摘要：吞嚥障礙一直是復健醫學的重要領域，靠著正確地吞嚥功能評估及語言治 療師的訓練病人，我們解決了大部分的問題，其中『正確的評估』常是關鍵因 子。電視螢光影吞嚥檢查可以觀察整個吞嚥過程一直被當作吞嚥的黃金或標準 檢查方式。但電視螢光影吞嚥檢查有輻射線的暴露，以鋇劑而非正常食物當測 量介質，病人接受度不高的問題。超音波早在1983年就被使用於吞嚥功能評估，但都屬於研究性質，非臨床 實際應用。本研究團隊首先發展出超音波評估吞嚥功能的臨床應用模式，當舌 骨上升小於1.5cm時是高危險吞嚥障礙病人，但仍有所不足，包括：探頭和下 顎接觸不夠好，測量到的值無法當場顯現需事後計算，測量到的只有舌骨移動 距離，而無移動速度，而舌骨移動速度對是否造成吸入是重要的參數，缺乏對 舌量測資料，而舌運動對小兒吞嚥障礙及口咽癌病人之吞嚥障礙非常重要，而 此類病人越來越多。本研究的目的便是修正這些不足，以建立新的超音波評估吞嚥功能系統， 我們將利用探頭水袋來改善接觸不良的問題，藉由軟體修正及撰寫來即時顯現 量測資料，並檢驗其可靠性。本研究的第一年預計完成軟硬體的設計，並且和電視螢光錄影吞嚥檢查比 較，以確認新方法的可靠性。第二年研究我們將以60名正常人做研究，探討年 齡、食團大小，食團濃度對吞嚥生理的影響。藉此建立超音波評估吞嚥生理研 究模式。第三年我們將評估不同程度吞嚥障礙的中風病人以確認超音波在臨床 上的可行性。藉本研究我們企圖建立以超音波為基礎之吞嚥功能評估儀。
Abstract: Dysphagia is a common disorder in rehabilitation medicine. The success of treating dysphagia patients depends on the meticulous assessment and proper training by the speech pathologist. Accurate assessment of swallowing function is always the key for successful treatment of dysphagia. Videofluoroscopic examination of swallowing (VFSS) is taken as the gold standard for the evaluation of swallowing function. However, it has the disadvantage of radiation exposure, cannot be tested by the real food, and poorly accepted by the subjects.Ultrasound has been used to assess the swallowing function as early as 1983 but the previous design is still in the experimental stage rather than the clinical practice. Our research team developed a ultrasound assess swallowing function model and found that if the hyoid bone elevation less than 1.5 cm, it may indicate a high risk of dysphagia. In the previous designed ultrasound model there are still several pitfalls including improper contact of transducer and mandible in some subjects, the date obtained needing off-line analysis, no hyoid bone movement velocity, lacking of tongue movement information. Among them, hyoid bone movement velocity and tongue movement information are crucial for assessing pediatric swallowing function as well as patients with dysphagia after radiotherapy in head neck cancer, which is a common disease in TaiwanThe purpose of this work is to correct these pitfalls to establish a new designed ultrasound program to evaluate swallowing function. We will use the water bag to improve the contact of transducer to mandible, redesign the soft-wear to online display the information and adding the information of tongue movement as well as hyoid bone movement velocity. This is a three-years project. In the first year, we will finish the new-design hardware and software and compare the data obtained with those of VFSS to verify their reliability. In the second year, we will explore the swallowing strategy of normal subjects in different age, food consistency and bolus size to establish the role of ultrasound in swallowing physiology study. In the third year, we will assess the stroke patients with different severity of dysphagia to establish the role of ultrasound in clinical application in swallowing function evaluation. With the three-year project, we will establish the ultrasound based swallowing evaluation model.