A statistical analysis of cervical auscultation signals from adults with unsafe airway protection

Background: Aspiration, where food or liquid is allowed to enter the larynx during a swallow, is recognized as the most clinically salient feature of oropharyngeal dysphagia. This event can lead to short-term harm via airway obstruction or more long-term effects such as pneumonia. In order to non-invasively identify this event using high resolution cervical auscultation there is a need to characterize cervical auscultation signals from subjects with dysphagia who aspirate. Methods: In this study, we collected swallowing sound and vibration data from 76 adults (50 men, 26 women, mean age 62) who underwent a routine videofluoroscopy swallowing examination. The analysis was limited to swallows of liquid with either thin (<5 cps) or viscous (≈300 cps) consistency and was divided into those with deep laryngeal penetration or aspiration (unsafe airway protection), and those with either shallow or no laryngeal penetration (safe airway protection), using a standardized scale. After calculating a selection of time, frequency, and time-frequency features for each swallow, the safe and unsafe categories were compared using Wilcoxon rank-sum statistical tests. Results: Our analysis found that few of our chosen features varied in magnitude between safe and unsafe swallows with thin swallows demonstrating no statistical variation. We also supported our past findings with regard to the effects of sex and the presence or absence of stroke on cervical ausculation signals, but noticed certain discrepancies with regards to bolus viscosity. Conclusions: Overall, our results support the necessity of using multiple statistical features concurrently to identify laryngeal penetration of swallowed boluses in future work with high resolution cervical auscultation

Automatic discrimination between safe and unsafe swallowing using a reputation-based classifier

<p>Abstract</p> <p>Background</p> <p>Swallowing accelerometry has been suggested as a potential non-invasive tool for bedside dysphagia screening. Various vibratory signal features and complementary measurement modalities have been put forth in the literature for the potential discrimination between safe and unsafe swallowing. To date, automatic classification of swallowing accelerometry has exclusively involved a single-axis of vibration although a second axis is known to contain additional information about the nature of the swallow. Furthermore, the only published attempt at automatic classification in adult patients has been based on a small sample of swallowing vibrations.</p> <p>Methods</p> <p>In this paper, a large corpus of dual-axis accelerometric signals were collected from 30 older adults (aged 65.47 ± 13.4 years, 15 male) referred to videofluoroscopic examination on the suspicion of dysphagia. We invoked a reputation-based classifier combination to automatically categorize the dual-axis accelerometric signals into safe and unsafe swallows, as labeled via videofluoroscopic review. From these participants, a total of 224 swallowing samples were obtained, 164 of which were labeled as unsafe swallows (swallows where the bolus entered the airway) and 60 as safe swallows. Three separate support vector machine (SVM) classifiers and eight different features were selected for classification.</p> <p>Results</p> <p>With selected time, frequency and information theoretic features, the reputation-based algorithm distinguished between safe and unsafe swallowing with promising accuracy (80.48 ± 5.0%), high sensitivity (97.1 ± 2%) and modest specificity (64 ± 8.8%). Interpretation of the most discriminatory features revealed that in general, unsafe swallows had lower mean vibration amplitude and faster autocorrelation decay, suggestive of decreased hyoid excursion and compromised coordination, respectively. Further, owing to its performance-based weighting of component classifiers, the static reputation-based algorithm outperformed the democratic majority voting algorithm on this clinical data set.</p> <p>Conclusion</p> <p>Given its computational efficiency and high sensitivity, reputation-based classification of dual-axis accelerometry ought to be considered in future developments of a point-of-care swallow assessment where clinical informatics are desired.</p

Cervical Auscultation for the Identification of Swallowing Difficulties

Swallowing difficulties, commonly referred to as dysphagia, affect thousands of Americans every year. They have a multitude of causes, but in general they are known to increase the risk of aspiration when swallowing in addition to other physiological effects. Cervical auscultation has been recently applied to detect such difficulties non-invasively and various techniques for analysis and processing of the recorded signals have been proposed. We attempted to further this research in three key areas. First, we characterized swallows with regards to a multitude of time, frequency, and time-frequency features while paying special attention to the differences between swallows from healthy adults and safe dysphagic swallows as well as safe and unsafe dysphagic swallows. Second, we attempted to utilize deep belief networks in order to classify these states automatically and without the aid of a concurrent videofluoroscopic examination. Finally, we sought to improve some of the signal processing techniques used in this field. We both implemented the DBSCAN algorithm to better segment our physiological signals as well as applied the matched complex wavelet transform to cervical auscultation data in order to improve its quality for mathematical analysis

Age, Sex, and Head Position Effects on Swallowing Accelerometry and Sounds

Accelerometry (the measurement of vibrations) and auscultation (the measurement of sounds) are both noninvasive techniques that have been explored for detecting abnormalities in swallowing. The differences between these techniques and the information they capture about swallowing have not previously been explored in a direct comparison. In this study, we investigated the differences between dual-axis swallowing accelerometry and swallowing sounds by recording data from adult participants and calculating a number of time and frequency domain features. During the experiment, 55 participants (ages 18-65) were asked to complete five saliva swallows with a neutral head position and then five saliva swallows in a 'chin-tuck' position. The resulting data was processed by previously designed techniques utilizing wavelet denoising, spline filtering, and fuzzy means segmentation. The pre-processed signals were then used to calculate nine time, frequency, and time-frequency domain features for each independent signal. In addition to finding a number of features that varied with the participant's age, sex, and head position, our statistical analysis determined that the majority of our chosen features were significantly different for different transducers. We conclude that swallowing accelerometry and swallowing sounds provide different information about deglutition despite utilizing similar transduction methods

A radial basis classifier for the automatic detection of aspiration in children with dysphagia

BACKGROUND: Silent aspiration or the inhalation of foodstuffs without overt physiological signs presents a serious health issue for children with dysphagia. To date, there are no reliable means of detecting aspiration in the home or community. An assistive technology that performs in these environments could inform caregivers of adverse events and potentially reduce the morbidity and anxiety of the feeding experience for the child and caregiver, respectively. This paper proposes a classifier for automatic classification of aspiration and swallow vibration signals non-invasively recorded on the neck of children with dysphagia. METHODS: Vibration signals associated with safe swallows and aspirations, both identified via videofluoroscopy, were collected from over 100 children with neurologically-based dysphagia using a single-axis accelerometer. Five potentially discriminatory mathematical features were extracted from the accelerometry signals. All possible combinations of the five features were investigated in the design of radial basis function classifiers. Performance of different classifiers was compared and the best feature sets were identified. RESULTS: Optimal feature combinations for two, three and four features resulted in statistically comparable adjusted accuracies with a radial basis classifier. In particular, the feature pairing of dispersion ratio and normality achieved an adjusted accuracy of 79.8 ± 7.3%, a sensitivity of 79.4 ± 11.7% and specificity of 80.3 ± 12.8% for aspiration detection. Addition of a third feature, namely energy, increased adjusted accuracy to 81.3 ± 8.5% but the change was not statistically significant. A closer look at normality and dispersion ratio features suggest leptokurticity and the frequency and magnitude of atypical values as distinguishing characteristics between swallows and aspirations. The achieved accuracies are 30% higher than those reported for bedside cervical auscultation. CONCLUSION: The proposed aspiration classification algorithm provides promising accuracy for aspiration detection in children. The classifier is conducive to hardware implementation as a non-invasive, portable "aspirometer". Future research should focus on further enhancement of accuracy rates by considering other signal features, classifier methods, or an augmented variety of training samples. The present study is an important first step towards the eventual development of wearable intelligent intervention systems for the diagnosis and management of aspiration

Quantitative and Portable Instrumentation for the Screening and Assessment of Pharyngeal Dysphagia

Dysphagia, the dysfunction of swallowing, is a common complication of neurological conditions, and presents increased risk of morbidity, mortality, and may critically reduce the subject's quality of life. The early detection of dysphagia is essential to maintaining the subject's health, while accurate diagnosis of the physiological source of dysphagia is essential for successful treatment. 'Silent' dysphagia, where there are no outward symptoms, is a particular concern, as many screening processes rely on patients self-reporting difficulties. A gap exists in available instrumentation, between simple techniques, which are subjective and require experience to employ, and highly sophisticated instruments, which are invasive to the patient and resource intensive. This thesis addresses this by exploring the possibility of developing instrumentation techniques which present the potential for portable, non-invasive solutions, which are relatively inexpensive and require dramatically less expertise to employ, enabling more effective dysphagia screening procedures to be introduced to clinical practice. This thesis develops the means for measuring laryngeal motion by the use of a non-invasive throat-mounted sensor in four stages: Firstly, a mathematical and a physical model of the larynx are constructed to develop our understanding of the relationship between laryngeal motion and sensor signals; secondly, swallowing sensor data was captured from 23 healthy participants; thirdly, the data from the participants was analysed to evaluate alternative data processing techniques, and to develop an understanding of practical factors deriving from inter-personal variations in physiology; finally, a prototype instrument was constructed, based on specifications evolved from our analysis. Initial testing of the prototype instrument has demonstrated the validity of the concepts employed in its design: it is straight-forward to use, compact, portable, non-invasive, and can be used to quantitatively measure laryngeal elevation in a repeatable fashion

Effects of liquid stimuli on dual-axis swallowing accelerometry signals in a healthy population

<p>Abstract</p> <p>Background</p> <p>Dual-axis swallowing accelerometry has recently been proposed as a tool for non-invasive analysis of swallowing function. Although swallowing is known to be physiologically modifiable by the type of food or liquid (i.e., stimuli), the effects of stimuli on dual-axis accelerometry signals have never been thoroughly investigated. Thus, the objective of this study was to investigate stimulus effects on dual-axis accelerometry signal characteristics. Signals were acquired from 17 healthy participants while swallowing 4 different stimuli: water, nectar-thick and honey-thick apple juices, and a thin-liquid barium suspension. Two swallowing tasks were examined: discrete and sequential. A variety of features were extracted in the time and time-frequency domains after swallow segmentation and pre-processing. A separate Friedman test was conducted for each feature and for each swallowing task.</p> <p>Results</p> <p>Significant main stimulus effects were found on 6 out of 30 features for the discrete task and on 5 out of 30 features for the sequential task. Analysis of the features with significant stimulus effects suggested that the changes in the signals revealed slower and more pronounced swallowing patterns with increasing bolus viscosity.</p> <p>Conclusions</p> <p>We conclude that stimulus type does affect specific characteristics of dual-axis swallowing accelerometry signals, suggesting that associated clinical screening protocols may need to be stimulus specific.</p

A Preliminary Investigation of Whether High Resolution Cervical Auscultation Signals Present Variations Between Thin Liquid Barium and Water Swallows

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 overt signs of dysphagia such as coughing. Though quick and convenient, bedside screening 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 been investigated in conjunction with videofluoroscopy exams performed using barium boluses. An HRCA-based bedside screening is highly desirable to expedite initial dysphagia diagnosis and overcome all drawbacks of current pass/fail screening tests. However, all research conducted using HRCA in dysphagia is based on thin liquid barium boluses and thus not guaranteed to provide valid results for water boluses. If HRCA signals show no significant differences between water and thin liquid barium boluses, then the same algorithms developed from thin liquid barium can be directly applied with water. This study investigates the similarities and differences between HRCA signals from thin liquid barium swallows and 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 no systematic difference between the HRCA signals of thin liquid barium swallows and water swallows. While no systematic difference exists, the evidence of complete conformity between HRCA signals of both materials was inconclusive. These results must be validated further to demonstrate similarity between the HRCA signals of thin liquid barium swallows and water swallows

Noninvasive Dynamic Characterization of Swallowing Kinematics and Impairments in High Resolution Cervical Auscultation via Deep Learning

Swallowing is a complex sensorimotor activity by which food and liquids are transferred from the oral cavity to the stomach. Swallowing requires the coordination between multiple subsystems which makes it subject to impairment secondary to a variety of medical or surgically related conditions. Dysphagia refers to any swallowing disorder and is common in patients with head and neck cancer and neurological conditions such as stroke. Dysphagia affects nearly 9 million adults and causes death for more than 60,000 yearly in the US. In this research, we utilize advanced signal processing techniques with sensor technology and deep learning methods to develop a noninvasive and widely available tool for the evaluation and diagnosis of swallowing problems. We investigate the use of modern spectral estimation methods in addition to convolutional recurrent neural networks to demarcate and localize the important swallowing physiological events that contribute to airway protection solely based on signals collected from non-invasive sensors attached to the anterior neck. These events include the full swallowing activity, upper esophageal sphincter opening duration and maximal opening diameter, and aspiration. We believe that combining sensor technology and state of the art deep learning architectures specialized in time series analysis, will help achieve great advances for dysphagia detection and management in terms of non-invasiveness, portability, and availability. Like never before, such advances will enable patients to get continuous feedback about their swallowing out of standard clinical care setting which will extremely facilitate their daily activities and enhance the quality of their lives