Characterizing Effortful Swallows from Healthy Community Dwelling Adults Across the Lifespan Using High-Resolution Cervical Auscultation Signals and MBSImP Scores: A Preliminary Study

Dysphagia https://doi.org/10.1007/s00455-021-10368-3 ORIGINAL ARTICLE Characterizing Effortful Swallows from Healthy Community Dwelling Adults Across the Lifespan Using High‑Resolution Cervical Auscultation Signals and MBSImP Scores: A Preliminary Study Cara Donohue1 · Yassin Khalifa2 · Subashan Perera3 · Ervin Sejdić2,4,6 · James L. Coyle1,5 Received: 10 November 2020 / Accepted: 10 September 2021 © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021 Abstract There is growing enthusiasm to develop inexpensive, non-invasive, and portable methods that accurately assess swallowing and provide biofeedback during dysphagia treatment. High-resolution cervical auscultation (HRCA), which uses acoustic and vibratory signals from non-invasive sensors attached to the anterior laryngeal framework during swallowing, is a novel method for quantifying swallowing physiology via advanced signal processing and machine learning techniques. HRCA has demonstrated potential as a dysphagia screening method and diagnostic adjunct to VFSSs by determining swallowing safety, annotating swallow kinematic events, and classifying swallows between healthy participants and patients with a high degree of accuracy. However, its feasibility as a non-invasive biofeedback system has not been explored. This study investigated 1. Whether HRCA can accurately differentiate between non-effortful and effortful swallows; 2. Whether differences exist in Modified Barium Swallow Impairment Profile (MBSImP) scores (#9, #11, #14) between non-effortful and effortful swallows. We hypothesized that HRCA would accurately classify non-effortful and effortful swallows and that differences in MBSImP scores would exist between the types of swallows. We analyzed 247 thin liquid 3 mL command swallows (71 effortful) to minimize variation from 36 healthy adults who underwent standardized VFSSs with concurrent HRCA. Results revealed differences (p < 0.05) in 9 HRCA signal features between non-effortful and effortful swallows. Using HRCA signal features as input, decision trees classified swallows with 76% accuracy, 76% sensitivity, and 77% specificity. There were no differences in MBSImP component scores between non-effortful and effortful swallows. While preliminary in nature, this study demonstrates the feasibility/promise of HRCA as a biofeedback method for dysphagia treatment. Keywords Dysphagia · Videofluoroscopy · Machine learning · Cervical auscultation · Biofeedback · Treatment · Deglutition · Deglutition disorders 4 Cara Donohue Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA 15260, USA 5 Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA 15260, USA Department of Otolaryngology, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15260, USA 6 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 1 2 Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA 15260, USA 3 Division of Geriatrics, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA 13 Vol.:(0123456789) C. Donohue et.al Characterizing Effortful Swallows from Healthy Community Dwelling Adults Introduction Within clinical settings, a common challenge for dysphagia practitioners remains the lack of inexpensive, portable, and non-invasive dysphagia management methods available for assessment and treatment. To diagnose dysphagia, instrumental methods remain the gold standard [e.g., videofluoroscopy (VF), fiberoptic endoscopic evaluation of swallowing (FEES)]. While these methods are objective and provide insight into swallowing physiology, there are limitations to performing them including the cost, limited access in some settings (and countries), exposure to radiation (i.e., VF), and inability for some patients to participate in the examination (e.g., patient size, COVID-19 restrictions, patient desire to forgo further imaging studies). In addition to this, few accurate and non-invasive methods to provide biofeedback during dysphagia treatment are readily available within clinical settings and few clinicians are trained in deploying these methods [1]. FEES and VF have been implemented as biofeedback methods for dysphagia treatment and have been shown to be advantageous for patient/caregiver education and developing individualized treatment plans [2–4]. In fact, clinician feedback and participant/patient performance have been shown to be more accurate for certain swallowing maneuvers using VF compared to other biofeedback methods [e.g., surface electromyography (sEMG)] [3, 4]. However, dysphagia treatment using only VF for biofeedback is unrealistic within clinical settings due to the cost, radiation exposure, and time constraints/accessibility [3, 4]. Due to the limitations of FEES and VF as biofeedback methods for treatment, other non-invasive modalities such as sEMG have been explored. Yet a study examining concurrent VF and sEMG found very weak to moderate correlations between submental sEMG durations and temporal kinematic measures of hyolaryngeal displacement using VF images when participants performed the Mendelsohn maneuver [5]. A recent systematic review that examined biofeedback methods used in dysphagia treatment found that accelerometry, sEMG, and tongue manometry were the most frequently used in research studies [6]. In three studies, visual biofeedback using sEMG and accelerometry led to significantly improved hyoid bone displacement (compared to a control) during dysphagia treatment that targeted functional swallowing exercises such as the effortful swallow and Mendelsohn maneuver [6]. While these results are promising, study limitations included small sample sizes, the heterogeneity of patients, and mixed evidence regarding whether biofeedback results in clinically meaningful, functional changes in swallowing [5–9]. More specifically in studies using accelerometry, low quality studies have been implemented with flawed study designs and the 13 use of subjective and non-validated swallowing outcome measures [6–9]. Due to the limitations of current biofeedback modalities, innovative methods for providing continuous monitoring and biofeedback during dysphagia treatment are under investigation. One such modality is a novel wearable electromyography sensor-array patch that has demonstrated similar signal quality as traditional, commercially available sEMG during water swallow tasks [10]. Another potential biofeedback modality currently being explored is high-resolution cervical auscultation (HRCA) [11]. HRCA is a method of characterizing swallow function that integra (...truncated)