngeal motion sound is presented to the presentation unit, and the measurement data of the laryngeal motion sound measured by the sound measurement unit Analyzing the sound data of the larynx closure sound, the buccal passage sound, the laryngeal opening sound, and the abnormal swallowing sound to determine whether or not the abdominal mass has passed through the esophagus, so whether or not aspiration has occurred in real time In addition to being able to accurately determine the throat movement of the patient at all times, nurses other than doctors, care helpers, and families can check on the spot whether the swallowing function is degraded or aspiration occurs. . Furthermore, since the weight can be relatively reduced and the size can be reduced, it is possible to perform measurement over a long period of time without burdening the patient even when worn on the patient's neck.

  In addition, the waveform data of significant sound data is converted into frequency analysis data, and the patient is in any state to determine whether swallowing function sound, cough, or voice based on the spectral intensity at a specific frequency in the frequency analysis data. For example, if aspiration occurs, the meal can be stopped immediately to prevent further aspiration, and effective treatment for recovery of swallowing function corresponding to each patient's disorder Can consider methods and rehabilitation methods.

It is a block diagram which shows schematic structure of one Example of the swallowing function data measurement apparatus by this invention. It is a figure which shows the external appearance shape of the swallowing function data measurement unit, and the process sequence of a control unit. It is a figure which shows the mounting state of the swallowing function data measurement unit. It is a figure showing typically that a plurality of swallowing function data measuring devices and a management computer form a swallowing function data measuring system. It is a longitudinal cross-sectional view for demonstrating the inside of an oral cavity, and an air suction function. It is a longitudinal cross-sectional view for demonstrating the inside of an oral cavity, and the swallowing function. It is a wave form diagram which shows an example of the sound data by swallowing operation | movement. It is a flowchart for demonstrating the swallowing function analysis control process which a control apparatus performs. It is a figure which shows the sound measurement position af of swallowing operation | movement. It is a figure which shows the measurement position P of the cricoid cartilage airway used as the generation source of the swallowing operation sound. It is a figure which shows the frequency characteristic of the sound data measured in the measurement position a. It is a figure which shows the frequency characteristic of the sound data measured in the measurement position b. It is a figure which shows the frequency characteristic of the sound data measured in the measurement position c. It is a figure which shows the frequency characteristic of the sound data measured in the measurement position d. It is a figure which shows the frequency characteristic of the sound data measured in the measurement position e. It is a figure which shows the frequency characteristic of the sound data measured in the measurement position f. It is a wave form diagram which shows the measurement data of swallowing operation sound. It is a wave form diagram which shows the frequency analysis data of the swallowing operation sound. It is a wave form diagram which shows the measurement data of a cough. It is a wave form diagram which shows the frequency analysis data of a cough. It is a wave form diagram which shows the measurement data of utterance. It is a wave form diagram which shows the frequency analysis data of utterance. It is a graph which shows the measurement result of swallowing trial frequency of elderly person A and swallowing time. It is a graph which shows the measurement result of swallowing trial frequency and swallowing time of elderly person B. It is a graph which shows the measurement result of the swallowing trial frequency and swallowing time of elderly person C. It is a graph which shows the measurement result of the swallowing trial frequency and swallowing time of the elderly person D. It is a graph which shows the measurement result of swallowing trial frequency and swallowing time of elderly person E. It is a graph which shows the measurement result of swallowing trial frequency and swallowing time of elderly person F. It is a graph which shows the measurement result of swallowing trial frequency and swallowing time of elderly person G. It is a graph which shows the measurement result of the swallowing trial frequency and swallowing time of the elderly person H. It is a graph which shows the measurement result of the swallowing trial frequency and swallowing time of the young person. It is a graph which shows the measurement result of swallowing trial frequency and swallowing time of young person J. It is a graph which shows the measurement result of swallowing trial frequency and swallowing time of young person K. It is a wave form diagram which shows swallowing time T1 on swallowing action sound data, and time T2 of esophageal passage sound. It is a figure which shows the time process to information presentation by swallowing operation sound measurement.

  Hereinafter, embodiments for carrying out the present invention will be described with reference to the drawings.

[Configuration of swallowing function data measurement device]
FIG. 1 is a block diagram showing a schematic configuration of an embodiment of a swallowing function data measuring device according to the present invention. As shown in FIG. 1, the swallowing function data measuring device 10 includes a swallowing function data measuring unit 20 and a control unit 50.
The swallowing function data measurement unit 20 is a neck wearing interface, and includes a sound measuring unit 30 and a presentation unit 40 in the wearing frame 22. The mounting frame 22 is formed in an approximately elliptical shape so that both ends thereof are in close contact with the measurement site, and is mounted on the outer circumference of the neck of the measurement subject (patient). Moreover, the mounting frame 22 is a resin molded product, and is reduced in weight and size so as not to be a burden on the neck of the measurement subject.

  The sound measurement unit 30 is provided inside both ends of the mounting frame 22 and is held by the elasticity of the mounting frame 22 so as to contact the skin surface of the measurement subject's neck (neck). The sound measurement unit 30 is composed of, for example, an electret condenser microphone that is small and has excellent sound measurement sensitivity and sound quality, and outputs an acoustic signal (sound data) based on the laryngeal operation sound. Further, the sound measuring unit 30 can measure only the laryngeal motion sound of the measurement subject effectively without measuring the surrounding noise other than the laryngeal motion sound unlike the stethoscope.

  The presentation unit 40 is provided outside both ends of the wearing frame 22 and presents a measurement result based on sound data of the laryngeal operation sound measured by the sound measurement unit 30. The presentation unit 40 of the present embodiment is made of a light emitting member such as a light emitting diode (LED), and can switch the light emission color to each of blue, green, and red according to the state of the swallowing operation. Note that the presentation unit 40 may use a small liquid crystal panel instead of a light emitting diode to display an arbitrary symbol mark (for example, XX) according to the swallowing operation and notify the swallowing operation state. good.

The control unit 50 is provided separately from the mounting frame 22 and is connected to the sound measurement unit 30 and the presentation unit 40 via signal lines. The control unit 50 also includes a gain amplification unit 60, a sound data analysis unit 70, a determination unit 80, a memory 90, an LED control unit 100, a wireless communication unit 110, and a battery 120.
The gain amplifying unit 60 amplifies the sound data detected by the sound measuring unit 30 with an arbitrary amplification factor.

  The sound data analyzing unit 70 analyzes sound data of the laryngeal closing sound, the bolus passing sound, the laryngeal opening sound, and the abnormal swallowing sound from the measurement data (acoustic signal) of the laryngeal movement sound measured by the sound measuring unit 30. Data analysis means. Further, in the sound data analysis unit 70, the number of occurrences of swallowing and sputum occurrence (for example, every hour) by the sound measurement unit 30 measuring the laryngeal motion sound other than meals, for example, in daily life and during sleeping. ) Etc. can also be monitored.

  The determination unit 80 is a determination unit that determines whether or not the bolus has passed through the esophagus by the epiglottis closing sound, the bolus passing sound, the epiglottis opening sound, and the abnormal swallowing sound analyzed by the sound data analysis unit 70.

  The memory 90 is a storage unit that stores measurement data measured by the sound measurement unit 30, each sound data analyzed by the sound data analysis unit 70, and a determination result.

  The LED control unit 100 is a control unit that causes the presentation unit 40 to present a determination result based on each sound data analyzed by the sound data analysis unit 70, and is attached to both ends of the mounting frame 22 based on the determination result of the determination unit 80. The light emitting member (LED) of the provided presentation part 40 is made to light-emit in arbitrary luminescent colors (for example, blue, green, red).

  The wireless communication unit 110 is an output unit that converts measurement data measured by the sound measurement unit 30 and each sound data analyzed by the sound data analysis unit 70 and a determination result into a radio signal and outputs the result to an external device. Further, a wired communication unit may be provided instead of the wireless communication unit 110.

The battery 120 is a rechargeable battery and is a power supply source to each unit. The sound data analysis unit 70 and the determination unit 80 are provided in a control unit 130 including a CPU (central processing unit), and each sound data is analyzed and determined based on each control program input in advance. I do.
The sound data analysis unit 70 extracts the epiglottis closing sound, the bolus passing sound, the epiglottis opening sound, and the swallowing abnormal sound included in the measurement data based on the difference between the frequency and the period of the measurement data, and the significant sound included in the measurement data. The sound data is classified into sound data and silence data, and when the predetermined time elapses after the silence data has been set in advance, the epiglottis closing sound, the bolus passing sound, the laryngeal opening sound, and the abnormal swallowing sound are analyzed from the significant sound data.

The sound data analysis unit 70 includes a swallowing function calculation unit 72 and a sound determination unit 74. The swallowing function calculator 72 is a swallowing function calculator that extracts swallowing operation sounds from the significant sound data and calculates swallowing time. The sound discriminating unit 74 is a sound discriminating unit that converts the waveform data of significant sound data into frequency analysis data and discriminates any of swallowing function sound, cough, and voice based on the spectrum intensity at a specific frequency of the frequency analysis data. is there.
[Processing procedure of control unit 50]
FIG. 2A is a diagram illustrating an appearance shape of the swallowing function data measurement unit 20 and a processing procedure of the control unit 50. FIG. 2B is a diagram showing a wearing state of the swallowing function data measurement unit 20. As shown in FIGS. 2A and 2B, the swallowing function data measurement unit 20 is mounted on the neck of the measurement subject, and the sound measurement unit 30 provided on the inner side of the end of the mounting frame 22 is measured on the neck. Adhere to the site.

  The acoustic signal (sound data) accompanying the throat movement detected by the sound measuring unit 30 is supplied to the control unit 50. Here, the procedure of the swallowing function data measurement method executed by the control unit 50 will be described. In the procedure 1 of FIG. 2A, the sound measurement unit 30 performs sound measurement at a sampling rate of 10 kHz. The acoustic signal input from the sound measurement unit 30 is amplified by the gain amplification unit 60 at an arbitrary amplification factor (for example, 200 times).

  In the procedure 2, the control unit 50 to which the amplified sound data is inputted sequentially stores sound data, analyzes each sound included in the sound data, and extracts features.

  In procedure 3, an arbitrary emission color is emitted at a predetermined time interval according to the swallowing operation sound while switching the emission color of the presentation unit 40 based on the parameter (determination result) extracted by the analysis of the sound data.

FIG. 2C is a diagram schematically showing that a plurality of swallowing function data measuring devices 10 ₁ to 10 _n and a management computer 220 form a swallowing function data measuring system 200. As shown in FIG. 2C, in the swallowing function data measurement system 200, a plurality of swallowing function data measuring devices 10 ₁ to 10 _n and a management computer 220 are communicably connected via a network 250. The plurality of swallowing function data measuring devices 10 ₁ to 10 _n sequentially transmit sound data measured from the measurement subject from the wireless communication unit 110, and the transmitted sound data is transmitted by the communication device 210 connected to the network 250. Received. Then, the management computer 220 stores the sound data (data measured by the swallowing function data measuring devices 10 ₁ to 10 _n ) input from the communication device 210 in the database 230 as time series data.

Furthermore, the management computer 220 emits light colors (based on parameters (determination results) extracted by analysis of sound data measured from the patients A to F on a monitor 240 installed in a nurse station or a doctor's room). (Blue, green, red) judgment marks are displayed. Since the monitor 240 is installed in a room different from the patient, the swallowing function of each patient can be confirmed in real time even when the nurse is away from the patient.
[How to measure swallowing function and swallowing function data]
FIG. 3A is a longitudinal sectional view for explaining the inside of the oral cavity and the air suction function. As shown in FIG. 3A, the throat 320 where the oral cavity 300 communicates with the nasal cavity 310 is provided with a epiglottis 340 that opens and closes the airway 330. Normally, the airway 330 is open for breathing.

  FIG. 3B is a longitudinal sectional view for explaining the inside of the oral cavity and the swallowing function. As shown in FIG. 3B, when carrying food to the stomach, the epiglottis 340 blocks the opening of the airway 330 and the bolus from the oral cavity 300 is carried to the esophagus 350. Thus, the epiglottis 340 has a different operating state when breathing (see FIG. 3A) and when carrying the bolus to the stomach (see FIG. 3B), and the sound varies depending on whether the airway 330 is opened or closed.

  Therefore, the swallowing function data measuring apparatus 10 measures the operation sound (sound data) accompanying the opening / closing operation of the epiglottis 340 as swallowing function data. That is, the sound measurement unit 30 acquires the swallowing sound when swallowing the bolus and the breathing sound before and after swallowing at the measurement position P near the outer upper side of the airway directly below the cricoid cartilage, and the airway stenosis sound and saliva that become swallowing abnormal sounds Measure the length of stored sound such as sputum and swallowing sound. Then, the degree of dysphagia is estimated from the time length of the measured sound data in the control unit 50.

FIG. 4 is a waveform diagram showing an example of sound data by the swallowing operation. As shown in FIG. 4, the sound data of the swallowing sound is measured by the sound measuring unit 30 arranged at the measurement position, and the epiglottis closing sound i where the epiglottis 340 closes the airway 330, the bolus passing sound ii, The epiglottis sound iii in which the epiglottis 340 opens the airway 330 is measured as sound data continuous in time series.
[Sound data analysis method]
In the swallowing function data measurement device 10, it is useful to use frequency characteristics in order to distinguish swallowing operation sounds from other coughs and the patient's own voice, but real-time responsiveness (response) is also important. Time domain information is also used.

  Therefore, the sound data analysis unit 70 performs analysis by wavelet transform in order to efficiently perform the swallowing operation sound discrimination process. A Gaussian window is used as the window function.

ウェーブレット変換式は、上記式（１）（２）のように表せる。ここで、ｆ（ｔ）は元信号データ、Ｃ（ａ，ｂ）は周波数成分である。係数ａ，ｂは窓関数のサイズを表わす係数であり、係数ａは窓幅スケール係数、係数ｂは時間方向に波をシフトさせる時間シフト係数である。ここでは、窓幅スケール係数ａは、３２段階のスケールで解析を行うように設定される。
〔嚥下機能解析制御処理のアルゴリズムについて〕
図５は制御装置が実行する嚥下機能解析制御処理を説明するためのフローチャートである。図５に示されるように、制御ユニット５０では、音測定部３０により測定された音データをＡＤ変換した後、当該変換された測定データの蓄積を行う。すなわち、一定数の音データをメモリ７０に格納すると、測定された音データの読み込みを行うと共に、音データの解析を行う。

The wavelet transform equation can be expressed as the above equations (1) and (2). Here, f (t) is the original signal data, and C (a, b) is the frequency component. The coefficients a and b are coefficients representing the size of the window function, the coefficient a is a window width scale coefficient, and the coefficient b is a time shift coefficient for shifting the wave in the time direction. Here, the window width scale coefficient a is set so that the analysis is performed with a scale of 32 steps.
[Algorithm of swallowing function analysis control processing]
FIG. 5 is a flowchart for explaining swallowing function analysis control processing executed by the control device. As shown in FIG. 5, the control unit 50 performs AD conversion on the sound data measured by the sound measurement unit 30, and then stores the converted measurement data. That is, when a certain number of sound data is stored in the memory 70, the measured sound data is read and the sound data is analyzed.

  In the present embodiment, first, sound data measured by the sound measuring unit 30 in S11 is acquired. In S12, when the input voltage from the sound measuring unit 30 exceeds the predetermined value a (in the case of YES), the process proceeds to S13, the measured value is stored in the memory 70 as the significant sound data e, and the process returns to S11. In S12, when the input voltage from the sound measuring unit 30 does not exceed the constant value a (in the case of NO), the process proceeds to S14, and the measured value is stored in the memory 70 as silence data.

Subsequently, in S15, a significant sound data number e is 0 or less, or silence data number n significant sound data determined silence _{t 0} in the following cases (case of NO), the process proceeds to S16. In S16, the significant sound data number e is 0, and if silent data the number n is less than or equal to the silence data determined silent time _{t 1} (the case of YES), the process proceeds to S17, the process returns to S11 to clear the silence data number n . Further, in S16, a significant sound data number e is not 0, or if silence data number n is not silent data determined silence t ₁ or less (in the case of NO), the process returns to S11 without clearing the silent data number n .

Further, in S15, a significant sound data number e is 0 or more, and silent data number when n is determined silent time _{t 0} or more significant sound data (in the case of YES), the process proceeds to S18.

  That is, in S13, a sound that may be swallowed, coughed or uttered is recorded as significant sound data e from the sound data stored in the memory 70, and in S14, a signal without noise or input sound is recorded as silence data. Label and record the number of each data group.

Also, if t ₀ seconds of silent data is checked after significant sound data in S15,-out swallowing or coughing, it is considered that utterance has been completed, to significant sound entire data in S18, performs a wavelet transform, the frequency characteristic Calculate and identify time intervals such as swallowing, coughing, and vocalization from the waveform information of the measured sound data.

Here, it is known that the silence period of t ₀ seconds is used because the apnea time during swallowing continues before and after the swallowing sound, and therefore the silence data continues after the swallowing operation sound data. Therefore, the time t ₀ = 0.2 seconds is used as a criterion for the end of swallowing.

  In S18, swallowing movement sound data, coughing sound data, vocalization data, and abnormal swallowing sound data are analyzed and extracted from the significant sound data, and in S19, any of swallowing, coughing, vocalization, or abnormality is determined based on the analysis result. .

  The abnormal swallowing sound data includes sound data when the swallowing time is measured longer than usual and sound data when the aspiration (dysphagia) movement sound is measured. Sound data in the case of being swallowed, or sound data when a passing sound of a bolus is detected when the epiglottis 340 opens the airway 330, or the like.

  Then, it progresses to S20 and makes the light emission member (LED) of the presentation part 40 light-emit with the light emission color according to the judgment result of said S19. For example, light is emitted in blue at the start of measurement, green in normal swallowing, and red in abnormal (aspiration). In addition, when abnormal swallowing sound data continues for a predetermined time or longer, there is a high possibility of accidental swallowing, and therefore it may be notified by switching to a blinking state in which red light emission and light extinction are repeated. As described above, the person around the subject to be measured (doctor, caregiver, care helper, family) can easily see that the swallowing operation is normally performed or the aspiration is observed by observing the emission color of the presentation unit 40. You can check if this is happening on the spot.

In the next S21, the determination result of S19 is transmitted to the management computer 220, and the determination result of each measurement subject is displayed on the monitor 240 in another room. After this, the process returns to S11. In addition, after S19, the process proceeds to S22, the number of significant sound data e is cleared, and the process returns to S11.
[Evaluation of measurement position of sound measurement unit]
The swallowing sound measurement position at the neck is preferably placed outside the airway near the cricoid cartilage due to physiological activities associated with swallowing movements, but at the same position every time depending on the physique of the subject and daily body movements. Is difficult to measure. Therefore, the influence on the signal intensity and frequency characteristics due to the difference in the measurement position of the sound measurement unit 30 is verified.

  FIG. 6A is a diagram illustrating sound measurement positions a to f of the swallowing operation. As shown in FIG. 6A, for example, sound data is measured in a state where the sound measuring unit 30 is located at six locations (points a to f) of the neck.

  FIG. 6B is a diagram showing a measurement position P on the outer side of the cricoid cartilage airway that is a generation source of the swallowing operation sound. The measurement position P shown in FIG. 6b corresponds to the position where the epiglottis 340 operates. The sound measurement unit 30 can measure the swallowing operation sound by the epiglottis 340 with better sound quality by adjusting the mounting position of the swallowing function data measurement unit 20 so that it is desirably the position of the measurement position P. However, actually, when the measurement subject changes the direction of the body or exercises, the position of the sound measurement unit 30 may be shifted. In that case, when it was verified whether or not the measurement at each of the measurement positions a to f was possible, the following experimental results were obtained.

  7A to 7F are diagrams showing frequency characteristics of sound data measured at the respective measurement positions a to f. Comparing the frequency characteristics shown in FIGS. 7A to 7F, the waveform characteristics of the frequency characteristics at the respective measurement positions a to f are almost the same. At the rear measurement positions e and f, there is a distance from the airway 330 and the esophagus 350, and the measurement of sound data is hindered by muscle activity. In addition, since the measurement results at the measurement positions a and d are clear, it can be seen that the upper measurement positions a and d are desirable among the six locations. However, since good measurement results can be obtained at the front measurement positions b and c, it can be seen that it is possible to accurately measure the swallowing operation sound without providing a large restriction on the measurement position.

Therefore, in the swallowing function data measurement unit 20, the sound measuring unit 30 disposed inside both ends of the wearing frame 22 generates swallowing operation sounds at the measurement positions a and d as much as possible among the measurement positions a to f of the measurement subject. It is desirable to determine the size and shape of the mounting frame 22 so that it can be measured.
[Method of extracting swallowing sound]
The swallowing function data measurement device 10 is not limited to a treatment facility such as a hospital or a care facility, and the sound data measurement device 10 is mounted on a measurement subject in a daily living space where home treatment or home care is performed at home. It is also assumed that Therefore, the measured sound data includes not only swallowing operation sounds but also daily noises such as conversation even during meals.

  In addition, physiological phenomena such as cough are an extra factor in distinguishing them from swallowing movement sounds, but the occurrence of cough during meals in dysphagia patients is important for determining the state of dysphagia. Therefore, sound data including swallowing, coughing, and conversation (speech) is measured by the sound measuring unit 30 and compared using the difference in frequency characteristics and the number of pulses as an index for discretizing the signal intensity.

  The number of pulses of the sound data is the number of times that the value of the input signal s [k] exceeds the set threshold value θ. For example, in this embodiment, θ = 0.5 is set.

  8A, FIG. 8B, FIG. 9A, FIG. 9B, FIG. 10A, and FIG. 10B show the waveforms of the swallowing operation sound, coughing, and utterance sound data, and the results of wavelet transform analysis. As shown in FIG. 8A, the swallowing operation sound includes the epiglottis closing sound A1 in which the epiglottis 340 closes the airway 330, the bolus passing sound A2 in which the bolus passes through the throat, and the epiglottis opening sound A3 in which the epiglottis 340 opens the airway 330. Three sounds A1 to A3 are measured as sound data continuous in time series. Therefore, the swallowing operation sounds A1 to A3 are characterized by being discontinuous in time as compared with the acoustic waveforms of cough A4 and utterance A5. This is because although there are individual differences depending on each measurement subject, there is a delay in the operation of the epiglottis 340 due to a decrease in muscle strength that opens and closes the epiglottis 340 and a decrease in the nervous system that responds to commands from the brain.

  Therefore, assuming that the number of pulses P [τ] at a certain time τ, the original signal is s (t), and the sampling period is Ts, the number of pulses P [τ] at a certain time τ at time t is expressed by the following equation (3) ).

例えば、上記一定時間をτ＝１００（ｍｓｅｃ）としてパルス数を計測したところ、嚥下動作音では、Ｐ［τ］＝１００程度、咳きではＰ［τ］＝１９０程度、発声ではおおむねＰ［τ］＝２５０以上（発声の言葉によって異なる）となる実験結果が得られた。

For example, when the number of pulses is measured with τ = 100 (msec) as the fixed time, P [τ] = 100 for swallowing operation sounds, P [τ] = 190 for coughing, and P [τ] for utterances. == 250 or more (depending on the language of utterance).

  On the other hand, when the analysis result is seen by wavelet transform, the frequency analysis data (see FIG. 8B) of the swallowing movement sound has a strong spectrum intensity in the frequency region B1 near 4000 Hz, and the frequency analysis data of the cough (see FIG. 9B) is 4000 Hz. It can be seen that the spectrum intensity is strong in the frequency region B2 in the vicinity, the frequency region B3 in the vicinity of 2000 Hz, and the frequency regions B4 and B5 at the start and end points of coughing.

  Further, the data at the time of utterance (see FIG. 10B) is a high frequency around 4000 Hz compared to the data of swallowing movement sound (see FIG. 8B) and cough data (see FIG. 9B), although there are utterance contents and individual differences among individuals. It can be seen that the spectral intensity of the band is weak and the peak of the spectral intensity is concentrated in the frequency region B6 of 500 Hz or less.

  Further, when comparing swallowing motion sound data (see FIG. 8B) and cough data (see FIG. 9B), a peak of a spectrum near 500 Hz often appears in the cough period in the initial stage. Furthermore, it can be seen that in the utterance section (see FIG. 10B), the spectral intensity in the frequency region B7 near 1500 Hz is greater than the swallowing operation sound.

From these experimental results, the swallowing, coughing, and vocalization sections have unique characteristics in the waveform and frequency, respectively, and it is possible to discriminate events by signal processing by indexing the frequency regions B1 to B7 of each data. Become. Similarly, it is also possible to determine the presence or absence of abnormal swallowing sounds based on the frequency characteristics.
[Comparison of swallowing time between elderly and young]
11A to 11H and FIGS. 12A to 12C show the results of comparison of swallowing motion sounds between a normal young healthy person who has no dysphagia and an elderly person who may have a dysphagia.

  As shown in FIGS. 11A to 11H, in the case of elderly people A to H, the swallowing time of each person varies from 0.4 to 0.8 seconds, but as shown in FIGS. 12A to 12C, young people It can be seen that the swallowing time of I to K is relatively longer than 0.3 seconds. Furthermore, it can also be seen from the measurement results of each individual's swallowing time that the variation in the swallowing time of the elderly is large depending on the number of trials, while the variation of the younger person is almost the same with little variation depending on the number of trials. From these facts, it is clear that when there is a dysphagia, the swallowing time becomes longer than 0.4 seconds and the swallowing time varies depending on the number of times.

  In addition, some elderly people may have a long swallow, or may repeat short swallows. This is presumed to be a phenomenon in which swallowing movement was performed reflexively because swallowing did not go well during swallowing, and the bolus remained in the oral cavity 300 and pushed the residue into the esophagus 350 as shown in FIG. 3B. Is done. Such residual bolus in the oral cavity 300 and a shift in swallowing timing cause aspiration (dysphagia), and it is desired to be detected.

  Therefore, not only the swallowing time but also the second stage during the swallowing time, that is, the time until the bolus passes through the esophagus is used as an evaluation index. As a method for determining the timing of swallowing, as shown in FIG. 13, among the swallowing operation sounds i to iii constituting the swallowing operation sound, the middle second stage bolus passing sound ii is used as a determination criterion.

Swallowing time for the entire swallowing operation and T _1, when the time until the intermediate time of the esophagus passing sound ii and T _2, swallowing - sets the esophagus passing time ratio T _{2 /} T ₁ as an evaluation function. Here, the evaluation function T for the experimental results (swallowing time) of the elderly persons A to H shown in FIGS. 11A to 11H and the experimental results (swallowing time) of the young persons I to K shown in FIGS. 12A to 12C. Table 1 is an example of the evaluation at ₂ / _{T 1,} are shown in Table 2.

表１に示すように若年者の場合、嚥下時間Ｔ_１が０．２９秒〜０．３２秒の範囲で変動するものの評価関数値Ｔ_２／Ｔ_１は０．４７〜０．５２となる。

As shown in Table 1, in the case of a young person, the evaluation function value T ₂ / T ₁ is 0.47 to 0.52 although the swallowing time T ₁ varies in the range of 0.29 seconds to 0.32 seconds.

表２に示されるように、高齢者の場合、嚥下時間Ｔ_１が０．３９秒〜０．８２秒と変動幅が大きいので、評価関数Ｔ_２／Ｔ_１は、０．３２〜０．６６となる。このように、高齢者と若年者との評価関数Ｔ_２／Ｔ_１を比較しても差違があることが分かる。このように、前述した図１の音データ解析部１３０及び図５のＳ１８のデータ解析処理において、嚥下時間Ｔ_１と嚥下−食道通過時間比からなる評価関数Ｔ_２／Ｔ_１に基づいて嚥下障害の有無を判定することが可能になる。

As shown in Table 2, when the elderly, since swallowing time _{T 1} is a large variation range 0.39 seconds ～0.82 seconds, the evaluation function _T 2 / _{T 1} is 0.32 to 0.66 It becomes. Thus, it can be seen that there is a difference even if the evaluation functions T ₂ / T ₁ of the elderly and the young are compared. Thus, in the sound data analysis unit 130 of FIG. 1 and the data analysis process of S18 of FIG. 5 described above, dysphagia is based on the evaluation function T ₂ / T ₁ composed of the swallowing time T ₁ and the swallowing-esophageal passage time ratio. It becomes possible to determine the presence or absence of.

  In addition, in the present embodiment, as described above, since it is a system that distinguishes swallowing, coughing, and utterance on the assumption that there is silence data of 0.2 seconds or more between each section, for example, When coughing and voicing timing overlap, it is difficult to recognize the boundaries of each section.

However, if swallowing and coughing or vocalization overlap, breathing during swallowing stops and apnea time (for example, 0.2 seconds) is before and after swallowing, so swallowing sound and coughing and vocalization Can be distinguished. Therefore, as described above, it is possible to analyze and recognize swallowing operation sound, coughing, and utterance from the sound data measured by the sound measuring unit 30 by indexing the frequency regions B1 to B7 of each frequency characteristic data. Based on the analysis results in the determination unit 80 of FIG. 1 and the determination process of S19 of FIG. 5 described above, the luminescent color corresponding to the determined state is caused to emit light to the surroundings (doctor, nurse, The status of the person to be measured can be notified to a care helper, family, etc.).
FIG. 14 is a diagram showing time processing until information presentation by swallowing motion sound measurement. As shown in FIG. 14, in the swallowing function data measurement device 10, the presentation unit 40 emits blue light at the start of measurement. Then, during normal swallowing, the presentation unit 40 emits green light after analysis, and when abnormal, it emits red light to notify surrounding people.

  After the swallowing operation sound is measured and the silence data is measured for 0.2 seconds, the sound data is analyzed. After that, when the swallowing is normal, a green emission color is presented to the presenting unit 40, and when the swallowing abnormality is present The red light emission color is presented to the presentation unit 40.

  As described above, after 0.2 seconds have elapsed after the swallowing operation, the swallowing detection result is presented to the presentation unit 40. Even if this time delay is present, the nurse or the care helper or the like performs the measurement. Considering the time required to stop the subject's meal, it is considered that there is almost no influence at the actual care site.

  Therefore, in the swallowing function data measurement system of the present invention, the sound data of the swallowing operation for each measurement target person (patient) is accumulated in the database 230, so that a treatment method corresponding to a decrease in the swallowing function of each measurement target person or Rehabilitation can be considered, and more effective treatment is possible.

  In the above embodiment, the swallowing function data measuring device and the swallowing function data measuring system for the purpose of detecting a decrease in swallowing function of the elderly have been described. When a patient whose function has deteriorated lives in his / her daily life, the occurrence of aspiration can be notified by wearing the swallowing function data measuring device 10.

  In addition, in the case of a patient who does not know when the deterioration of swallowing function (dysphagia) starts, if the swallowing function data measuring device 10 is previously mounted, even if swallowing has been performed normally, what time point Thus, it is possible to verify in time series whether or not aspiration has occurred with the passage of time as to whether the swallowing function has deteriorated.

  In the above embodiment, the case of determining dysphagia associated with a meal has been described as an example. However, the sound measurement unit 30 measures the laryngeal motion sound, for example, during daily life and during sleep, other than meals. It is also possible to monitor the number of occurrences of swallowing of the brim and the salmon (for example, every hour).

10, 10 ₁ to 10 _n Swallowing function data measuring device 20 Swallowing function data measuring unit 22 Wearing frame 30 Sound measuring unit 40 Presenting unit 50 Control unit 60 Gain amplifying unit 70 Sound data analyzing unit 72 Swallowing function calculating unit 74 Sound discriminating unit 80 determination unit 90 memory 100 LED control unit 110 wireless communication unit 120 battery 130 control unit 200 swallowing function data measurement system 210 communication device 220 management computer 230 database 240 monitor 250 network 300 oral cavity 310 nasal cavity 320 throat
330 airway 340 epiglottis 350 esophagus

Claims (13)

A sound measuring unit for have a microphone for acquiring sound signal by collecting larynx operation sound accompanying the swallowing behavior of the measured person,
A presentation unit for presenting a measurement result based on the laryngeal motion sound measured by the sound measurement unit;
Sound data analyzing means for analyzing the sound data of the epiglottis from the measurement data of the laryngeal movement sound measured by the sound measurement unit , distinguishing each sound data of the laryngeal passage sound and the epiglottis from coughing and vocalization ,
It is determined in real time at the end of each swallowing operation whether the bolus has passed through the esophagus due to the epiglottis closing sound, the bolus passing sound, and the epiglottis opening sound analyzed by the sound data analyzing means. And determining means for determining the presence or absence of the cough and voicing ,
Control means for causing the presenting unit to present the determination result of the determination means;
Equipped with a,
The swallowing function data measuring apparatus , wherein the control means presents the determination result in a different manner corresponding to the swallowing motion, cough, and utterance state determined by the determining means . A storage unit that stores measurement data measured by the sound measurement unit, each sound data analyzed by the sound data analysis unit, and a determination result of the determination unit;
An output unit for outputting each data stored in the storage unit to the outside;
The swallowing function data measuring device according to claim 1, further comprising:   The sound data analysis means extracts the epiglottis closing sound, the bolus passing sound, the epiglottis opening sound, and the abnormal swallowing sound included in the measurement data based on the frequency characteristics of the measurement data. The swallowing function data measuring device according to claim 1 or 2.   The sound data analysis unit classifies the measurement data into significant sound data and silence data according to an input voltage from the sound measurement unit, and the sound data is analyzed once when a predetermined time elapses. Each end of the swallowing operation, and analyzing the epiglottis closing sound, the food mass passing sound, the epiglottis opening sound, and the abnormal swallowing sound from the significant sound data every time the swallowing operation is completed. The swallowing function data measuring device according to any one of claims 1 to 3.   The swallowing function data measuring device according to claim 4, wherein the sound data analyzing means includes swallowing function calculating means for extracting swallowing operation sound from the significant sound data and calculating swallowing time.   The sound data analysis means converts the waveform data of the significant sound data into frequency analysis data, and discriminates any of swallowing operation sound, cough, and voice based on the spectrum intensity at a specific frequency of the frequency analysis data. The swallowing function data measuring device according to claim 4, further comprising a determining unit.   The sound measuring unit is provided inside a wearing frame to be worn by the measurement subject, and the mounting frame is formed so that the sound measuring unit is closely attached to a neck outer periphery in the vicinity of the larynx of the measuring subject. The swallowing function data measuring device according to claim 1, wherein The sound measuring unit is provided inside a wearing frame to be worn by the measurement subject,
The presenting unit is a light emitting member disposed outside the mounting frame,
The swallowing function data measuring device according to claim 1, wherein the control unit causes the light emitting member to emit light in a different light emission color according to a swallowing state based on a determination result of the determination unit. A plurality of swallowing function data measuring devices according to any one of claims 1 to 8, and an external for storing each sound data and determination results output from the output units of the plurality of swallowing function data measuring devices in time series A swallowing function data measurement system having a control device,
Forming a communication network between the plurality of swallowing function data measuring devices and the external control device;
The external control device is:
A database that stores each sound data and determination results measured by the plurality of swallowing function data measuring devices in time series;
A display unit for displaying the determination result transmitted from the plurality of swallowing function data measurement devices;
A swallowing function data measurement system characterized by comprising: A sound measuring unit for have a microphone for acquiring sound signal by collecting larynx operation sound accompanying the swallowing behavior of the measured person,
Sound data analysis means for analyzing measurement data of the laryngeal motion sound measured by the sound measurement unit;
A swallowing function data measuring method using a swallowing function data measuring device having:
In the sound data analysis means, the sound data of the laryngeal movement sound measured by the sound measuring unit is distinguished from cough and utterance sound data of the epiglottis closing sound, bolus passing sound, laryngeal opening sound, and swallowing abnormal sound. Parse and
The analyzed the epiglottis閉音, the bolus passes through sound, the epiglottis Hirakioto, bolus to determine in real time for each end of a single swallow operation whether passing through esophagus by the swallowing abnormal sound And determining the presence or absence of the cough and utterance, and presenting the determination result in a different manner corresponding to the determined swallowing motion, cough and utterance state, and measuring swallowing function data Method. In the sound data analysis means, the epiglottis閉音included in the measurement data, the bolus passes through sound, extracts the epiglottis Hirakioto, and swallowing time for the entire swallowing operation of the measurement data and T _1, the bolus 11. The method of measuring swallowing function data according to claim 10, wherein the presence or absence of dysphagia is determined based on the evaluation function T ₂ / T ₁ when the time until the intermediate time of the passing sound is T ₂ .   In the sound data analysis means, the measurement data is classified into significant sound data and silence data according to an input voltage from the sound measurement unit, and the one time when the silence data has passed a predetermined time. Each time the swallowing operation is completed, the epiglottis closing sound, the food passing sound, the epiglottis opening sound, and the abnormal swallowing sound are analyzed from the significant sound data every time the swallowing operation is completed. The swallowing function data measuring method according to claim 10 or 11.   In the sound data analysis means, the waveform data of the significant sound data is converted into frequency analysis data, and based on the spectrum intensity at a specific frequency of the frequency analysis data, any of swallowing function sound, cough, and voice is discriminated. The method for measuring swallowing function data according to claim 12.

Images