Ultrasound for bedside characterization of swallowing biomechanical impairments and biofeedback

Project Summary/Abstract Older adults are at risk for developing swallowing disorders (dysphagia) due to advancing age coupled with complicating comorbid diseases. Dysphagia is defined as altered swallow safety (aspiration) and/or efficiency (residue) and, if undetected and unmonitored, consequences include compromised health status (aspiration

pneumonia, choking) and affected quality of life. Radiologic imaging (videofluoroscopy) is the most comprehensive and well-studied modality for evaluation. However, clinicians treating patients in non-hospital settings do not have ready access to this instrumentation. While less comprehensive, ultrasound imaging has

been proposed as a bedside solution that would allow clinicians to monitor specific changes in swallowing physiology, conduct therapy, and provide evidence for appropriate referral for videofluoroscopic assessment. However, there is a lack of evidence regarding congruence between ultrasound and videofluoroscopic measures

of swallowing biomechanics (criterion validity) and whether ultrasound can detect clinically salient features of swallowing. Further, ultrasound imaging for swallowing biofeedback has not been tested in people with dysphagia. These limitations have prevented clinical translation of this tool. We propose to: (Aim 1) validate

ultrasound measures of oropharyngeal movements vs simultaneous MBSS and determine how these measures relate to clinical metrics of swallowing function (Modified Barium Swallowing Impairment Profile [MBSImP] Scoring; Analysis of Swallowing Physiology: Kinematics, Events, and Timing [ASPEKT]); (Aim 2) determine

whether ultrasound biofeedback improves execution of therapeutic swallowing maneuvers in persons with dysphagia. For Aim 1, we will recruit older individuals (≥60-years, N=70) with neurogenic (e.g. cerebrovascular accident [CVA]) and neurodegenerative disorders (e.g. Alzheimer’s Disease/Alzheimer’s Disease Related

Dementias [ADRD]) who are referred for a MBSS in our standard-of-care clinic. During MBSS, we will collect simultaneous ultrasound imaging with the probe placed in various sagittal, coronal, and transverse positions along the neck to capture lingual, pharyngeal, hyoid, vocal fold, and bolus movements. For both modalities, time-

dependent movements of oropharyngeal structures including displacements, velocities, and relative timing will be measured. Ultrasound measurements will be validated vs measurements from MBSS imaging and evaluated relative to clinical metrics of swallowing physiology using MBSImP scoring and ASPEKT. For Aim 2, a subset of

participants (N=44) will be randomly sampled to test whether real-time ultrasound biofeedback improves performance of therapeutic maneuvers for patients with dysphagia. We will compare ultrasound measurements of maneuvers completed with and without visual ultrasound biofeedback. This project will lay the groundwork for

future investigations on ultrasound as a point-of-care tool to transform dysphagia diagnosis, monitoring and treatment at the bedside and in non-hospital settings.