Skip to main content

Advertisement

SpringerLink
Log in

Development of Innovative Feedback Device for Swallowing Therapy

  • Original Article
  • Published:
Journal of Medical and Biological Engineering Aims and scope Submit manuscript

Abstract

Dysphagia, which results from various disorders, may increase the risk of aspiration pneumonia, dehydration, and malnutrition. The aim of this study was to develop an innovative evaluation and treatment system for swallowing therapy using virtual reality (VR) feedback and electrical stimulation (ES), and to make an initial evaluation of its potential. In this system, the activation of the submental muscle and acceleration of laryngeal movement are used as the evaluation and feedback information. Twenty-one patients with chronic dysphagia for an average of 26.3 months were recruited for the VR feedback study. Each participant underwent 16 treatment sessions. After therapy, the Functional Oral Intake Scale results changed from 3.3 ± 1.5 to 5.0 ± 1.6 with statistical significance (p = 0.000). Thirteen healthy subjects were enrolled in the ES study. ES was applied for more than 2 s while the subjects were swallowing. With and without ES, swallowing triggering times were 456.17 ± 106.92 and 552.13 ± 105.97 ms, respectively. These differences were statistically significant (p = 0.04). Accelerations of laryngeal movement were 0.23 ± 0.1 g (g = 9.8 m/s2) and 0.20 ± 0.08 g, respectively, with a significant statistical difference (p = 0.033). The feasibility of a prototype that combines swallowing evaluation, VR feedback therapy, and synchronized ES is demonstrated for further clinical trials. Further comprehensive clinical studies are needed to verify the clinical efficacy of the device.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Wilkins, T., Gillies, R. A., Thomas, A. M., & Wagner, P. J. (2007). The prevalence of dysphagia in primary care patients: A HamesNet Research Network Study. Journal of the American Board of Family Medicine, 20, 144–150.

    Article  Google Scholar 

  2. Coates, C., & Bakheit, A. M. O. (1997). Dysphagia in Parkinson’s disease. European Neurology, 38(1), 49–52.

    Article  Google Scholar 

  3. Fuh, J. L., Lee, R. C., Wang, S. J., Lin, C. H., Wang, P. N., Chiang, J. H., & Liu, H. C. (1997). Swallowing difficulty in Parkinson’s disease. Clinical Neurology and Neurosurgery, 99(2), 106–112.

    Article  Google Scholar 

  4. Easterling, C. S., & Robbins, E. (2008). Dementia and dysphagia. Geriatric Nursing, 29(4), 275–285.

    Article  Google Scholar 

  5. Logemann, J. A. (1998). Evaluation and treatment of swallowing disorders. Austin, TX: Pro-Ed Inc.

    Google Scholar 

  6. Mercier, L., Audet, T., Hebert, R., Rochette, A., & Dubois, M. F. (2001). Impact of motor, cognitive, and perceptual disorders on ability to perform activities of daily living after stroke. Stroke, 32, 2602–2608.

    Article  Google Scholar 

  7. Ding, R., Larson, R. C., Logemann, J. A., & Rademaker, A. W. (2002). Surface electromyographic and electroglottographic studies in normal subjects under two swallow conditions: Normal and during the Mendelsohn manuever. Dysphagia, 17(12), 1–12.

    Article  Google Scholar 

  8. Huckabee, M. L., & Cannito, M. P. (1999). Outcomes of swallowing rehabilitation in chronic brainstem dysphagia: A retrospective evaluation. Dysphagia, 14, 93–109.

    Article  Google Scholar 

  9. McKee, M. G. (1991). Contributions of psychophysiologic monitoring to diagnosis and treatment of chronic head pain: A case study. Headache Quarterly, II(4), 327–330.

    MathSciNet  Google Scholar 

  10. McKee, M. G. (2008). Biofeedback: An overview in the context of heart–brain medicine. Cleveland Clinic Journal of Medicine, 75(Suppl 2), 31–34.

    Article  MathSciNet  Google Scholar 

  11. Bogaardt, H. C., Grolman, W., & Fokkens, W. J. (2009). The use of biofeedback in the treatment of chronic dysphagia in stroke patients. Folia Phoniatrica et Logopaedica, 61(4), 200–205.

    Article  Google Scholar 

  12. Carnaby-Mann, G. D., & Crary, M. A. (2010). McNeill dysphagia therapy program: A case-control study. Archives of Physical Medicine and Rehabilitation, 91(5), 743–749.

    Article  Google Scholar 

  13. Crary, M. A. (1995). A direct intervention program for chronic neurogenic dysphagia secondary to brainstem stroke. Dysphagia, 10(1), 6–18.

    Article  Google Scholar 

  14. Reddy, N. P., Katakam, A., Gupta, V., Unnikrishnan, R., Narayanan, J., & Canilang, E. P. (2000). Measurements of acceleration during videofluorographic evaluation of dysphagic patients. Medical Engineering & Physics, 22, 405–412.

    Article  Google Scholar 

  15. Reddy, N. P., Simcox, D. L., Gupta, V., Motta, G. E., Coppenger, J., Das, A., & Buch, O. (2000). Biofeedback therapy using accelerometry for treating dysphagic patients with poor laryngeal elevation: Case studies. Journal of Rehabilitation Research and Development, 37, 361–372.

    Google Scholar 

  16. Wang, C. M., Chuang, C. C., Chen, C. P., Tseng, W. C., & Chen, J. Y. (2014). Noninvasive swallowing test for young healthy adults: Finding the best location to monitor thyroid cartilage movements. Journal of Medical and Biological Engineering, 34(4), 393–398.

    Article  Google Scholar 

  17. Schultheis, M., & Rizzo, A. (2001). The application of virtual reality technology in rehabilitation. Rehabilitation Psychology, 46, 296–311.

    Article  Google Scholar 

  18. You, S. H., Jang, S. H., Kim, Y. H., Hallett, M., Ahn, S. H., Kwon, Y. H., et al. (2005). Virtual reality-induced cortical reorganization and associated locomotor recovery in chronic stroke: An experimenter-blind randomized study. Stroke, 36(6), 1166–1171.

    Article  Google Scholar 

  19. Saleh, S., Adamovich, S. V., & Tunik, E. (2014). Mirrored feedback in chronic stroke: Recruitment and effective connectivity of ipsilesional sensorimotor network. Neurorehabilitation and Neural Repair, 28(4), 344–354.

    Article  Google Scholar 

  20. Laver, K., George, S., Thomas, S., Deutsch, J. E., & Crotty, M. (2012). Cochrane review virtual reality for stroke rehabilitation. European Journal of Physical and Rehabilitation Medicine, 48(3), 523–530.

    Google Scholar 

  21. Bogaardt, H., van Dam, D., Wever, N. M., Bruggeman, C. E., Koops, J., & Fokkens, W. J. (2009). Use of neuromuscular electrostimulation in the treatment of dysphagia in patients with multiple sclerosis. The Annals of Otology, Rhinology, and Laryngology, 118(4), 241–246.

    Article  Google Scholar 

  22. Crary, M. A., Mann, G. D. C., & Groher, M. E. (2005). Initial psychometric assessment of a Functional Oral Intake Scale for dysphagia in stroke patients. Archives of Physical Medicine and Rehabilitation, 86(8), 1516–1520.

    Article  Google Scholar 

  23. Fabio, R. P. D. (1987). Reliability of computerized surface electromyography for determining the onset of muscle activity. Physical Therapy, 67, 43–48.

    Google Scholar 

  24. Vaiman, M., Eviatar, E. (2009). Surface electromyography as a screening method for evaluation of dysphagia and odynophagia. Head & Face Medicine, 5(9). http://www.head-face-med.com/content/5/1/9.

  25. Poorjavad, M., Moghadam, S. T., Ansari, N. N., Daemi, M. (2014). Surface electrical stimulation for treating swallowing disorders after stroke: A review of the stimulation intensity levels and the electrode placements marziyeh. Stroke Research and Treatment, article ID 918057, 7 pages. doi:10.1155/2014/918057.

  26. Ludlow, C. L., Humbert, I., Saxon, K., Poletto, C., Sonies, B., & Crujido, L. (2007). Effects of surface electrical stimulation both at rest and during swallowing in chronic pharyngeal dysphagia. Dysphagia, 22(1), 1–10.

    Article  Google Scholar 

  27. Lim, K. B., Lee, H. J., Lim, S. S., & Choi, Y. I. (2009). Neuromuscular electrical and thermal-tactile stimulation for dysphagia caused by stroke: A randomized controlled trial. Journal of Rehabilitation Medicine, 41(3), 174–178.

    Article  Google Scholar 

  28. Humbert, I. A., Poletto, C. J., Saxon, K. G., Kearney, P. R., Crujido, L., Wright-Harp, W., et al. (2006). The effect of surface electrical stimulation on hyo-laryngeal movement in normal individuals at rest and during swallowing. Journal of Applied Physiology, 101, 1657–1663.

    Article  Google Scholar 

  29. Humbert, I. A., Michou, E., MacRae, P. R., & Crujido, L. (2012). Electrical stimulation and swallowing: How much do we know? Seminars in Speech and Language, 33(3), 203–216.

    Article  Google Scholar 

  30. Jang, H. J., Leigh, J. H., Seo, H. G., Han, T. R., & Oh, B. M. (2015). Effortful swallow enhances vertical hyolaryngeal movement and prolongs duration after maximal excursion. Journal of Oral Rehabilitation, 42(10), 765–773.

    Article  Google Scholar 

  31. Humbert, I. A., Lokhande, A., German, R., Gonzalez-Fernandez, M., & Celnik, P. (2013). Human hyo-laryngeal movements show adaptive motor learning during swallowing. Dysphagia, 28(2), 139–145.

    Article  Google Scholar 

  32. Benson, H., & Stuart, E. M. (1993). Wellness book: The comprehensive guide to maintaining health and treating stress-related illness. New York: Simon & Schuster.

    Google Scholar 

  33. Sejdic, E., Steele, C. M., & Chau, T. (2009). Segmentation of dual-axis swallowing accelerometry signals in healthy subjects with analysis of anthropometric effects on duration of swallowing activities. IEEE Transactions on Biomedical Engineering, 56(4), 1090–1097.

    Article  Google Scholar 

  34. Lee, J., Steele, C. M., & Chau, T. (2008). Time and time–frequency characterization of dual-axis swallowing accelerometry signals. Physiological Measurement, 29, 1105–1120.

    Article  Google Scholar 

  35. Wheeler-Hegland, K. M., Rosenbek, J. C., & Sapienza, C. M. (2008). Submental sEMG and hyoid movement during Mendelsohn maneuver, effortful swallow, and expiratory muscle strength training. Journal of Speech Language and Hearing Research, 51(5), 1072–1087.

    Article  Google Scholar 

  36. Gupta, V., Reddy, N. P., & Canilang, E. P. (1996). Surface EMG measurements at the throat during dry and wet swallowing. Dysphagia, 11, 173–179.

    Article  Google Scholar 

  37. NICE (2014). Transcutaneous neuromuscular electrical stimulation for oropharyngeal dysphagia. NICE interventional procedure guidance 490. http://www.nice.org.uk/guidance/ipg490.

  38. Freed, M. L., Freed, L., Chatburn, R. L., & Christian, M. (2001). Electrical stimulation for swallowing disorders caused by stroke. Respiratory Care, 46(5), 466–474.

    Google Scholar 

  39. VitalStim Therapy Instructors (2008). Safety Issues regarding the use of VitalStim Therapy. vitalstimtherapy.com. http://www.djoglobal.com/sites/default/files/vitalstim/VitalStim_Contraindications_Precautions.pdf.

  40. Srivastava, A., Taly, A. B., Gupta, A., & Murali, T. (2010). Post-stroke depression: Prevalence and relationship with disability in chronic stroke sur vivors. Annals of Indian Academy of Neurology, 13(2), 123–127.

    Article  Google Scholar 

  41. Kawai, T., Watanabe, Y., Tonogi, M., Yamane, G. Y., Abe, S., Yamada, Y., & Callan, A. (2009). Visual and auditory stimuli associated with swallowing: an fMRI study. The Bulletin of Tokyo Dental College, 50(4), 169–181.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Biomedical Engineering, National Cheng Kung University, 1 University Road, Tainan City, 701, Taiwan, R.O.C.

    Chih-Ming Li, Shang-Heng Hsieh & Jia-Jin Jason Chen

  2. Department of Digital Media Design and Management, Far East University, 49 Zhonghua Road, Xinshi District, Tainan City, 744, Taiwan, R.O.C.

    Hsiao-Yu Lee

  3. Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, 7 Chung Shan S. Road, Taipei City, 100, Taiwan, R.O.C.

    Tyng-Guey Wang

  4. Department of Speech and Hearing Disorders and Sciences, National Taipei University of Nursing and Health Sciences, 365 Ming-te Road, Taipei City, 106, Taiwan, R.O.C.

    Hsueh-Pei Wang

Authors
  1. Chih-Ming Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hsiao-Yu Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shang-Heng Hsieh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tyng-Guey Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hsueh-Pei Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jia-Jin Jason Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jia-Jin Jason Chen.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, CM., Lee, HY., Hsieh, SH. et al. Development of Innovative Feedback Device for Swallowing Therapy. J. Med. Biol. Eng. 36, 357–368 (2016). https://doi.org/10.1007/s40846-016-0146-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40846-016-0146-8

Keywords

Search

Navigation