JPH0690956A - Analysis and treatment for distubance of swallowing function - Google Patents

Abstract

PURPOSE: To enable a specialist physician to use in his/her own hospital and make very many subjects analyzable by installing a transducer means actuated by displacement and/or pressure at a position desired for analysis of the behavior during the time of swallowing through larynx or the like. CONSTITUTION: A transducer 2 is installed at a place 1 to be analyzed of a subject. An electric signal generated by the transducer 2 is transmitted to a sampling means 4 through an electric wire 3, and further connected to an A-D card. A microprocessor 5 directly connected with the output of the transducer 2 receives the data from the sampling means 4 integrated with this and examines the data precisely. The data examined in the form of data expressing intensity against time is indicated on a display 6.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to analysis and treatment for disorders of swallowing function.

[0002]

BACKGROUND OF THE INVENTION Impaired swallowing function occurs in the human body as a result of various physiological causes, and analyzing swallowing behavior of a subject is useful in diagnosing various diseases. Furthermore, when an abnormal swallowing behavior is found in a subject, it is important to recognize the problem and educate the subject to appropriately perform swallowing behavior.

Analysis of this type of problem has been conventional in this field. Shakwer et al., For example, used a very complex technique based on a combination of balloon pressure and ultrasound scanner techniques to assess a subject's behavior during swallowing (see Ultrasonic analysis of tongue, hyoid, and laryngeal movements while on the go "Investigative Radiolog
y, 1984, 9: 82-86). These authors followed the tongue movement with an ultrasonic scanner and the larynx movement with an external device. 1
In 2 out of 0 subjects, the first swallow of the two swallows was used for the measurement due to the difficulty of displaying the pressure transducer of the larynx, while the 10 swallowed were analyzed. Of the 8 subjects, only 2 swallows were tracked and the second swallow was arbitrarily selected for analysis, repeating the results obtained on their laryngeal movements. Was difficult. The reason why the above method is adopted is that the large-scale equipment adopted cannot give a result repeatedly and cannot be left on the subject for a long time.
This is a very serious drawback, as will be appreciated by those skilled in the art. This is because long-term measurement and analysis of a subject's behavior is often necessary to enable meaningful conclusions to be drawn. In addition, ultrasound can be used to track the first oral phase of swallowing behavior, but was not useful for tracking frequency, swallowing speed or depth.

Recent reviews (swallow pathophysiology,
Otolaryngologic Clinic of NorthAmerica, Section 21,
No. 4, December 1988, pp. 637-647).
es and Baum reviewed the techniques available for the clinical assessment of swallowing. Techniques detailed include X-ray axial tomography (CAT), ultrasound (US), X-ray (still and video fluoroscopy), magnetic resonance imaging (MRI), manometry and scintigraphy. All of these techniques are complex, some of them CAT, US, X
Wire, requires expensive and very complex equipment such as MRI, some are invasive techniques such as manometry, and some require injection of external substances. Therefore, it would be highly desirable to be able to provide a simple method for effectively analyzing a subject's behavior during swallowing behavior, and that method would require extensive analysis of many subjects. It is desirable to be implemented by using simple and inexpensive equipment that utilizes non-intrusive techniques so that it can be done.

[0005]

SUMMARY OF THE INVENTION The object of the invention is to overcome the drawbacks of the methods currently available, allow a specialist doctor to use them in his hospital and to analyze a large number of subjects. To provide such a method. Another object of the invention is to provide a device for carrying out the method, which device is relatively inexpensive and simple to operate.

A further object of the invention is, on the one hand, a method and a device which allow an iterative analysis of long-term swallowing behavior and, on the other hand, a single swallowing and a detailed analysis of its stages. To provide. Yet another object of the present invention is to provide a method of tracking swallowing behavior and providing biofeedback to a subject, thereby allowing the subject to modify his swallowing behavior. . The swallowing parameters that can be modified include, but are not limited to, the frequency of the swallowing action, the amplitude of a single swallowing, the consistency and continuity of laryngeal movement, e.g. the tongue, hyoid bone and mouth muscles. Includes additional anatomical movements involved in swallowing such as.

Still another object of the present invention is to provide a biofeedback device which can be used by a doctor or a subject himself, is easy to operate and is effective. Another object of this invention is a biofeedback device that may be used by a person in need of treatment at home after being treated and / or analyzed by a qualified doctor for the purpose of practicing correct swallowing movements. To provide.

According to the present invention, the method for analyzing swallowing of a subject comprises the following steps: 1) a step of providing transducer means operating by displacement and / or pressure, 2) the above transducer. A step of arranging the means in a desired positional relationship in relation to the anatomical structure of the subject whose behavior is desired to be analyzed during swallowing such as the larynx, 3) swallowing Sampling the signal produced by the transducer means when made, 4) determining the start and end times of swallowing of the above signal, and the relative induced intensities of the sampled signal at the sampling time. Scrutinizing to determine that the induced intensity depends on the movement of anatomical structures acting on the transducer, and 5) the subject. Step of providing the data or data points visible representing the induced intensity of the sampled signals representing the swallowing behavior.

Different signals can be provided as different swallow parameters. The swallowing parameters include, for example, the start and end times of swallowing, their shape, sequence, continuity, and the various anatomical consistency involved in swallowing, such as the larynx, tongue, hyoid bone and mouth muscles. and so on. Various devices known as transducer means that operate by displacement and / or pressure can be used. For example, a strain gauge or a piezoelectric transducer may be used, but the invention is not limited thereto. Piezoelectric transducers are the preferred embodiment. The reason is that it responds to small pressures, is light, and is easy to place near the larynx and other anatomical structures of the subject. However, as will be apparent to the technician, any equivalent transducer that can be conveniently placed on the subject can be used. A more suitable piezoelectric material transducer is such as the piezoelectric film produced by Pennwalt Corporation under the trademark Kynar. Kyna
When a piezoelectric film, such as r-film, is used, it is also possible to produce a matrix-like output, at which different locations on the film produce signals indicating strength and position when pressure is independently applied. . This method can track the movement of the larynx over time.

Examples of transducers and various uses of such transducers are given, for example, in European Patent Application No. 14,693, British Patent Application No. 2,13.
No. 8,144, U.S. Pat. No. 4,359,726. Farrden, J., "Application of Piezoelectric / Pyroelectric Films in Medical Transducers," J. Clin. Engg., 3
Also noteworthy is the paper April / 1988, pp. 133-138.

Further, an optical displacement transducer can be used to generate the swallowing motion related signal, such as an optical device comprising optical fibers. If the transducer is a contact working device, it is placed in contact with the object to be inspected. However, if the transducer consists of a light-actuated element, it may be located remotely from the structure under test, depending on the actual nature of the sensor. Proper placement of the transducer is, of course, within the skill of the person doing the job, and various forms of transducer that are currently available or will be developed for future use. Depends on.

Unless otherwise indicated, whenever reference is made to monitoring laryngeal movements in the description, it refers to all dissections associated with swallowing, such as the tongue, hyoid bone and mouth muscles. It should be understood that it is intended to include academic structure. Thus, for example, when it is desired to analyze the movement of the tongue during swallowing, a transducer such as Kynar film is placed on the tongue and removed or repositioned at the end of each swallow.

According to the present invention, there is also provided a device for analyzing swallowing of a subject, which device has means as described below. 1) Displacement and / or pressure-actuated transducer means, 2) Anatomical examination of the subject, for which it is desired to analyze the behavior of the transducer means during swallowing, for example in the larynx. Means for arranging in a desired positional relationship in relation to the structure, 3) sampling means for continuously or periodically sampling the signal generated by the transducer means, these comprising eg amplification means, The amplification means receives an electrical signal generated by a transducer such as a piezoelectric film, amplifies the signal and converts it into a signal that can be provided to a microprocessor, 4) the onset of swallowing. Probing for determination of end and end times, and relative induced intensities of sampled signals at sampling times And a visible data or data point display means for displaying data representative of the pressure-induced intensity of the sampled signal, such as an AD converter, for example. .

The inspection means may use a microprocessor or a microcomputer. Preferably a personal computer such as an IBM PC is used for this purpose. The signal generated by the transducer means, transmitted, and received by the sampling means is provided to the microcomputer by means known to those skilled in the art. The means are not discussed here.

The display means may be any type of display as long as the doctor can see the analysis result. Often a display, such as a normal display on a personal computer, will be used for the first visit. But for more detailed analysis and records,
It is desirable to keep a printed record of the results of the analysis. For this purpose, a printer or plotter can often be used as the display means. Furthermore, the data generated during the analysis can be stored for later reference or scrutiny by a suitable storage means, eg magnetic or optical disks, PC hard disks, etc.

The present invention further discloses a method of signaling a subject who does not perform swollen movements correctly, whereby the subject performs swallowing modified by the biofeedback swallowing technique. So that you can educate yourself. The method comprises the following steps. 1) providing a transducer means that operates by displacement and / or pressure; 2) analyzing the behavior of the transducer means during swallowing, eg the larynx of a subject. Step of arranging in a desired positional relationship in relation to the anatomical structure of the examiner, 3) Step of sampling the signal generated by the transducer means when swallowed, 4) Probing for determining the time interval between two separate swallows and for determining the relative induced intensities of the signals sampled at the sampling time, 5) two separate swallows Determine whether the interval between is greater than a predetermined time interval,
If the predetermined time interval is exceeded, generating a signal that instructs the subject to swallow, and 6) for each swallowing parameter analyzed. Determine if the strength and / or frequency of the sampled signal is not far from a predetermined value or range of values, and if the value and / or frequency of the sampled signal is above the predetermined value or value If the distance is out of the range, a signal for instructing the subject to make a correct swallow is generated. Thus, for example, in a subject who does not swallow sufficiently deep, the value of the sampled signal indicates the depth of swallowing, and the predetermined value of the signal is the minimum acceptable swallowing. Let's be deep. Also, if the subject does not swallow deep enough, the value of the sampled signal should be less than the minimum predetermined swallowing depth, so that the subject swallows deeper. Will generate a signal to teach. On the other hand, if the swallowing steps are out of order, a proper signal will be generated, which signal may differ in type and / or intensity from the signal generated by swallowing that is not deep enough, for example. Ah

[0017]

DESCRIPTION OF THE PREFERRED EMBODIMENT Reference is now made to FIG. 1 to further illustrate the invention. FIG. 1 shows a typical configuration of an apparatus according to one embodiment of the invention, which can be used to carry out the method of the invention. The location of the subject to be analyzed, for example the neck (larynx) or tongue, is indicated diagrammatically by the number 1. A transducer, for example a piezoelectric transducer, is designated by the numeral 2. The electrical signal generated by the piezoelectric transducer 2 is
It is transmitted via the wire 3 to the sampling means 4, which is, for example, an amplifier and is further coupled to an AD card. Usually, an AD card is included in the computer, the microprocessor 5, which is directly associated with the output of the transducer 2 if no amplifier is required, is a sampling means 4 which is integrated with the microprocessor 5 as described above. Receive data from and scrutinize the data. The data scrutinized in the form of data representing the intensity over time are displayed on the display 6. The display is that of a personal computer if the microprocessor 5 is housed in a personal computer. Then, the data is printed out by the printer 7 additionally or alternatively.

If the device of FIG. 1 is used as a device for educating a subject on biofeedback, the display means 6 and 7 can be omitted and the means 8 for giving the signal shown in broken lines in the figure. Can be provided. The means for providing a signal will signal to the subject that the swallowed movement is less than the desired movement. The means 8 for giving a signal may be a means for giving a signal by a sound such as a device for producing a beep or a means for giving a signal visually such as a display, or a vibration / position placed in contact with the skin of a subject. It may be a means for providing a signal by contact, such as a contact stimulus. In addition to signals of different intensities, two different types of signals, whether swallowing is insufficient in frequency, depth, shape, repeatability, continuity or consistency, and to what extent Will be given to the subject to indicate Of course different signals can be provided to indicate different defects in the swallow. For example, for the larynx and hyoid bone, movement in two planes (vertical / horizontal) is important as well as the continuity of movement, and the timing and sequence of events during swallowing are all anatomical. The structure of the muscles will be considered, and the stretching of the muscles of the mouth could also be analyzed.

The device shown in FIG.
It is a device for analysis that can also be used as a device for biofeedback. However, the invention can be used by a subject to practice according to parameters preset by a doctor as a result of the analysis made,
It is also intended to provide a simpler and cheaper device. This simplified device, which may broadly consist of the elements referred to in FIG. 1, is only capable of providing biofeedback by means of the signaling. On the other hand, as explained, the analysis device of FIG. 1 can be used as is as a biofeedback device, but would normally be unnecessarily expensive and complicated for home practice purposes.

FIG. 2 diagrammatically shows some swallows displayed on the display of a printer or a PC, for example. This figure shows the intensity of each swallow and all swallows that occurred at the time of inspection. In terms of the data shown in the figure, insufficient swallowing can be determined in terms of swallowing depth or in terms of frequency (time lapse between two swallowing).

FIG. 3 shows a single swallow analysis.
Two swallows are shown. The first swallow begins at time t ₁ as indicated by S10, and ends the time t _'1. The maximum swallow is greater than the minimum intensity MS of the swallow set for a particular subject.
Therefore, swallow S10 is a correct swallow, and if a biofeedback system is used, no signal will be output from the system. The second swallow S20 starts at time t _2, ending in time t _'2. This swallow has a maximum value that is less than the minimum desired relative intensity for the subject. Thus, if a biofeedback system were used, a signal would be generated indicating to the subject that the depth of ingestion was insufficient.

Furthermore t _'1 and time is between t ₂ will be compared with a preset time interval. Is shorter than the maximum time interval if the time interval t ₂ -t _'1 is set in advance, swallow 20 would those occur spontaneously.
On the other hand, if the time interval reaches the maximum allowable time interval value, a signal is generated to instruct the subject to make the next swallow at time t ₂ , and swallow 20 is a biofeedback. Will be the result of the teaching produced by the device. Additional information regarding each swath aspect may similarly be obtained from the data for a single swallow.

All of the above description and examples are given for the purpose of explanation. Many different embodiments could be made in various devices, components, and methods without exceeding the scope of the claimed invention.

[Brief description of drawings]

FIG. 1 is a connection diagram showing a configuration of an apparatus according to an embodiment of the present invention.

FIG. 2 is a diagram showing swallows displayed on a printer or a display.

FIG. 3 is a diagram showing a single swallowing analysis.

[Explanation of symbols]

 1-Location of subject's analysis 2-Transducer 3-Electric wire 4-Sampling means 5-Microprocessor 6-Display 7-Printer 8-Signal giving means

Claims (18)

[Claims] 1. A method for analyzing swallowing of a subject, comprising the following steps. 1) a step of providing a transducer means that operates by displacement and / or pressure; 2) an anatomy of a subject for whom it is desired to analyze the behavior of the transducer means during swallowing, such as for example the larynx. The desired position in relation to the biological structure, 3) sampling the signal produced by the transducer means when swallowing is done, 4) starting the swallowing of the above signal Probing for determination of end and end times, and determination of relative induced intensities of sampled signals at sampling times, and 5) Induction of sampled signals representing swallowing behavior of a subject. The process of providing visible data or data points that represent the intensity of the data. 2. The method of claim 1, wherein the anatomical structure is selected from the larynx, hyoid bone, tongue and mouth muscles. 3. A method according to claim 1, wherein the pressure-actuated transducer means comprises a strain gauge. 4. A method according to claim 1, wherein the pressure-operated transducer means comprises a piezoelectric transducer. 5. The method of claim 4, wherein the piezoelectric transducer is a piezoelectric film. 6. The method of claim 5, wherein the piezoelectric film is a Kynar film. 7. The method of claim 5, wherein the piezoelectric film is a matrix-designed piezoelectric film sensor that provides a plurality of pressure-induced signals at a plurality of locations. 8. An apparatus for swallowing analysis of a subject, comprising the following means. 1) Displacement and / or pressure-actuated transducer means, 2) Anatomical examination of the subject, for which it is desired to analyze the behavior of the transducer means during swallowing, for example in the larynx. Means for arranging in a desired positional relationship in relation to the structure 3) Sampling means for sampling the signal generated by the transducer means continuously or periodically, 4) Swallowing the above signals A probing means for probing for the determination of the start and end times of the, and the relative induced intensities of the sampled signal at the sampling time, and 5) induced by the pressure of the sampled signal Visible data or data point display means for displaying data representing intensity. 9. The method of claim 8 including scrutiny means for scrutinizing the signals produced by the transducer means to determine swallowing events such as persistence at different stages and their continuity and shape. apparatus. 10. The device according to claim 8, wherein the inspection means comprises a microprocessor or a microcomputer, preferably a personal computer. 11. The apparatus according to claim 8, wherein the display means is a printer or a plotter. 12. Apparatus according to claim 8 or 9, wherein the displacement transducer means comprises an optical sensor means. 13. The apparatus of claim 12, wherein the optical sensor means comprises one or more optical fibers. 14. A method of signaling a subject to perform a modified swallow, comprising the steps of: 1) a step of providing a transducer means that operates by displacement and / or pressure; and 2) with the anatomical structure of the subject for whom it is desired to analyze the behavior of the transducer means during swallowing. In relation to the desired positional relationship, 3) sampling the signal produced by the transducer means when swallowing is done, 4) said signal between two separate swallows. Probing for determining the time interval and for determining the relative induced intensities of the signals sampled at the sampling time, 5) the interval between two spaced swallows is predetermined Determine if the time interval has exceeded
If the predetermined time interval is exceeded, generating a signal that instructs the subject to swallow, and 6) for each swallowing parameter analyzed. Determine if the strength and / or frequency of the sampled signal is not far from a predetermined value or range of values, and if the value and / or frequency of the sampled signal is above the predetermined value or value Generating a signal that teaches the subject to make the correct swallow if away from the range. 15. A biofeedback device for signaling a subject to perform a modified swallow, especially for home use, comprising: 1) Displacement and / or pressure operated transducer means, 2) Means for placing said transducer means in a desired positional relationship in relation to the subject's larynx or other anatomical structure. 3) Sampling means for continuously or periodically sampling the signal generated by the transducer means 4) Determining the start and end times of the swallowing of the signal and / or the sequence of events And a probing means for probing for the determination of the relative induced intensities of the signals sampled at the sampling time, 5) said relative induced intensities and / or order and preset limiting Comparison means for comparing with different values, and 6) generate a signal when the intensity and / or the order of the sampled signals deviates from a preset limiting value. Because of the signal generation means. 16. The signal generating means generates a beep sound and / or a visual signal and / or a touch signal.
5. The device according to 5. 17. A device according to any one of the preceding claims, which is essentially described and illustrated. 18. A method of teaching a subject to make a modified swallow, comprising the steps of: 1) Analyzing the swallowing behavior of a subject by the method according to any of claims 1 to 7 in order to determine the value and / or range of the desired swallowing parameter for a particular subject. , 2) presetting the value and / or range of a desired desired swallowing parameter in the biofeedback device according to any one of claims 15 to 17, 3) the biofeedback device and claim for a subject Providing instructions for performing the method of paragraph 14.