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Kimura S, Emoto T, Suzuki Y, Shinkai M, Shibagaki A, Shichijo F. Novel Approach Combining Shallow Learning and Ensemble Learning for the Automated Detection of Swallowing Sounds in a Clinical Database. SENSORS (BASEL, SWITZERLAND) 2024; 24:3057. [PMID: 38793908 PMCID: PMC11124773 DOI: 10.3390/s24103057] [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: 03/12/2024] [Revised: 05/02/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024]
Abstract
Cervical auscultation is a simple, noninvasive method for diagnosing dysphagia, although the reliability of the method largely depends on the subjectivity and experience of the evaluator. Recently developed methods for the automatic detection of swallowing sounds facilitate a rough automatic diagnosis of dysphagia, although a reliable method of detection specialized in the peculiar feature patterns of swallowing sounds in actual clinical conditions has not been established. We investigated a novel approach for automatically detecting swallowing sounds by a method wherein basic statistics and dynamic features were extracted based on acoustic features: Mel Frequency Cepstral Coefficients and Mel Frequency Magnitude Coefficients, and an ensemble learning model combining Support Vector Machine and Multi-Layer Perceptron were applied. The evaluation of the effectiveness of the proposed method, based on a swallowing-sounds database synchronized to a video fluorographic swallowing study compiled from 74 advanced-age patients with dysphagia, demonstrated an outstanding performance. It achieved an F1-micro average of approximately 0.92 and an accuracy of 95.20%. The method, proven effective in the current clinical recording database, suggests a significant advancement in the objectivity of cervical auscultation. However, validating its efficacy in other databases is crucial for confirming its broad applicability and potential impact.
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Affiliation(s)
- Satoru Kimura
- Division of Science and Technology, Graduate School of Sciences and Technology for Innovations, Tokushima University, Tokushima 770-8506, Japan;
| | - Takahiro Emoto
- Division of Science and Technology, Industrial and Social Science, Graduate School of Technology, Tokushima University, Tokushima 770-8506, Japan
| | - Yoshitaka Suzuki
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8504, Japan; (Y.S.); (M.S.); (A.S.)
| | - Mizuki Shinkai
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8504, Japan; (Y.S.); (M.S.); (A.S.)
| | - Akari Shibagaki
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8504, Japan; (Y.S.); (M.S.); (A.S.)
| | - Fumio Shichijo
- Department of Neurosurgery, Suzue Hospital, Tokushima 770-0028, Japan;
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Gong Y, Qiao J, Huang Y, Zhang Q, Dou Z. Mealcoach: Contact Microphone-Based Meal Supervision For Post-Stroke Dysphagia Patients. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-5. [PMID: 38083131 DOI: 10.1109/embc40787.2023.10340832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Meal supervision for post-stroke dysphagia patients significantly improves prognosis during rehabilitation. Aspiration often occurs during meals, which may further incur aspiration pneumonia. Therefore, it's necessary to know the patient's swallowing ability as well as the occurrence of cough. Recently, some researchers have detected swallowing or coughing with audio signals and have made remarkable achievements. However, the users need to stay in quiet environments or wear uncomfortable cervical auscultation devices because the signals generated by swallowing are weak. In this work, we present MealCoach, a system that utilizes a contact microphone to collect high-quality signals to identify the events during meals. We take advantage of the insensitivity of contact microphones to ambient noise for free-living environment supervision. After balancing the wearing experience and identification accuracy, we elaborately select the optimal site to leverage the unique characteristics of cricoid cartilage movement during meals to accurately identify swallowing, coughing, speaking, and other events during meals. We collected data from thirty PSD patients in the hospital and evaluated our system, and the results demonstrate that MealCoach achieves a mean classification accuracy of 95.4%.
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Hoffmann J, Roldan-Vasco S, Krüger K, Niekiel F, Hansen C, Maetzler W, Orozco-Arroyave JR, Schmidt G. Pilot Study: Magnetic Motion Analysis for Swallowing Detection Using MEMS Cantilever Actuators. SENSORS (BASEL, SWITZERLAND) 2023; 23:3594. [PMID: 37050654 PMCID: PMC10099077 DOI: 10.3390/s23073594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 06/19/2023]
Abstract
The swallowing process involves complex muscle coordination mechanisms. When alterations in such mechanisms are produced by neurological conditions or diseases, a swallowing disorder known as dysphagia occurs. The instrumental evaluation of dysphagia is currently performed by invasive and experience-dependent techniques. Otherwise, non-invasive magnetic methods have proven to be suitable for various biomedical applications and might also be applicable for an objective swallowing assessment. In this pilot study, we performed a novel approach for deglutition evaluation based on active magnetic motion sensing with permanent magnet cantilever actuators. During the intake of liquids with different consistency, we recorded magnetic signals of relative movements between a stationary sensor and a body-worn actuator on the cricoid cartilage. Our results indicate the detection capability of swallowing-related movements in terms of a characteristic pattern. Consequently, the proposed technique offers the potential for dysphagia screening and biofeedback-based therapies.
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Affiliation(s)
- Johannes Hoffmann
- Department of Electrical and Information Engineering, Faculty of Engineering, Kiel University, 24118 Kiel, Germany
| | - Sebastian Roldan-Vasco
- GITA Lab, Faculty of Engineering, Universidad de Antioquia, Medellín 050010, Colombia
- Faculty of Engineering, Instituto Tecnológico Metropolitano, Medellín 050536, Colombia
| | - Karolin Krüger
- Department of Electrical and Information Engineering, Faculty of Engineering, Kiel University, 24118 Kiel, Germany
| | - Florian Niekiel
- Fraunhofer Institute for Silicon Technology ISIT, 25524 Itzehoe, Germany
| | - Clint Hansen
- Department of Neurology, Kiel University, 24118 Kiel, Germany
| | - Walter Maetzler
- Department of Neurology, Kiel University, 24118 Kiel, Germany
| | - Juan Rafael Orozco-Arroyave
- GITA Lab, Faculty of Engineering, Universidad de Antioquia, Medellín 050010, Colombia
- Pattern Recognition Lab, Friedrich-Alexander-Universität, 91054 Erlangen, Germany
| | - Gerhard Schmidt
- Department of Electrical and Information Engineering, Faculty of Engineering, Kiel University, 24118 Kiel, Germany
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Rios D, Rios M, Nóbrega AC, Oliveira LBD, Vaz D, Sales H, Almeida BLD, Lopes LS, Siqueira ICD, Lucena R. Alterations in deglutition in children with congenital Zika virus syndrome. Codas 2023; 35:e20210270. [PMID: 36629551 PMCID: PMC10010433 DOI: 10.1590/2317-1782/20212021270] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/23/2022] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To characterize swallowing in children with congenital Zika virus syndrome in comparison to typical children. METHODS This cross-sectional study enrolled 45 children diagnosed with congenital Zika virus syndrome and 45 others with typical development. Swallowing was evaluated through clinical feeding evaluations Protocolo de Avaliação Clínica da Disfagia Pediátrica and using acoustic swallowing parameters (Doppler sonar). RESULTS The mean age of children with congenital Zika virus syndrome was 26.69 ± 4.46 months and the mean head circumference was 29.20 ± 1.98 cm. Moderate/severe oropharyngeal dysphagia was found in 32(71.1%) of the children with congenital Zika virus syndrome. Significant differences were found between the groups on clinical evaluation: Children with congenital Zika virus syndrome presented insufficient lip closure 42(93.3%) and altered tonus of the tongue 35(77.8%) and cheeks 34(75.6%). In the children in the comparison group, only 6(13.3%) presented insufficient lip closure and 1(2.2%) had inadequate tongue posture. Changes during swallowing with liquid and spoonable food were not observed in the comparison group. When liquid/food was offered, affected children presented difficulties in sipping movements 14(77.8%) and lip/spoon contact 35(75%). The presence of residual food in the oral cavity after swallowing 38(86.4%) and clinical signs indicative of laryngotracheal penetration/aspiration, such as coughing, gagging and/or labored breathing, were also notable. No differences were found between the groups with regard to the acoustic parameters evaluated instrumentally. CONCLUSION Children with congenital Zika virus syndrome present alterations in the oral phase of swallowing, as well as clinical signs indicative of pharyngeal phase impairment.
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Affiliation(s)
- Débora Rios
- Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia - UFBA - Salvador (BA), Brasil
| | - Mino Rios
- Departamento de Psicologia, Universidade do Estado da Bahia - UNEB - Salvador (BA), Brasil
| | - Ana Caline Nóbrega
- Departamento de Fonoaudiologia, Instituto de Ciências da Saúde, Universidade Federal da Bahia - UFBA - Salvador (BA), Brasil
| | | | - Daniel Vaz
- Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia - UFBA - Salvador (BA), Brasil
| | - Henrique Sales
- Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia - UFBA - Salvador (BA), Brasil
| | | | - Leticia Serra Lopes
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz - Fiocruz Salvador, (BA), Brasil
| | | | - Rita Lucena
- Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia - UFBA - Salvador (BA), Brasil
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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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6
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Mootassim‐Billah S, Van Nuffelen G, Schoentgen J, De Bodt M, Dragan T, Digonnet A, Roper N, Van Gestel D. Assessment of cough in head and neck cancer patients at risk for dysphagia-An overview. Cancer Rep (Hoboken) 2021; 4:e1395. [PMID: 33932152 PMCID: PMC8551981 DOI: 10.1002/cnr2.1395] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/22/2021] [Accepted: 03/26/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND This literature review explores the terminology, the neurophysiology, and the assessment of cough in general, in the framework of dysphagia and regarding head and neck cancer patients at risk for dysphagia. In the dysphagic population, cough is currently assessed perceptually during a clinical swallowing evaluation or aerodynamically. RECENT FINDINGS Recent findings have shown intra and inter-rater disagreements regarding perceptual scoring of cough. Also, aerodynamic measurements are impractical in a routine bedside assessment. Coughing, however, is considered to be a clinically relevant sign of aspiration and dysphagia in head and cancer patients treated with concurrent chemoradiotherapy. CONCLUSION This article surveys the literature regarding the established cough assessment and stresses the need to implement innovative methods for assessing cough in head and neck cancer patients treated with concurrent chemoradiotherapy at risk for dysphagia.
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Affiliation(s)
- Sofiana Mootassim‐Billah
- Department of Radiation Oncology, Speech Therapy, Institut Jules BordetUniversité Libre de BruxellesBrusselsBelgium
| | - Gwen Van Nuffelen
- Department of Otolaryngology and Head and Neck Surgery, University Rehabilitation Center for Communication DisordersAntwerp University HospitalAntwerpBelgium
- Department of Translational Neurosciences, Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
- Department of Logopaedics and Audiological Sciences, Faculty of Medicine and Health SciencesUniversity of GhentGhentBelgium
| | - Jean Schoentgen
- BEAMS (Bio‐, Electro‐ And Mechanical Systems)Université Libre de BruxellesBrusselsBelgium
| | - Marc De Bodt
- Department of Otolaryngology and Head and Neck Surgery, University Rehabilitation Center for Communication DisordersAntwerp University HospitalAntwerpBelgium
- Department of Translational Neurosciences, Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
- Department of Logopaedics and Audiological Sciences, Faculty of Medicine and Health SciencesUniversity of GhentGhentBelgium
| | - Tatiana Dragan
- Department of Radiation Oncology, Head and Neck Unit, Institut Jules BordetUniversité Libre de BruxellesBrusselsBelgium
| | - Antoine Digonnet
- Department of Surgical Oncology, Head and Neck Surgery Unit, Institut Jules BordetUniversité Libre de BruxellesBrusselsBelgium
| | - Nicolas Roper
- Department of Oto‐Rhino‐Laryngology and Head & Neck Surgery, Erasme HospitalUniversité Libre de BruxellesBrusselsBelgium
| | - Dirk Van Gestel
- Department of Radiation Oncology, Head and Neck Unit, Institut Jules BordetUniversité Libre de BruxellesBrusselsBelgium
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Best Practice Recommendations for Stroke Patients with Dysphagia: A Delphi-Based Consensus Study of Experts in Turkey-Part I: Management, Diagnosis, and Follow-up. Dysphagia 2021; 37:217-236. [PMID: 33687558 DOI: 10.1007/s00455-021-10273-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 02/16/2021] [Indexed: 12/12/2022]
Abstract
Dysphagia is one of the most common and important complications of stroke. It is an independent marker of poor outcome after acute stroke and may become chronic after the acute period and continues to affect all aspects of the patient's life. Patients with stroke may encounter any of the medical branches in the emergency room or outpatient clinic, and as in our country, there may not be specialists specific for dysphagia, such as speech-language pathologists (SLP), in every hospital. This study aimed to raise awareness and create a common opinion of medical specialists for stroke patients with dysphagia. This recommendation paper has been written by a multidisciplinary team and offers 45 recommendations for stroke patients with dysphagia. It was created using the eight-step Delphi round via e-mail. This study is mostly specific to Turkey. However, since it contains detailed recommendations from the perspective of various disciplines associated with stroke, this consensus-based recommendation paper is not only a useful guide to address clinical questions in practice for the clinical management of dysphagia in terms of management, diagnosis, and follow-up, but also includes detailed comments for these topics.
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8
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Avoiding the Downward Spiral After Stroke: Early Identification and Treatment of Dysphagia. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00290-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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9
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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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10
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Donohue C, Khalifa Y, Perera S, Sejdić E, Coyle JL. A Preliminary Investigation of Whether HRCA Signals Can Differentiate Between Swallows from Healthy People and Swallows from People with Neurodegenerative Diseases. Dysphagia 2020; 36:635-643. [PMID: 32889627 DOI: 10.1007/s00455-020-10177-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 08/24/2020] [Indexed: 12/13/2022]
Abstract
High-resolution cervical auscultation (HRCA) is an emerging method for non-invasively assessing swallowing by using acoustic signals from a contact microphone, vibratory signals from an accelerometer, and advanced signal processing and machine learning techniques. HRCA has differentiated between safe and unsafe swallows, predicted components of the Modified Barium Swallow Impairment Profile, and predicted kinematic events of swallowing such as hyoid bone displacement, laryngeal vestibular closure, and upper esophageal sphincter opening with a high degree of accuracy. However, HRCA has not been used to characterize swallow function in specific patient populations. This study investigated the ability of HRCA to differentiate between swallows from healthy people and people with neurodegenerative diseases. We hypothesized that HRCA would differentiate between swallows from healthy people and people with neurodegenerative diseases with a high degree of accuracy. We analyzed 170 swallows from 20 patients with neurodegenerative diseases and 170 swallows from 51 healthy age-matched adults who underwent concurrent video fluoroscopy with non-invasive neck sensors. We used a linear mixed model and several supervised machine learning classifiers that use HRCA signal features and a leave-one-out procedure to differentiate between swallows. Twenty-two HRCA signal features were statistically significant (p < 0.05) for predicting whether swallows were from healthy people or from patients with neurodegenerative diseases. Using the HRCA signal features alone, logistic regression and decision trees classified swallows between the two groups with 99% accuracy, 100% sensitivity, and 99% specificity. This provides preliminary research evidence that HRCA can differentiate swallow function between healthy and patient populations.
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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, Department of Biomedical Informatics, School of Medicine 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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11
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Coyle JL, Sejdić E. High-Resolution Cervical Auscultation and Data Science: New Tools to Address an Old Problem. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:992-1000. [PMID: 32650655 PMCID: PMC7844341 DOI: 10.1044/2020_ajslp-19-00155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/15/2020] [Accepted: 02/16/2020] [Indexed: 06/11/2023]
Abstract
High-resolution cervical auscultation (HRCA) is an evolving clinical method for noninvasive screening of dysphagia that relies on data science, machine learning, and wearable sensors to investigate the characteristics of disordered swallowing function in people with dysphagia. HRCA has shown promising results in categorizing normal and disordered swallowing (i.e., screening) independent of human input, identifying a variety of swallowing physiological events as accurately as trained human judges. The system has been developed through a collaboration of data scientists, computer-electrical engineers, and speech-language pathologists. Its potential to automate dysphagia screening and contribute to evaluation lies in its noninvasive nature (wearable electronic sensors) and its growing ability to accurately replicate human judgments of swallowing data typically formed on the basis of videofluoroscopic imaging data. Potential contributions of HRCA when videofluoroscopic swallowing study may be unavailable, undesired, or not feasible for many patients in various settings are discussed, along with the development and capabilities of HRCA. The use of technological advances and wearable devices can extend the dysphagia clinician's reach and reinforce top-of-license practice for patients with swallowing disorders.
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Affiliation(s)
- James L. Coyle
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA
- Department of Otolaryngology, School of Medicine, University of Pittsburgh, PA
| | - Ervin Sejdić
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, PA
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, PA
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12
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Donohue C, Mao S, Sejdić E, Coyle JL. Tracking Hyoid Bone Displacement During Swallowing Without Videofluoroscopy Using Machine Learning of Vibratory Signals. Dysphagia 2020; 36:259-269. [PMID: 32419103 DOI: 10.1007/s00455-020-10124-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
Abstract
Identifying physiological impairments of swallowing is essential for determining accurate diagnosis and appropriate treatment for patients with dysphagia. The hyoid bone is an anatomical landmark commonly monitored during analysis of videofluoroscopic swallow studies (VFSSs). Its displacement is predictive of penetration/aspiration and is associated with other swallow kinematic events. However, VFSSs are not always readily available/feasible and expose patients to radiation. High-resolution cervical auscultation (HRCA), which uses acoustic and vibratory signals from a microphone and tri-axial accelerometer, is under investigation as a non-invasive dysphagia screening method and potential adjunct to VFSS when it is unavailable or not feasible. We investigated the ability of HRCA to independently track hyoid bone displacement during swallowing with similar accuracy to VFSS, by analyzing vibratory signals from a tri-axial accelerometer using machine learning techniques. We hypothesized HRCA would track hyoid bone displacement with a high degree of accuracy compared to humans. Trained judges completed frame-by-frame analysis of hyoid bone displacement on 400 swallows from 114 patients and 48 swallows from 16 age-matched healthy adults. Extracted features from vibratory signals were used to train the predictive algorithm to generate a bounding box surrounding the hyoid body on each frame. A metric of relative overlapped percentage (ROP) compared human and machine ratings. The mean ROP for all swallows analyzed was 50.75%, indicating > 50% of the bounding box containing the hyoid bone was accurately predicted in every frame. This provides evidence of the feasibility of accurate, automated hyoid bone displacement tracking using HRCA signals without use of VFSS 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
| | - Shitong Mao
- Department of Electrical and Computer Engineering, Swanson School of Engineering, Department of Bioengineering, Swanson School of Engineering, Department of Biomedical Informatics, School of Medicine Intelligent Systems Program, School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, 15260, USA
| | - Ervin Sejdić
- Department of Electrical and Computer Engineering, Swanson School of Engineering, Department of Bioengineering, Swanson School of Engineering, Department of Biomedical Informatics, School of Medicine 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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Kurosu A, Coyle JL, Dudik JM, Sejdic E. Detection of Swallow Kinematic Events From Acoustic High-Resolution Cervical Auscultation Signals in Patients With Stroke. Arch Phys Med Rehabil 2018; 100:501-508. [PMID: 30071198 DOI: 10.1016/j.apmr.2018.05.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/12/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine whether there were any associations between high-resolution cervical auscultation (HRCA) acoustic signals recorded by a contact microphone and swallowing kinematic events during pharyngeal swallow as assessed by a videofluoroscopic (VF) examination. DESIGN Prospective pilot study. SETTING University teaching hospital, university research laboratories. PARTICIPANTS Patients (N=35) with stroke who have suspected dysphagia (26 men + 9 women; age = 65.8±11.2). METHODS VF recordings of 100 liquid swallows from 35 stroke patients were analyzed, and a variety of HRCA signal features to characterize each swallow were calculated. MAIN OUTCOME MEASURES Percent of signal feature maxima (peak) occurring within 0.1 seconds of swallow kinematic event identified from VF recording. RESULTS Maxima of HRCA signal features, such as standard deviation, skewness, kurtosis, centroid frequency, bandwidth, and wave entropy, were associated with hyoid elevation, laryngeal vestibule closure, and upper esophageal sphincter opening, and the contact of the base of the tongue and posterior pharyngeal wall. CONCLUSIONS Although the kinematic source of HRCA acoustic signals has yet to be fully elucidated, these results indicate a strong relationship between these HRCA signals and several swallow kinematic events. There is a potential for HRCA to be developed for diagnostic and rehabilitative clinical management of dysphagia.
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Affiliation(s)
- Atsuko Kurosu
- Department of Communication Science and Disorders, School of Health and Rehabilitation and Sciences, University of Pittsburgh, Pittsburgh, PA
| | - James L Coyle
- Department of Communication Science and Disorders, School of Health and Rehabilitation and Sciences, University of Pittsburgh, Pittsburgh, PA; Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Joshua M Dudik
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA
| | - Ervin Sejdic
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA.
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Dudik JM, Kurosu A, Coyle JL, Sejdić E. Dysphagia and its effects on swallowing sounds and vibrations in adults. Biomed Eng Online 2018; 17:69. [PMID: 29855309 PMCID: PMC5984479 DOI: 10.1186/s12938-018-0501-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To utilize cervical auscultation as a means of screening for risk of dysphagia, we must first determine how the signal differs between healthy subjects and subjects with swallowing disorders. METHODS In this experiment we gathered swallowing sound and vibration data from 53 (13 with stroke, 40 without) patients referred for imaging evaluation of swallowing function with videofluoroscopy. The analysis was limited to non-aspirating swallows of liquid with either thin (< 5 cps) or viscous ([Formula: see text]) consistency. After calculating a selection of generalized time, frequency, and time frequency features for each swallow, we compared our data against our findings in a previous experiment that investigated identical features for a different group of 56 healthy subjects. RESULTS We found that nearly all of our chosen features for both vibrations and sounds showed significant differences between the healthy and disordered swallows despite the absence of aspiration. We also found only negligible differences between dysphagia as a symptom of stroke and dysphagia as a symptom of another condition. CONCLUSION Non-aspirating swallows from healthy controls and patients with dysphagia have distinct feature patterns. These findings should greatly help the development of the cervical auscultation field and serve as a reference for future investigations into more specialized characterization methods.
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Affiliation(s)
- Joshua M Dudik
- Department of Electrical and Computer Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Atsuko Kurosu
- Department of Communication Sciences and Disorders, University of Pittsburgh, Pittsburgh, PA, USA
| | - James L Coyle
- Department of Communication Sciences and Disorders, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ervin Sejdić
- Department of Electrical and Computer Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
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