A Therapeutic Wearable Sensor for Dysphagia

Dysphagia or difficulty swallowing disproportionately affects the elderly. Along with normal age-related deterioration of swallowing muscles and connective tissue, 45% of individuals with Alzheimer’s dementia (AD) exhibit swallowing dysfunction. The loss of coordinated swallowing leads to two major sequelae. The first is aspiration, which can lead to pneumonia, pneumonitis, and death. The second is poor nutrition leading to muscle wasting and worsening frailty. While the modification of food and liquid consistency to better match a patient’s swallowing capabilities is popular, there is little evidence to suggest that this practice leads to meaningful clinical outcomes. The current standard of care for the prevention of aspiration is behavioral swallowing therapy with the goal of improving function of the structures critical for safe swallowing. A key goal of swallowing rehabilitation is for patients to continue swallowing spontaneously once discharged from therapy to stabilize function and prevent deterioration. New and compelling evidence generated in our group shows the positive effect of adding a new cross-system training approach that optimizes the point at which swallowing occurs in the mid-to-late expiration period of the respiratory cycle. This optimal pattern imparts physiological advantages for airway closure and pharyngeal clearance mechanisms resulting in a significant reduction in aspiration. This approach, using a large, wired technology system for recording and training swallowing and respiratory movements, has been shown to distinguish safe from unsafe swallows relative to respiratory phase. However, carry over into real life swallowing is impeded by the absence of available in-home training and practice methods that are practical, affordable and match the in-clinic training paradigm. Neuromuscular electrical stimulation devices (e.g. FDA-cleared VitalStimTM) have shown inconsistent clinical benefit in dysphagia especially when tested in a blinded