AspiRATE study: Development of new technology to assess swallow safety
Research type
Research Study
Full title
The AspiRATE study: a proof of concept assessment of a novel intervention to acoustically detect silent aspiration in patients with acquired dysphagia.
IRAS ID
218224
Contact name
Sue Pownall
Contact email
Sponsor organisation
Sheffield Teaching Hospitals NHS Foundation Trust
Duration of Study in the UK
0 years, 9 months, 13 days
Research summary
Research Summary
Dysphagia (disordered swallowing) is a symptom experienced by many different patient groups - for example stroke, cancer, brain injury. It can lead to aspiration (penetration of food/fluid/secretions into the airway) which can result in chest infection, choking and/or pneumonia, which has a significant mortality rate.
It is therefore important to know if someone is aspirating, as the diet or feeding methods can be changed to reduce the risk of aspiration and its complications.
Aspiration may trigger a protective cough reflex to clear the material, but in some people this protective mechanism is absent, and they have no indication that they have aspirated; this is called silent aspiration.
Currently most patients who are thought to have dysphagia are assessed at bedside by clinical assessment – those who may be aspirating silently require further, more objective assessment. The assessments for this currently are videofluoroscopy (video X-ray of the swallow process) and FEES (flexible endoscopic evaluation of swallowing).
Some patients – for example those with cognitive challenges such as learning difficulty or dementia, or those who are bed bound in nursing homes – are unable to access these swallow safety assessments. These patients are therefore receiving less accurate, non-technical swallow assessment which are subject to human error and may therefore result in them being at greater risk of aspiration (if aspiration is missed) or receiving unnecessary medical interventions such as PEG tube placement (if aspiration is incorrectly judged to be happening).This study will look at the use of new equipment which we are developing to assess swallow safety in patients with swallowing problems (dysphagia).
Summary of Results
Aim of the study This proof-of-concept trial aimed to establish whether silent aspiration can be detected in patients with dysphagia (swallowing difficulties), using a microphone array attached to the neck (to capture acoustic respiratory changes), pulse oximetry (to detect reduction in blood oxygen levels) and respiratory rate analysis, with data combined and analysed via post-capture signal processing techniques.
The project aimed to develop equipment and signal processing algorithms to a point where a novel intervention was established that allows semi-automated detection of safe versus unsafe (aspiration) swallows. The intervention was trialed in patients with dysphagia within standard videofluoroscopy clinics under clinical supervision. There was ongoing development of the intervention and signal processing algorithms during this process. Public and patient involvement work fed back into the design process.
Recruitment:
The study recruited 25 patients.
Following segmentation, a total of 384 swallowing events were identified, 330 events were available for analysis following exclusion of some cases because of background noise in the recording.
Main Findings:
· The study found a significant difference in sounds between those swallows where aspiration occurred and where aspiration was absent.
· This technique and algorithms have shown promise, thus we are now looking to refine the equipment array and secure funding for a full scale trial.REC name
North West - Preston Research Ethics Committee
REC reference
18/NW/0236
Date of REC Opinion
14 May 2018
REC opinion
Further Information Favourable Opinion