A New System to Measure Jaw Opening Force and Speed: Apply in Aging and Stroke, and Correlate to Anterior Tongue Pressure and Swallowing-Respiration Coordination

Background: Jaw-opening force(JOF) and jaw-opening speed(JOS) are related to dysphagia in aging and stroke. Studies demonstrated that JOF strengthening had increased hyoid elevation and upper esophageal sphincter opening during swallowing in elderly, and decreased aspiration in dysphagic stroke patients after high JOS training. However, the measurements of JOF and JOS were not found on a single tool. Furthermore, the JOF, JOS, ratio of anterior tongue pressure(ATP) to JOF were not yet correlated to the parameters of swallowing-respiration coordination(SRC) that neither in normal controls nor in post-stroke patients. Moreover, JOF strengthening effects on SRC in stroke was not found. Aims: 1. To develop an JOF and JOS measurement tool with an automatic analysis software; 2. To define the JOF and JOS in different age groups; 3. To define the JOF and JOS at follow-up in subacute stroke patients; 4. To define the JOF and JOS in subacute stroke patients with and without NG tube feeding; 5. To test the effects of adjunctive JOF strengthening in subacute stroke patients who needed NG tube feeding; 5. To identify the correlation of JOF and JOS to the parameters of SRC detected by non-invasive system. First study year, a new assessment tool with two modules (modes) to measure the JOF and JOS will be set-up based on Biopac system. An automatic analysis software system based on LabView will be completed after data collected. The outcomes measurements, including the JOF, JOS, ATP, ratio of ATP/JOF and SRC will be recorded in 40(20males/ 20females) normal non-dysphagic controls, aged 20-40 y/o. Second study year, same outcomes measurements as first year will be collected in 60(30males/ 30females) non-dysphagic controls, aged 40-80 y/o. Together with the data collected in first study year, three age groups will be analyzed and compared. Third study year, 75 post-stroke patients, aged 20-80 years old, will be recruited for the outcome measurements when admitted to Rehabilitation Department within first week and follow-up 2 weeks later. The comparison within stroke patients will be (1) NG tube: yes v.s. no; (2) NG tube removed at follow-up: yes v.s. no; (3) adjunctive JOF strengthening: yes v.s. no. Anticipatory results: (1) A two modules new jaw movement measurement tool with an automatic analysis system will be completed. (2) Of normal controls, the youngest age group will have greater JOF, JOS, and ratio of ATP/JOF than the middle and oldest age groups, and the oldest age group will be the least of TOF, JOS, and ratio of ATP/JOF. (3) The subacute post-stroke patients without NG tube feeding at admission to Rehabilitation Department will have greater JOF, JOS, and ratio of ATP/JOF than patients with NG tube feeding. Upon the follow-up after two weeks, the adjunctive JOF strengthening group and the NG tube removed group will have greater JOF, JOS, and ratio of ATP/JOF than the tube un-removable group. JOF, JOS, and ratio of ATP/JOF will show positive correlation with parameters of oropharyngeal-SRC. (4) Convolutional Neural Network(CNN) for classification the groups of dysphagia and SRC.

Project ID:PB10901-1815
External Project ID:MOST108-2221-E182-016-MY3