JP2006263299A - Swallowing sound analysis system - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To develop a system capable of screening an erroneous aspiration from the feature of the swallowing sound of a patient having dysphagia. <P>SOLUTION: The system comprises a sensor which is attached on the skin surface corresponding to the cervix of a patient and catches the sound of opening and closing epiglottis as a feature of swallowing sound, and a sound of passing food through an opening part of an esophagus, and it analyzes obtained numerical information with time and frequency based on an electric signal from this sensor, and it can evaluate quantitatively and objectively if the erroneous aspiration of the patient is present or absent from the feature of swallowing sound at the time of pharynges. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates to impaired swallowing function such as “cannot be swallowed” or “depressed” due to dementia, long-term bedridden, tooth meshing disorder, dry mouth, aging swallowing reflex, etc. The present invention relates to an analysis system that enables screening of aspiration in which food and drink enter the trachea instead of the esophagus due to the characteristics of the patient's swallowing sound.

  In the conventional aspiration test method, morphological and functional abnormalities are detected through swallowing angiography, drinking test, repeated saliva swallowing test (RSST), and the presence or absence of aspiration or laryngeal residue is confirmed. The method of feeding has been adjusted to reduce aspiration and laryngeal residue. In particular, swallowing angiography is thought to give very useful information, but it is easy to do because it cannot be done frequently due to exposure by X-rays, and you have to ask a proper facility with equipment. I can't.

  On the other hand, in the “Drinking Test”, the possibility of aspiration is determined based on whether or not it can be drunk. It has been pointed out that there are problems to be missed.

The “Repetitive Salivary Swallowing Test (RSST)” is a palpation of the subject's larynx, which is performed as a simple and highly safe aspiration screening test. There are problems that patients cannot use.
These aspiration testing methods are said to be good methods for observing the course as an aspiration screening test, but the evaluation may differ depending on the experience and personal judgment of the clinical staff, and it is quantitative to other staff. It is also difficult to explain.

  In the conventional swallowing sound collection device (Patent Document 1), swallowing sound amplitude comparison, presence or absence of swallowing sound that appears several seconds after swallowing sound, relationship between swallowing sound and muscle contraction, respiratory state during swallowing, etc. EMG, respiration sensor, pressure sensor, bioimpedance measurement device, low frequency treatment device can be used so that it can be used for treatment. Although it is described that the diagnosis and treatment of the condition can be performed, there is a problem that some people do not aspirate even if there is no empty swallowing sound, and in the amplitude comparison of swallowing sound, the amplitude of swallowing sound detected by the sensor is It varies greatly depending on the sensor mounting state or the state of the patient's wearing site. Therefore, in order to judge the swallowing state of the patient based on the change in the amplitude of the swallowing sound, it is necessary to remove those effects, but it is easy to realize the reproducible sensor mounting in this way. is not.

Traditionally, food manufacturers have sold recommended difficult-to-swallow meals depending on the swallowing condition, but swallowing conditions may vary and vary depending on the individual patient. It is difficult to determine whether or not.
JP 2003-111748 A

  The present invention is a screening test for aspiration, which is more easily conducted than conventional techniques to determine whether the subject patient is more likely to cause aspiration. Focusing on the relationship at the time of passage to the esophageal entrance, the sound of the epiglottis, the opening of the epiglottis and the passage sound of food passing through the entrance to the esophagus are captured and analyzed to diagnose the swallowing state. .

  In the prior art, a signal indicating the start of swallowing is sent by a trigger switch, so that the collected information can be accurately analyzed. However, in the present invention, an input means for collecting swallowing sounds is attached. Detect swallowing of the epiglottis and start swallowing, and by detecting food passing sound and opening of the epiglottis, it is possible to accurately analyze the swallowing state. Even the patient's pace can be tested.

  In addition, since swallowing with nothing in the mouth, i.e. by swallowing, analysis can be performed, so patients who cannot follow the instructions or patients with dementia can hear the swallowing sound during unconscious swallowing. Collect and analyze swallowing sounds.

  By quantifying the current swallowing state according to the present invention, it is possible to eat optimally, and it is also possible to determine whether the food currently eaten is likely to cause aspiration, making it safer for patients You will be able to provide meals that meet your needs.

  The present invention is a sensor that is attached to the skin surface corresponding to a patient's neck and can capture the sound of the epiglottis, the sound of the epiglottis, and the sound of food passing through the esophageal entrance, which are characteristic of swallowing sounds. And an input means for capturing the electric signal output from the sensor, a control means for converting the electric signal into numerical information, and time-frequency analysis of the numerical information, and the sound of the epiglottis and food passing through the esophageal entrance A computing means for analyzing the relationship between the passing sound and the opening of the epiglottis, an output means for displaying the computation result, and a storage means for storing the computation result. To provide a swallowing sound analysis system comprising a device 1 having a transmission means capable of transmitting results and a device 2 having a storage means for collectively managing the calculation results and having a transmission means with the device 1 By It is intended to solve the above problems.

  By recording the characteristics of swallowing sound in the laryngeal phase as numerical information according to the present invention and quantitatively and objectively evaluating it, it does not depend on experience or personal judgment that was a problem of conventional cervical auscultation methods , Can explain to other staff. Also, unlike the conventional method of judging based on the change in the amplitude of the swallowing sound, the distribution state of the frequency component of the swallowing sound is irrelevant to the amplitude of the swallowing sound, and therefore has the advantage that it does not depend on the sensor mounting state. is there. Therefore, in the conventional method, it is difficult to determine whether the change in the amplitude of the detected swallowing sound is caused by a change in the swallowing state or a sensor attachment failure, and erroneous determination is generated. Although assumed, this can be avoided in the present invention.

The present invention is an analysis of the swallowing state in the laryngeal phase, and in particular in the field of welfare, it is not the purpose of treatment, and it is determined whether there is a possibility that the patient in front of the eye may have aspiration. In order to know, detailed information such as the movement of the mouth and throat muscles, the situation where the bolus passes through the throat is not necessary.
In addition, for patients who have a high possibility of aspiration, cold / warm / vibration stimulation is performed to improve the swallowing response. However, by knowing how much stimulation is sufficient, it is not possible to The necessary stimulus can be reduced, reducing the burden on both patients and caregivers.

INDUSTRIAL APPLICABILITY The present invention can also be used as a guideline for determining how much viscous food an elderly person or a patient with dysphagia can eat without aspiration, and reduces the burden on the caregiver.
In addition, it is possible to present a guide for determining the amount that can be eaten in a bite.

  Since there is a correlation between the tendency of aspiration to occur with aging, the relationship between the sound of the opening and closing of the epiglottis of the present invention and the sound of food passing through the esophageal entrance, this system is regularly inspected. By presenting the need for swallowing age and swallowing training, self-management can be promoted and used as aspiration prevention, and the demand for this system will continue to expand as the population ages. Is expected.

  Since the present invention can quantitatively evaluate the effects of treatment and swallowing training, it can be used for evaluation of appropriate treatment and swallowing training.

  By utilizing the present invention, a swallowing food ordering system can be constructed, and foods and meals adapted to each patient can be provided and consumed, leading to an improvement in the patient's QOL.

  In the swallowing sound analysis system of the present invention, the above-described implementation method, effects, and illustrated examples are merely examples, and are not limited. For example, the device 1 may have a configuration of a dedicated device and a personal computer. May be a single configuration having the function of the device 2 and the form is not limited as long as an equivalent function can be realized.

  The swallowing sound analysis system according to the present invention has the configuration disclosed in FIG. 1 and uses a sensor capable of collecting fine displacement, displacement speed, and displacement acceleration of the swallowing sound, for example, an acceleration sensor, on the patient's neck skin surface. Affix it with surgical tape and fix it, and collect the swallowing sound when the patient swallows. The electrical signal output from the sensor is converted into numerical information by the control means. This numerical information is subjected to time-frequency analysis by short-time Fourier transform or wavelet transform, etc., and the frequency that changes over time of the closing sound of the epiglottis, the passing sound when food passes through the esophageal entrance, and the opening of the epiglottis Then, the three sounds are identified by the amplitude ratio, and the calculation result is displayed on a monitor or the like by calculation means for analyzing the swallowing state from the time relationship of the three sounds. On this monitor, waveform information is displayed from numerical information by the control means, and calculation results and diagnosis results are displayed.

  Since the frequency of the swallowing sound signal changes with time, the characteristics of the swallowing sound can be quantitatively analyzed by performing time-frequency analysis using short-time Fourier transform or wavelet transform.

  The swallowing sound is characterized by the closing of the epiglottis, the sound of food passing through the esophageal entrance, and the opening of the epiglottis in sequence. By analyzing the temporal relationship between these sounds, the state of dysphagia was confirmed. Is done.

As is apparent from FIG. 8, the frequency band of the opening and closing sound of the epiglottis is about 10 to 400 Hz, and the frequency band of the passing sound when food passes through the esophageal entrance is 300 to 800 Hz, based on the frequency band of the opening and closing sound of the epiglottis. Wide area.
The input means used here needs to cover the sensitivity and frequency band capable of detecting the acceleration of fine vibrations of swallowing sound. Here, the acceleration sensor which is the sensor described in the embodiment of the present invention is an example and is not limited.

  The signal of the passing sound differs depending on food, but it can be identified because it has a high frequency component and has a higher amplitude than the opening and closing sound of the epiglottis.

  Since the opening / closing sound of the epiglottis and the passing sound when passing through the esophageal entrance can be identified, the swallowing start signal can be recognized, and the closing sound of the epiglottis and the passing sound passing through the esophageal entrance By detecting the time difference between open sounds of the epiglottis, it is possible to confirm the state of dysphagia, approaching the state where aspiration is likely to occur by analyzing the comparison with the initial value, the comparison with the previous value, and the variation of the time series. You can analyze whether or not.

FIG. 3 shows signal waveforms of a swallowing sound of the epiglottis (I sound), a passing sound of food passing through the esophageal entrance (II sound), and an opening sound of the epiglottis (III sound).
The time from the peak of (I sound) to the peak of (III sound) is T ₁ , the time from the peak of (I sound) to the peak of (II sound) is T ₂ , and the time from the peak of (II sound) to (III sound) the time to peak of) and T _3. By analyzing T ₂ / T ₁ (%), it is shown whether it is easy to aspirate or not.

FIGS. 4 to 6 show that (II sound) approaches (III sound), so that it becomes easy to aspirate, that is, T ₂ / T ₁ (%) increases. In healthy individuals, (I sound), (II sound), and (III sound) can be clearly recognized, but in swallowing disabled persons, (II sound) is not finished before (III sound) is emitted (III sound) (Sound) can no longer be identified, and dysphagia is analyzed.

FIG. 7 shows the result of changing the amount of water according to the age of the healthy person. Here, it can be seen that T ₂ / T ₁ (%) increases with aging. The closer to 100%, the higher the probability of dysphagia. It can also be seen that the greater the amount of food, the easier the aspiration.

In FIG. 8, the calculation result which showed the swallowing sound of the healthy person is shown as an example of the time frequency analysis result. The upper part of FIG. 8 shows the swallowing sound signal, where the horizontal axis represents time and the vertical axis represents amplitude.
The lower row shows the result of wavelet transform of the signal as a change in frequency over time, with the horizontal axis representing time and the vertical axis representing frequency.

  For patients who have a high possibility of aspiration, cold, warm, and vibration stimulation are performed on site to improve the swallowing response, but the criteria for how much stimulation is sufficient Compared to the opening and closing sounds of the epiglottis and the sound of food passing through the esophageal entrance before and after treatment, the effect of the treatment can be seen, reducing unnecessary stimulation and improving the patient's QOL To do.

Ingredients / meal physical properties such as density, viscosity, degree of deformation, adhesion, etc. are used as parameters to classify food / meal swallowing difficulty, and information on food / meal and swallowing difficulty is stored in the storage unit of the device 1 in advance. In addition, the degree of difficulty in swallowing is determined according to the analysis result of the swallowing sound, a selectable food / meal list is displayed, and the patient selects from the food / meal list and transmits it to the device 2.
Further, the information about the food / meal and difficulty of swallowing may be stored in the device 2.
In this case, the analysis result of the swallowing sound of the device 1 is transmitted to the device 2, the selectable food / meal list is received from the device 2, the list is displayed, selected, and transmitted to the device 2 again. In any case, it can be applied to a swallowing food / meal order sales system.

  The present invention can also be used in the research and development of orally ingestible foods for the elderly, dysphagia or difficult persons, and the sound of the epiglottis when the swallowing size, viscosity, acidity, temperature, etc. are changed, By comparing the relationship between the sound of the epiglottis and the sound of food passing through the esophagus entrance, objective and quantitative evaluation can be performed, and appropriate foods that are easy to swallow can be developed. it can.

  Since this invention can be utilized also in research and development of a swallowing training apparatus, an appropriate swallowing training apparatus can be developed.

It is the functional block diagram which simplified and showed the structure of embodiment of the swallowing sound analysis system. It is sectional drawing showing the site | part of various organs and a sensor mounting | wearing site | part regarding the larynx stage of swallowing exercise | movement. It is the wave form diagram which displayed the signal waveform of the swallowing sound. It is a wave form diagram which shows the signal waveform of the healthy person's swallowing sound. It is a wave form diagram which shows that the passage sound (II sound) through which food passes an esophagus entrance part is approaching the opening sound (III sound) of the epiglottis. It is a wave form diagram which shows that the passing sound (II sound) which a food passes an esophagus entrance part, and the opening sound of a epiglottis (III sound) overlap, and the probability of a dysphagia is high. The measurement result of T ₂ / T ₁ (%) when the amount of water is changed according to the age of healthy individuals is shown. An example of the detailed analysis result of the swallowing sound of a healthy person is shown.

Explanation of symbols

1 Swallowing sound collection sensor 2 Device 1
3 Device 2
4 Input means 5 Control means 6, 12 Arithmetic means 7, 13 Storage means 8 Output 9, 11 Communication means 10 Network 21 Epiglottis 22 Sensor mounting part 23 Airway 24 Esophageal 25 Food

Claims (8)

Attached to the skin surface corresponding to the patient's swallowing sound-capable neck, can capture the sound of the epiglottis, the opening of the epiglottis, and the passing sound when food passes through the esophageal entrance A sensor,
Input means for capturing an electrical signal output from the sensor;
Control means for converting the electrical signal into numerical information, and time-frequency analysis of the numerical information to analyze the relationship between the closing sound of the epiglottis and the passing sound when food passes through the esophageal entrance, and the opening of the epiglottis An apparatus 1 having a calculation means, an output means for displaying the calculation result, a storage means for storing the calculation result, and a transmission means capable of transmitting the calculation result to the apparatus 2 via a network;
Having a storage means for collectively managing the calculation results;
An apparatus 2 having a transmission means with the apparatus 1;
A swallowing sound analysis system characterized by comprising.   The swallowing sound analysis system according to claim 1, further comprising an analysis unit that distinguishes the sound of the epiglottis, the passing sound when the food passes through the esophageal entrance, and the opening of the epiglottis by time-frequency analysis.   An analysis unit is provided for analyzing a temporal relationship of three sounds including a closing sound of the epiglottis, a passing sound when food passes through the esophageal entrance, and an opening sound of the epiglottis, and evaluating a dysphagia. Item 2. The swallowing sound analysis system according to Item 1.   The calculation results analyzed according to claim 2 and claim 3 are stored as needed, and the relationship between the sound of the epiglottis and the sound of food passing through the esophageal entrance and the sound of the epiglottis is determined as the previous state or initial value. The swallowing sound analysis system according to claim 1, wherein a swallowing state is evaluated by detecting a change from the state and a time-series variation.   The aging-related swallowing disorder is detected by detecting the feature that the passing sound when the food passes through the esophagus approaches the sound of the epiglottis with aging, and evaluating dysphagia associated with aging. Swallowing sound analysis system.   Based on the physical properties of the food, the characteristics of whether the passing sound when the food passes through the esophageal entrance is approaching the sound of the epiglottis are detected, and the patient's swallowing condition and whether the food can be swallowed are evaluated. The swallowing sound analysis system according to claim 1.   The information on the ingredients and meals sent from the apparatus 2 is stored in advance in the storage unit of the apparatus 1, and the information on the optimum ingredients and meals is output by using claims 1 to 6. The swallowing sound analysis system according to claim 1, wherein the selected information can be transmitted to the device 2 and transmitted to the device 2.   The apparatus 1 transmits the analysis results according to claims 1 to 6 to the apparatus 2, and the apparatus 2 selects the optimum food / meal using the analysis results sent from the apparatus 1, and the food・ Meal information is transmitted to the device 1, so that the device 1 can output the food / meal information to the output means, select from the food / meal information, and transmit the selected information to the device 2. The swallowing sound analysis system according to claim 1, wherein

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