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Vergara J, Miles A, Lopes de Moraes J, Chone CT. Contribution of Wireless Wi-Fi Intraoral Cameras to the Assessment of Swallowing Safety and Efficiency. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:821-836. [PMID: 38437030 DOI: 10.1044/2023_jslhr-23-00375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
BACKGROUND Clinical evaluation of swallowing provides important clinical information but is limited in detecting penetration, aspiration, and pharyngeal residue in patients with suspected dysphagia. Although this is an old problem, there remains limited access to low-cost methods to evaluate swallowing safety and efficiency. PURPOSE The purpose of this technical report is to describe the experience of a single center that recently began using a wireless Wi-Fi intraoral camera for transoral endoscopic procedures as an adjunct to clinical swallowing evaluation. We describe the theoretical structure of this new clinical evaluation proposal. We present descriptive findings on its diagnostic performance in relation to videofluoroscopic swallowing study as the gold standard in a cohort of seven patients with dysphagia following head and neck cancer. We provide quantitative data on intra- and interrater reliability. Furthermore, this report discusses how this technology can be applied in the clinical practice of professionals who treat patients with dysphagia and provides directions for future research. CONCLUSIONS This preliminary retrospective study suggests that intraoral cameras can reveal the accumulated oropharyngeal secretions and postswallow pharyngolaryngeal residue in patients with suspected dysphagia. Future large-scale studies focusing on validating and exploring this contemporary low-cost technology as part of a clinical swallowing evaluation are warranted.
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Affiliation(s)
- José Vergara
- Department of Surgery, Head and Neck Surgery, University of Campinas, São Paulo, Brazil
| | - Anna Miles
- Department of Speech Science, School of Psychology, University of Auckland, New Zealand
| | - Juliana Lopes de Moraes
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Campinas, São Paolo, Brazil
| | - Carlos Takahiro Chone
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Campinas, São Paolo, Brazil
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2
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Alfano LN, James MK, Ramdharry GM, Lowes LP. 266th ENMC International Workshop: Remote delivery of clinical care and validation of remote clinical outcome assessments in neuromuscular disorders: A response to COVID-19 and proactive planning for the future. Hoofddorp, The Netherlands, 1-3 April 2022. Neuromuscul Disord 2023; 33:339-348. [PMID: 36965197 DOI: 10.1016/j.nmd.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 03/07/2023]
Affiliation(s)
- Lindsay N Alfano
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Center for Gene Therapy, Columbus, OH, United States; The Ohio State University College of Medicine, Department of Pediatrics, Columbus, OH, United States.
| | - Meredith K James
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Gita M Ramdharry
- Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, United Kingdom; Department of Neuromuscular Diseases, UCL Institute of Neurology, London, United Kingdom
| | - Linda P Lowes
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Center for Gene Therapy, Columbus, OH, United States; The Ohio State University College of Medicine, Department of Pediatrics, Columbus, OH, United States
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Shu K, Perera S, Mahoney AS, Mao S, Coyle JL, Sejdić E. Temporal Sequence of Laryngeal Vestibule Closure and Reopening is Associated With Airway Protection. Laryngoscope 2023; 133:521-527. [PMID: 35657100 PMCID: PMC9718890 DOI: 10.1002/lary.30222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Upper esophageal sphincter opening (UESO), and laryngeal vestibule closure (LVC) are two essential kinematic events whose timings are crucial for adequate bolus clearance and airway protection during swallowing. Their temporal characteristics can be quantified through time-consuming analysis of videofluoroscopic swallow studies (VFSS). OBJECTIVES We sought to establish a model to predict the odds of penetration or aspiration during swallowing based on 15 temporal factors of UES and laryngeal vestibule kinematics. METHODS Manual temporal measurements and ratings of penetration and aspiration were conducted on a videofluoroscopic dataset of 408 swallows from 99 patients. A generalized estimating equation model was deployed to analyze association between individual factors and the risk of penetration or aspiration. RESULTS The results indicated that the latencies of laryngeal vestibular events and the time lapse between UESO onset and LVC were highly related to penetration or aspiration. The predictive model incorporating patient demographics and bolus presentation showed that delayed LVC by 0.1 s or delayed LVO by 1% of the swallow duration (average 0.018 s) was associated with a 17.19% and 2.68% increase in odds of airway invasion, respectively. CONCLUSION This predictive model provides insight into kinematic factors that underscore the interaction between the intricate timing of laryngeal kinematics and airway protection. Recent investigation in automatic noninvasive or videofluoroscopic detection of laryngeal kinematics would provide clinicians access to objective measurements not commonly quantified in VFSS. Consequently, the temporal and sequential understanding of these kinematics may interpret such measurements to an estimation of the risk of aspiration or penetration which would give rise to rapid computer-assisted dysphagia diagnosis. LEVEL OF EVIDENCE 2 Laryngoscope, 133:521-527, 2023.
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Affiliation(s)
- Kechen Shu
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Subashan Perera
- Division of Geriatrics, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Amanda S. Mahoney
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shitong Mao
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James L. Coyle
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ervin Sejdić
- Edward S. Rogers Department of Electrical and Computer Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, Ontario, Canada
- North York General Hospital, Toronto, Ontario, Canada
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Mialland A, Atallah I, Bonvilain A. Toward a robust swallowing detection for an implantable active artificial larynx: a survey. Med Biol Eng Comput 2023; 61:1299-1327. [PMID: 36792845 DOI: 10.1007/s11517-023-02772-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 01/04/2023] [Indexed: 02/17/2023]
Abstract
Total laryngectomy consists in the removal of the larynx and is intended as a curative treatment for laryngeal cancer, but it leaves the patient with no possibility to breathe, talk, and swallow normally anymore. A tracheostomy is created to restore breathing through the throat, but the aero-digestive tracts are permanently separated and the air no longer passes through the nasal tracts, which allowed filtration, warming, humidification, olfaction, and acceleration of the air for better tissue oxygenation. As for phonation restoration, various techniques allow the patient to talk again. The main one consists of a tracheo-esophageal valve prosthesis that makes the air passes from the esophagus to the pharynx, and makes the air vibrate to allow speech through articulation. Finally, swallowing is possible through the original tract as it is now isolated from the trachea. Yet, many methods exist to detect and assess a swallowing, but none is intended as a definitive restoration technique of the natural airway, which would permanently close the tracheostomy and avoid its adverse effects. In addition, these methods are non-invasive and lack detection accuracy. The feasibility of an effective early detection of swallowing would allow to further develop an implantable active artificial larynx and therefore restore the aero-digestive tracts. A previous attempt has been made on an artificial larynx implanted in 2012, but no active detection was included and the system was completely mechanic. This led to residues in the airway because of the imperfect sealing of the mechanism. An active swallowing detection coupled with indwelling measurements would thus likely add a significant reliability on such a system as it would allow to actively close an artificial larynx. So, after a brief explanation of the swallowing mechanism, this survey intends to first provide a detailed consideration of the anatomical region involved in swallowing, with a detection perspective. Second, the swallowing mechanism following total laryngectomy surgery is detailed. Third, the current non-invasive swallowing detection technique and their limitations are discussed. Finally, the previous points are explored with regard to the inherent requirements for the feasibility of an effective swallowing detection for an artificial larynx. Graphical Abstract.
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Affiliation(s)
- Adrien Mialland
- Institute of Engineering and Management Univ. Grenoble Alpes, Univ. Grenoble Alpes, CNRS, Grenoble INP, Gipsa-lab, 38000, Grenoble, France.
| | - Ihab Atallah
- Institute of Engineering and Management Univ. Grenoble Alpes, Otorhinolaryngology, CHU Grenoble Alpes, 38700, La Tronche, France
| | - Agnès Bonvilain
- Institute of Engineering and Management Univ. Grenoble Alpes, Univ. Grenoble Alpes, CNRS, Grenoble INP, Gipsa-lab, 38000, Grenoble, France
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Qiao J, Jiang YT, Dai Y, Gong YB, Dai M, Liu YX, Dou ZL. Research on a real-time dynamic monitoring method for silent aspiration after stroke based on semisupervised deep learning: A protocol study. Digit Health 2023; 9:20552076231183548. [PMID: 37434729 PMCID: PMC10331777 DOI: 10.1177/20552076231183548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 06/05/2023] [Indexed: 07/13/2023] Open
Abstract
Objective This study aims to establish a real-time dynamic monitoring system for silent aspiration (SA) to provide evidence for the early diagnosis of and precise intervention for SA after stroke. Methods Multisource signals, including sound, nasal airflow, electromyographic, pressure and acceleration signals, will be obtained by multisource sensors during swallowing events. The extracted signals will be labeled according to videofluoroscopic swallowing studies (VFSSs) and input into a special dataset. Then, a real-time dynamic monitoring model for SA will be built and trained based on semisupervised deep learning. Model optimization will be performed based on the mapping relationship between multisource signals and insula-centered cerebral cortex-brainstem functional connectivity through resting-state functional magnetic resonance imaging. Finally, a real-time dynamic monitoring system for SA will be established, of which the sensitivity and specificity will be improved by clinical application. Results Multisource signals will be stably extracted by multisource sensors. Data from a total of 3200 swallows will be obtained from patients with SA, including 1200 labeled swallows from the nonaspiration category from VFSSs and 2000 unlabeled swallows. A significant difference in the multisource signals is expected to be found between the SA and nonaspiration groups. The features of labeled and pseudolabeled multisource signals will be extracted through semisupervised deep learning to establish a dynamic monitoring model for SA. Moreover, strong correlations are expected to be found between the Granger causality analysis (GCA) value (from the left middle frontal gyrus to the right anterior insula) and the laryngeal rise time (LRT). Finally, a dynamic monitoring system will be established based on the former model, by which SA can be identified precisely. Conclusion The study will establish a real-time dynamic monitoring system for SA with high sensitivity, specificity, accuracy and F1 score.
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Affiliation(s)
- Jia Qiao
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-Sen University
| | - Yuan-tong Jiang
- School of Software Engineering, South China University of Technology
| | - Yong Dai
- Clinical Medical College of Acupuncture-Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine
| | - Yan-bin Gong
- Department of Computer Science and Engineering, The Hong Kong University of Science and Technology
| | - Meng Dai
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-Sen University
| | - Yan-xia Liu
- School of Software Engineering, South China University of Technology
| | - Zu-lin Dou
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-Sen University
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Bandini A, Smaoui S, Steele CM. Automated pharyngeal phase detection and bolus localization in videofluoroscopic swallowing study: Killing two birds with one stone? COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 225:107058. [PMID: 35961072 PMCID: PMC9983708 DOI: 10.1016/j.cmpb.2022.107058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 07/26/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE The videofluoroscopic swallowing study (VFSS) is a gold-standard imaging technique for assessing swallowing, but analysis and rating of VFSS recordings is time consuming and requires specialized training and expertise. Researchers have recently demonstrated that it is possible to automatically detect the pharyngeal phase of swallowing and to localize the bolus in VFSS recordings via computer vision approaches, fostering the development of novel techniques for automatic VFSS analysis. However, training of algorithms to perform these tasks requires large amounts of annotated data that are seldom available. In this paper, we demonstrate that the challenges of pharyngeal phase detection and bolus localization can be solved together using a single approach. METHODS We propose a deep-learning framework that jointly tackles pharyngeal phase detection and bolus localization in a weakly-supervised manner, requiring only the initial and final frames of the pharyngeal phase as ground truth annotations for the training. Our approach stems from the observation that bolus presence in the pharynx is the most prominent visual feature upon which to infer whether individual VFSS frames belong to the pharyngeal phase. We conducted extensive experiments with multiple convolutional neural networks (CNNs) on a dataset of 1245 bolus-level clips from 59 healthy subjects. RESULTS We demonstrated that the pharyngeal phase can be detected with an F1-score higher than 0.9. Moreover, by processing the class activation maps of the CNNs, we were able to localize the bolus with promising results, obtaining correlations with ground truth trajectories higher than 0.9, without any manual annotations of bolus location used for training purposes. CONCLUSIONS Once validated on a larger sample of participants with swallowing disorders, our framework will pave the way for the development of intelligent tools for VFSS analysis to support clinicians in swallowing assessment.
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Affiliation(s)
- Andrea Bandini
- KITE Research Institute - Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON M5G 2A2, Canada; The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy; Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Sana Smaoui
- KITE Research Institute - Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON M5G 2A2, Canada; Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Catriona M Steele
- KITE Research Institute - Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON M5G 2A2, Canada; Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, ON, Canada.
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Frakking TT, Chang AB, Carty C, Newing J, Weir KA, Schwerin B, So S. Using an Automated Speech Recognition Approach to Differentiate Between Normal and Aspirating Swallowing Sounds Recorded from Digital Cervical Auscultation in Children. Dysphagia 2022; 37:1482-1492. [PMID: 35092488 PMCID: PMC9643257 DOI: 10.1007/s00455-022-10410-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 01/19/2022] [Indexed: 12/16/2022]
Abstract
Use of machine learning to accurately detect aspirating swallowing sounds in children is an evolving field. Previously reported classifiers for the detection of aspirating swallowing sounds in children have reported sensitivities between 79 and 89%. This study aimed to investigate the accuracy of using an automatic speaker recognition approach to differentiate between normal and aspirating swallowing sounds recorded from digital cervical auscultation in children. We analysed 106 normal swallows from 23 healthy children (median 13 months; 52.1% male) and 18 aspirating swallows from 18 children (median 10.5 months; 61.1% male) who underwent concurrent videofluoroscopic swallow studies with digital cervical auscultation. All swallowing sounds were on thin fluids. A support vector machine classifier with a polynomial kernel was trained on feature vectors that comprised the mean and standard deviation of spectral subband centroids extracted from each swallowing sound in the training set. The trained support vector machine was then used to classify swallowing sounds in the test set. We found high accuracy in the differentiation of aspirating and normal swallowing sounds with 98% overall accuracy. Sensitivity for the detection of aspiration and normal swallowing sounds were 89% and 100%, respectively. There were consistent differences in time, power spectral density and spectral subband centroid features between aspirating and normal swallowing sounds in children. This study provides preliminary research evidence that aspirating and normal swallowing sounds in children can be differentiated accurately using machine learning techniques.
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Affiliation(s)
- Thuy T. Frakking
- Research Development Unit, Caboolture Hospital, Metro North Hospital & Health Service, McKean St, Caboolture, QLD 4510 Australia ,Centre for Clinical Research, School of Medicine, The University of Queensland, Herston, QLD 4029 Australia ,Speech Pathology Department, Gold Coast University Hospital, Gold Coast Hospital & Health Service, 1 Hospital Boulevard, Southport, QLD 4215 Australia
| | - Anne B. Chang
- Department of Respiratory Medicine, Queensland Children’s Hospital, 501 Stanley St, South Brisbane, QLD 4101 Australia ,Child Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT 0811 Australia ,Australian Centre for Health Services Innovation, Queensland University of Technology, Level 7, 62 Graham St, South Brisbane, QLD 4101 Australia
| | - Christopher Carty
- Research Development Unit, Caboolture Hospital, Metro North Hospital & Health Service, McKean St, Caboolture, QLD 4510 Australia ,Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, 4222 Australia
| | - Jade Newing
- School of Engineering and Built Environment, Griffith University, Parklands Dr, Southport, QLD 4215 Australia
| | - Kelly A. Weir
- Menzies Health Institute QLD & School of Health Sciences & Social Work, Griffith University, Gold Coast Campus, 1 Parklands Avenue, Southport, QLD 4222 Australia ,Allied Health Research, Gold Coast University Hospital, Gold Coast Hospital & Health Service, 1 Hospital Boulevard, Southport, QLD 4215 Australia
| | - Belinda Schwerin
- School of Engineering and Built Environment, Griffith University, Parklands Dr, Southport, QLD 4215 Australia
| | - Stephen So
- School of Engineering and Built Environment, Griffith University, Parklands Dr, Southport, QLD 4215 Australia
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Schwartz R, Khalifa Y, Lucatorto E, Perera S, Coyle J, Sejdic E. A Preliminary Investigation of Similarities of High Resolution Cervical Auscultation Signals Between Thin Liquid Barium and Water Swallows. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2022; 10:4900109. [PMID: 34963825 PMCID: PMC8694539 DOI: 10.1109/jtehm.2021.3134926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/27/2021] [Accepted: 12/03/2021] [Indexed: 11/06/2022]
Abstract
Dysphagia, commonly referred to as abnormal swallowing, affects millions of people annually. If not diagnosed expeditiously, dysphagia can lead to more severe complications, such as pneumonia, nutritional deficiency, and dehydration. Bedside screening is the first step of dysphagia characterization and is usually based on pass/fail tests in which a nurse observes the patient performing water swallows to look for dysphagia overt signs such as coughing. Though quick and convenient, bedside screening only provides low-level judgment of impairment, lacks standardization, and suffers from subjectivity. Recently, high resolution cervical auscultation (HRCA) has been investigated as a less expensive and non-invasive method to diagnose dysphagia. It has shown strong preliminary evidence of its effectiveness in penetration-aspiration detection as well as multiple swallow kinematics. HRCA signals have traditionally been collected and investigated in conjunction with videofluoroscopy exams which are performed using barium boluses including thin liquid. An HRCA-based bedside screening is highly desirable to expedite the initial dysphagia diagnosis and overcome all the drawbacks of the current pass/fail screening tests. However, all research conducted for using HRCA in dysphagia is based on thin liquid barium boluses and thus not guaranteed to provide valid results for water boluses used in bedside screening. If HRCA signals show no significant differences between water and thin liquid barium boluses, then the same algorithms developed on thin liquid barium boluses used in diagnostic imaging studies, it can be then directly used with water boluses. This study investigates the similarities and differences between HRCA signals from thin liquid barium swallows compared to those signals from water swallows. Multiple features from the time, frequency, time-frequency, and information-theoretic domain were extracted from each type of swallow and a group of linear mixed models was tested to determine the significance of differences. Machine learning classifiers were fit to the data as well to determine if the swallowed material (thin liquid barium or water) can be correctly predicted from an unlabeled set of HRCA signals. The results demonstrated that there is no systematic difference between the HRCA signals of thin liquid barium swallows and water swallows. While no systematic difference was discovered, the evidence of complete conformity between HRCA signals of both materials was inconclusive. These results must be validated further to confirm conformity between the HRCA signals of thin liquid barium swallows and water swallows.
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Affiliation(s)
- Ryan Schwartz
- Department of Electrical and Computer EngineeringSwanson School of EngineeringUniversity of Pittsburgh Pittsburgh PA 15261 USA
| | - Yassin Khalifa
- Department of Electrical and Computer EngineeringSwanson School of EngineeringUniversity of Pittsburgh Pittsburgh PA 15261 USA
| | - Erin Lucatorto
- Department of Communication Science and DisordersSchool of Health and Rehabilitation SciencesUniversity of Pittsburgh Pittsburgh PA 15260 USA
| | - Subashan Perera
- Division of Geriatric MedicineDepartment of MedicineUniversity of Pittsburgh Pittsburgh PA 15261 USA
| | - James Coyle
- Department of Communication Science and DisordersSchool of Health and Rehabilitation SciencesUniversity of Pittsburgh Pittsburgh PA 15260 USA
| | - Ervin Sejdic
- Department of Electrical and Computer EngineeringSwanson School of EngineeringUniversity of Pittsburgh Pittsburgh PA 15261 USA
- The Edward S. Rogers Department of Electrical and Computer EngineeringFaculty of Applied Science and EngineeringUniversity of Toronto Toronto ON M5S 2E4 Canada
- North York General Hospital Toronto ON M2K 1E1 Canada
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Donohue C, Khalifa Y, Perera S, Sejdić E, Coyle JL. How Closely do Machine Ratings of Duration of UES Opening During Videofluoroscopy Approximate Clinician Ratings Using Temporal Kinematic Analyses and the MBSImP? Dysphagia 2020; 36:707-718. [PMID: 32955619 DOI: 10.1007/s00455-020-10191-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
Clinicians evaluate swallow kinematic events by analyzing videofluoroscopy (VF) images for dysphagia management. The duration of upper esophageal sphincter opening (DUESO) is one important temporal swallow event, because reduced DUESO can result in pharyngeal residue and penetration/aspiration. VF is frequently used for evaluating swallowing but exposes patients to radiation and is not always feasible/readily available. High resolution cervical auscultation (HRCA) is a non-invasive, sensor-based dysphagia screening method that uses signal processing and machine learning to characterize swallowing. We investigated HRCA's ability to annotate DUESO and predict Modified Barium Swallow Impairment Profile (MBSImP) scores (component #14). We hypothesized that HRCA and machine learning techniques would detect DUESO with similar accuracy as human judges. Trained judges completed temporal kinematic measurements of DUESO on 719 swallows (116 patients) and 50 swallows (15 age-matched healthy adults). An MBSImP certified clinician completed MBSImP ratings on 100 swallows. A multi-layer convolutional recurrent neural network (CRNN) using HRCA signal features for input was used to detect DUESO. Generalized estimating equations models were used to determine statistically significant HRCA signal features for predicting DUESO MBSImP scores. A support vector machine (SVM) classifier and a leave-one-out procedure was used to predict DUESO MBSImP scores. The CRNN detected UES opening within a 3-frame tolerance for 82.6% of patient and 86% of healthy swallows and UES closure for 72.3% of patient and 64% of healthy swallows. The SVM classifier predicted DUESO MBSImP scores with 85.7% accuracy. This study provides evidence of HRCA's feasibility in detecting DUESO without VF images.
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Affiliation(s)
- Cara Donohue
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA, 15260, USA
| | - Yassin Khalifa
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, 15260, USA
| | - Subashan Perera
- Division of Geriatrics, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Ervin Sejdić
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, 15260, USA.,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, 15260, USA.,Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, 15260, USA.,Intelligent Systems Program, School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, 15260, USA
| | - James L Coyle
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA, 15260, USA.
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SejdiĆ E, Khalifa Y, Mahoney AS, Coyle JL. ARTIFICIAL INTELLIGENCE AND DYSPHAGIA: NOVEL SOLUTIONS TO OLD PROBLEMS. ARQUIVOS DE GASTROENTEROLOGIA 2020; 57:343-346. [PMID: 33331470 DOI: 10.1590/s0004-2803.202000000-66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Dysphagia management, from screening procedures to diagnostic methods and therapeutic approaches, is about to change dramatically. This change is prompted not solely by great discoveries in medicine or physiology, but by advances in electronics and data science and close collaboration and cross-pollination between these two disciplines. In this editorial, we will provide a brief overview of the role of artificial intelligence in dysphagia management.
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Affiliation(s)
- Ervin SejdiĆ
- University of Pittsburgh, Department of Electrical and Computer Engineering, Swanson School of Engineering, Pittsburgh, Pennsylvania, United States.,University of Pittsburgh, Department of Bioengineering, Swanson School of Engineering, Pittsburgh, Pennsylvania, United States.,University of Pittsburgh, Department of Biomedical Informatics, School of Medicine, Pittsburgh, Pennsylvania, United States.,University of Pittsburgh, Intelligent Systems Program, School of Computing and Information, Pittsburgh, Pennsylvania, United States
| | - Yassin Khalifa
- University of Pittsburgh, Department of Electrical and Computer Engineering, Swanson School of Engineering, Pittsburgh, Pennsylvania, United States
| | - Amanda S Mahoney
- University of Pittsburgh, Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania, United States
| | - James L Coyle
- University of Pittsburgh, Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania, United States.,University of Pittsburgh, Department of Otolaryngology, School of Medicine, Pittsburgh, Pennsylvania, United States
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