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Bioengineering aids recovery for swallowing disorders

University of Canterbury researchers at the Rose Centre for Stroke Recovery and Research have revealed an innovative new treatment for people with swallowing impairments.

Swallowing impairments, also known as dysphagia, impact on people affected by stroke or other neurological disorders. The new treatment will make a big difference to potentially thousands of lives, says Professor Maggie-Lee Huckabee, Director of the Rose Centre.

“Food and drink sustain us – physiologically, nutritionally, socially and culturally. They are critical to maintaining health, but equally valued for the human engagement that emerges from sharing a drink with a friend, or a meal with family.

“Individuals who struggle with eating and drinking can develop chest infections or require feeding through a tube, and consequently experience exclusion from many social engagements.”

New thinking brings solution

Historically, swallowing has been considered a reflex, and thus amenable only to rehabilitation programmes that focus on increasing strength of muscles in the throat. More recent research suggests that the cortex – the thinking part of the brain – plays a significant role in modulating this ‘pseudo-reflex’.

This new understanding led UC’s researchers to approach the problem differently, using bioengineering application to facilitate recovery. Bioengineering applies engineering principles to biological systems, and can include elements of electrical and mechanical engineering, computer science, chemistry and biology. This approach is central to the Rose Centre’s clinical research programme.

The Biofeedback in Strength and Skill Training (BiSSkiT) software-driven treatment protocol was developed through a collaboration between clinical researchers and medical bioengineers; including Professor Huckabee and Esther Guiu Hernandez at the Rose Centre, and Associate Professor Paul Gaynor and Adjunct Professor Richard Jones, in UC’s Department of Electrical and Computer Engineering. Rather than focusing on strengthening, the innovative skill training protocol in the BiSSkiT software takes a different approach.

“Swallowing relies on precision and speed in movement, not strength,” says Professor Huckabee.

“With BiSSkiT, a small device that measures the electrical activity of muscles involved in swallowing displays that information through the software as a waveform on a computer screen. When patients see what is happening, they can then improve precision in motor control of swallowing by using the waveform to hit a randomly placed ‘target’ on the computer screen.”

Research at the Rose Centre suggests very positive outcomes following two weeks of skill training in patients with Parkinson’s disease. Significant improvements were seen across a small group of ten patients in speed and efficiency of swallowing, which carried over to improvement on quality of life measures. Further research is under way, which supports the research education of four UC PhD students.

Approved for clinical use

The end of 2016 marked a major step in development of the software, thanks in part to UC’s global connections. Considered a Class 1 medical device, the software has recently received CE mark approval, so is now approved for sale to the European market for clinical use. Further approvals have been granted for sales in New Zealand and in the coming year, approvals will be sought for Australasian and North American markets, potentially helping thousands of people with swallowing disorders.

“This development offers people with swallowing disorders a completely new opportunity to improve their quality of life,” Professor Huckabee says.

The skill training protocol is being evaluated through international trials in a larger group of patients with Parkinson’s disease, as well as others with motor neurone disease and Huntington’s disease. In addition to the novel skill training approach, there is also a strengthening protocol if the traditional approach to muscle strengthening is required. Other UC students are developing a test based on the software that will help clinicians determine which type of training is required.

Changing brains, changing lives

Housed at St George’s Medical Centre, the Rose Centre sees patients from around Aotearoa New Zealand, Australia and the United States of America, and integrates clinical diagnostic and rehabilitation services for swallowing impairment with the development and execution of translational research. Professor Huckabee says the keystone of translational research at the centre is patient engagement.

“The brain is a remarkably adaptable organ and because of the way swallowing is controlled by the brain, there is great potential for rehabilitation.

“The key to recovery is finding a way for patients to visualise the very abstract task of swallowing, which is exactly what the BiSSkiT software does. If they can see it, they are much more likely to be able to change it.”

The focus on patient engagement has recently been formalised with the development of the PERC programme – Patients, Engineers, Researchers and Clinicians. Funded by the Farina Thompson Charitable Trust, this unique programme brings together all partners in the collaborative development of translational research, which applies findings from basic science to enhance human health and wellbeing. The PERC programme at the Rose Centre will provide a platform for development of several other projects that provide visual feedback of other aspects of swallowing.

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