Modelling of Pharyngeal Laryngeal Effectiveness
- Conditions
- Swallowing Disorders
- Interventions
- Other: Swallowing evaluation
- Registration Number
- NCT06014710
- Lead Sponsor
- University Hospital, Toulouse
- Brief Summary
The purpose of this study is to collect the signals of pharyngeal laryngeal activity through five non-invasive sensors (microphone, accelerometer, surface electromyography (EMG), nasal cannula and oximeter) in order to identify indicators of functional efficiency of swallowing, protection of the lower airways and phonation.
440 patients (subjects with swallowing disorders), spread over 4 centers and 80 healthy subjects spread over 2 centers will be recruited for the study in an interventional research study involving the prospective, multicentric and longitudinal.
Pharyngolaryngeal effectiveness will be measured from 6 indicators identified by examinations or reference tests grouped into 3 functions:
* swallowing: pharyngeal transport capacity (Yale Residue) and Penetration Aspiration Scale (PAS) rated by videofluoroscopy of swallowing (VFS) or flexible endoscopic evaluation of swallowing (FEES);
* airway protection: cough trigger (citric acid test) and cough power (peak expiratory flow);
* phonation: vocal efficiency (maximum phonation time) and velar efficiency (nasal scores).
The signals obtained from the 5 sensors will be annotated. Stochastic modelling based on hidden Markov models will be used initially and followed by the implementation of deep neural networks to model indicators. For the complication's prediction algorithm, deep neural networks will also be used to evaluate signal-based methods.
The expected benefits are to obtain automated recognition of pharyngeal-laryngeal effectiveness to diagnose swallowing disorders using objective and quantifiable indicators, non-invasive devices, to assess the severity of these disorders and to identify the risk of complications.
- Detailed Description
The process of swallowing is complex and difficult to assess because of its dynamic nature, the lack of specialists and the technical means necessary for its exploration. Thus, the majority of patients with swallowing disorders do not benefit from any specific instrumental evaluation yet essential to the diagnosis of different types of disorders. The precise analysis of the deficit and its causes makes it possible to guide the choice of adaptation or rehabilitation strategies, with the aim of preventing the risk of complications, mainly nutritional (malnutrition) and respiratory (pneumonia). The development of new, more accessible diagnostic techniques would improve access to care for this population. The purpose of this study is to collect the signals of pharyngeal laryngeal activity through five non-invasive sensors (microphone, accelerometer, surface EMG, nasal cannula and oximeter) in order to identify indicators of functional efficiency of swallowing, protection of the lower airways and phonation. Modelling the mechanisms of pharyngeal-laryngeal efficacy through the use of artificial intelligence would provide an automated assessment of disorders and prognostic risk of complications.
Primary objective: From the signals of 5 non-invasive sensors, model a multidimensional scale of pharyngeal-laryngeal efficiency measuring the 3 main functions of pharyngeal-larynx: swallowing function (evaluated by pharyngeal transport and closure of the larynx) ; airway protection function (evaluated by cough reflex and cough power); phonation function (evaluated by voice and velar efficiency)
Secondary Objectives:
* Develop a diagnostic model of different physiopathological mechanisms of swallowing
* Determine an algorithm that can predict the severity of these disorders based on pharyngeal efficacy indicators
* Determine an algorithm capable of predicting the risk of complications from swallowing disorders, based on modelling pharyngeal effectiveness (primary objective) and clinical data
Study design: An interventional research study involving the prospective, multicentric and longitudinal human person to develop a scale of pharyngeal-laryngeal effectiveness measured from signals from 5 non-invasive sensors. The signals will be collected from each participant using the sensors (microphone, accelerometer, nasal cannula, surface EMG and oximeter). Algorithms will be developed from these signals to predict different indicators of pharyngeal-laryngeal efficiency measured by baseline tests. The study population will include patients with swallowing disorders (to identify pathological signal patterns) and healthy volunteers (to identify non-pathological physiological patterns of swallowing mechanisms).
440 patients (subjects with swallowing disorders), spread over 4 centers and 80 healthy subjects spread over 2 centers will be recruited for the study.
Research procedures
For patients with swallowing disorders:
During a hospital visit as part of their care pathway, patients with the criteria will be offered to participate in the research protocol. The subjects who have given their written consent will then carry out their assessment of the swallowing performed according to the available reference examination (videofluoroscopy or nasofibroscopy). In parallel, they will carry the following sensors: microphone, accelerometer, surface electromyography, nasal cannula and pulse oximeter. For research purposes, the subjects will also perform a cough and phonation test and questionnaires. Other data used are collected as part of routine care.
At the end of the assessment, the patient will receive management advice based on the reference exams and his medical record.
Each subject (or his caregiver) will be contacted by phone once a month for 6 months to monitor the occurrence of complications, The end of study visit at 6 months will be done either at the hospital with a new examination of the swallowing, by telephone, as medically indicated.
For healthy volunteers:
Only one visit is planned for the evaluation of the swallowing with the examination of nasofibroscopy and the installation of the sensors. The procedures (tests, examinations and questionnaires) will be identical to the data collection of the initial visit of patients with swallowing disorders)
Duration of the research: The first patient will be included from 2023. The inclusion period is 18 months. Patients will be monitored for 6 months (+/- 2 months) after inclusion Healthy volunteers will have one visit (estimated time: 2H) The total duration of the clinical study is expected to be 26 months
Data analysis: The characteristics of the subjects as well as the various clinical indicators of swallowing and their evolution during monitoring will be described. Development and validation algorithms to model the various pharyngo-laryngeal effectiveness indicators and predictive algorithms of swallowing disorders will be produced using statistical approaches and also using machine learning. The signals obtained from the 5 sensors will be annotated. The signals will be standardized and synchronized to allow the modelling of the sequences corresponding to the following events: swallowing of food, saliva, cough, throat clearing, speech, wet voice. Stochastic modelling based on hidden Markov models will be used initially and followed by the implementation of deep neural networks to model indicators. For the complication's prediction algorithm, deep neural networks will also be used to evaluate signal-based methods.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 520
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Experimental arm Swallowing evaluation Patients with swallowing disorders and healthy volunteers
- Primary Outcome Measures
Name Time Method Swallowing safety Baseline Swallowing Safety : the Penetration Aspiration Scale (PAS) rated by VFS (videofluoroscopy of swallowing) or FEES (flexible endoscopic evaluation of swallowing). The Penetration Aspiration Scale (PAS) is a 8-point scale ranging from 1 to 8 : 1 is considered the best and 8 the worst
Voice efficiency Baseline Vocal efficiency evaluated by maximum phonation time on the letter "a" held in seconds
Velar efficiency Baseline velar efficiency evaluated by assessment of the sentences without nasal phonemes and sentences with nasal phonemes
Lung defense reflex Baseline Cough trigger reviewed by citric acid test
Power of cough Baseline Cough power rated by peak expiratory flow in litres per minute
Swallowing efficacy Baseline Swallowing efficacy : pharyngeal transport capacity (assessed by the Yale Pharyngeal residue severity rating scale). The Yale Pharyngeal residue severity rating scale (YPRSRS) is a 5-point scale ranging from I (none) to V (severe).
- Secondary Outcome Measures
Name Time Method Self-assessment of severity of swallowing disorders Baseline Severity of swallowing disorders measured by patient self-assessment with visual analogic scale ranging from 1 = no severity to 10 = very severe.
General quality of life assessment Baseline and 6 months Quality of life assessed by euroqol 5-dimension 5-level questionnaire (EQ-5D-5L). The EQ-5D-5L is questionnaire with 5 items from 1 to 5 : 1 is considered the best and 5 the worst and a scale from 100 " the best health you can imagine " to 0 " the worst health you can imagine ".
Quality of life assessment for patients with cancer Baseline and 6 months Quality of life assessed by Cancer Quality of life questionnaire (CLQ-C30) for patients with cancer. The CLQ-C30 questionnaire is composed of 30 items.
Severity of swallowing disorders assessed by oropharyngeal swallowing effectiveness scale Baseline Severity of swallowing disorders measured by oropharyngeal swallowing effectiveness scale from baseline studies (FEES or VFS). The OroPharyngeal Swallowing Efficiency (OPSE) is a subjective evaluation of the severity expressed as a percentage of the bolus actually passing through the esophagus according to the formula:
100% (of the bolus introduced into the mouth) - X% of the bolus having gone astray - Y% of the bolus stagnating in the form of residue
Trial Locations
- Locations (4)
University hospital of Bordeaux
🇫🇷Bordeaux, France
University Hospital of Toulouse
🇫🇷Toulouse, France
University hospital of Rouen
🇫🇷Rouen, France
University hospital of Tours
🇫🇷Tours, France