所謂的吞嚥障礙，是指進食困難，常見於神經功能異常患者，如中風及巴金氏症患者。隨著台灣地區老化的加速，吞嚥障礙的問題亦日顯嚴重。治療吞嚥障礙前，評估是十分重要的。電視螢光攝影檢查，是吞嚥障礙的標準檢查，但是由於它的輻射暴露及昂貴價格，使得在臨床上的實用性受限，也無法為經常性的生物回饋訓練所用。吞嚥牽涉一連串口部及咽部動作，需要複雜的神經動作統合，才得以完成。在吞嚥評估與治療方面，雖有一些非侵犯性的系統零星地被提出，但可能由於個體間差異大，無法正確偵測吞嚥反射時間，亦無法做電刺激迴授控制，使得應用受限。肌電圖可測得吞嚥動作，動作感測器可測得吞嚥解剖位置相對的動作。本研究的目的設計一套創新的吞嚥評估與治療系統。測得肌肉電生理訊號和甲狀軟骨的移動情況，當作生物回饋輔助治療的資訊，與電刺激輔助治療之迴授訊號之依據，期望能藉這些輔助設計，加速吞嚥功能之回復。本研究的電刺激系統採新式智慧型混合式刺激，協助觸發吞嚥反射。
吞嚥評估平台是利用表面肌電圖儀及微小化的三軸加速規，來偵測口部、下頷與咽喉的活動情形。表面肌電圖電極置於舌下肌，可測得肌肉的活動；加速規貼附於甲狀軟骨上方，可量測喉頭上抬的加速度，並藉兩者數值而求得吞嚥反射時間，本系統可同步記錄電刺激前與電刺激中的肌電圖訊號。藉舌下肌表面肌電訊號與喉頭上抬的加速度，自動啟動或終止刺激。次閥值電刺激可在不同吞嚥時期施以電刺激。本研究提出並驗證一創新的電刺激方法假設。舌下肌活化時, 此系統將自動開啟電刺激。喉頭上抬數秒後，病人吞嚥作完成，此系統自動關閉。與傳統電刺激比較，我們設計的自動化系統能有效減少過度與過久的電刺激，不但較有效率，並能增患者之舒適度。此外，這些量化的數值，可用來評估吞嚥功能，也可在生物回饋治療時，轉為視聽覺之刺激源。虛擬實境式的生物回饋治療，藉所呈現的即時動畫特效，能增強病人的動機，而得到更好的訓練效果。
在本先期研究結果發現，本研究之吞嚥功能評估、生物回饋、混合式電刺激系統，已被證實可以縮短吞嚥反射、降低病患嗆咳的發生，並促進吞嚥功能之改善。同時，並相信此評估及混合式電刺激系統，不論是施以對巴金森氏症、中風或是其他神經缺陷引起的吞嚥障礙族群，都將有所裨益。

Dysphagia, difficulty in eating, especially in stroke survivals has become a severe clinical problem due to the increasing aging population in Taiwan. Although clinical usage of videofluorography provides clinically relevant assessment for all phases of swallowing, its radiation exposure and high cost have hindered it from routine clinical use and for biofeedback application. There is clear evidence that swallowing is a muscular activity that requires the complex sensory-motor integration of mouth and larynx movement. A few of non-invasive systems have been proposed but only lead to limited applications due to unreliable detection of swallowing action. The swallowing movement can be detected from electromyogram (EMG) or from motion detection sensors attached to anatomic markers related to swallowing movement. The aim of this study is to develop an innovative evaluation and treatment system for dysphagia which utilizes surface EMG of submental muscle together with movement of thyroid cartilage for the evaluation and feedback information for the application of biofeedback or electrical stimulation (ES) to assist the swallowing function. In this study, ES system can be performed by the concepts of hybrid activation for potential mechanism of potentiation and triggered swallow reflex.
We first designed an evaluation platform, including sEMG (surface electromyogram) and one miniature tri-axial accelerometer, for assessing the swallowing function. The activity detected by muscle activity from sEMG of submental muscle and the lifting of thyroid cartilage recorded by the accelerator can be used for deriving triggering time. Furthermore, a hybrid activation system which can measure the sEMG before and during ES was established. The sub-threshold ES can be applied at varied phases of swallowing. Novel way of ES was proposed and validated in this study, which ES can be initiated when tongue base is activated followed by a major synchronous stimulation while the lifting of laryngeal perceived. The EMG and acceleration signals acquired can also serve as a biofeedback training protocol. The proposed dysphagia assessment, biofeedback training, and ES-trigger assisted systems have been proven to shorten the triggering time, reduce occurrence of aspiration, and improve swallowing comfort in pilot clinical trials. It is believed this integrated assessment and ES-assisted swallowing induced by hybrid muscle activation would benefit wide ranges of dysphagia due to stroke, Parkinsonism, and other neurological deficits.

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