| Abstract: | 吞嚥障礙是高齡社會的一大課題，從嘴唇的口匝肌至食道下擴約肌間任何一部分發生問題可能導致吞嚥障礙，其原因可分為：(1)食道前之吞嚥障礙 (pre-esophageal dysphagia)：大部分發生於經或肌肉病變，如腦中風、頭部外傷、退化性疾病、皮肌炎(dermatomyositis)、重症肌無（myasthenia gravis）、肌肉萎縮（muscular dystrophy）、小兒麻痺症(bulbar poliomyelitis)或其他腦經中樞病灶等。(2)食道之吞嚥障礙(esophageal dysphagia）。口、、食道手術後或正常的化也可能會出現吞嚥方面的問題，且引起併發症並增加死亡。吞嚥障礙患者於經損傷後，下頜舌骨肌(mylohyoid)及甲舌骨肌(thyrohyoid)因缺乏經支配而呈現無況，造成舌骨上抬延遲，進而使舌喉肌(hyolaryngeal)無法將會厭軟骨蓋住呼吸道，將容導致吸入性肺炎。吞嚥障礙的評估與檢查對於病人的後續處、預後與醫支出等均會產生重大的影響，因此早期且正確地評估與檢查吞嚥障礙的病患，從而給予適當的處置，實為床吞嚥健訓必要之課題。吞嚥障礙治方法甚多，而電激治吞嚥障礙與健吞嚥肌群是近床治師所普遍採用之治策；雖然此治策在床大運用，但是其治及健成效仍然未有充分床實證研究證實其成效。另外，市售之 VitalStim 吞嚥障礙治儀所設計之電極係針對食道肌群進電激與傳統治吞嚥障礙之吞嚥肌群(頰肌、咬肌、舌骨上肌、舌骨下肌及會厭肌)電激部位一致，而且未提出足夠床實證研究據證實優於傳統吞嚥障礙治方法。因此，VitalStim 吞嚥障礙治儀所宣稱之治成效人質疑。爰此，本研究之目的為突破上述改善中風病患吞嚥障礙與吞嚥肌群健訓之瓶頸，設計開發吞嚥肌群健訓用電激經輔具，並進床應用驗證。本研究為一計畫，首先開發一套「吞嚥肌群健訓電激經輔具」，硬體設計製作包含吞嚥電激模組、微電腦處模組、無線傳輸模組、EMG模組及電源控制及系統態顯示模組等。在韌體程式開發及軟體設計方面，將開發吞嚥電激設定程式、吞嚥電激控制程式、無線傳輸控制程式及設計使用者資管介面等四部份。吞嚥電激系統整合與功能測試後也將進中風病患吞嚥障礙床應用實驗與吞嚥肌群健訓效果測試評估。本研究之完成除將開發一套兼具位化、無線傳輸、輕薄短小、可攜式等功能特色於一體之「吞嚥肌群健訓電激經輔具」，並針對吞嚥肌群(頰肌、咬肌、舌骨上肌、舌骨下肌及會厭肌)設計符合吞嚥機制之經電激模式，以提供床中風病患吞嚥障礙床應用實驗與使用於健訓吞嚥肌群。另外，床應用實驗結果將可作為健治策選擇及治處方之考。
Dysphagia is an important issue among the aging, and any part from to esophagus have abnormalities will cause dysphagia. Dysphagia contributes significantly to mortality and morbidity. The types of dysphagia includes: (1) pre-esophageal dysphagia: usually population of neurological disorders, such as stroke, head injury, degeneration disease, dermatomyositis, myasthenia gravis, muscular dystrophy, bulbar poliomyelitis or others CNS disease will have pre-esophageal dysphagia; (2) esophageal dysphagia. Swallowing physiology in dysphagia are delayed initiation of the pharyngeal swallow and reduced strength of the swallow characterized by reduced excursion of the hyolaryngeal complex and resultant residues in the pharynx 21. Penetration (passage of the bolus into the entrance to the airway, just above the vocal cords) and aspiration (passage of the bolus into the airway below the vocal cords) is a risk associated with both of these abnormalities. However, research has failed to demonstrate more than transient effects with this technique. Interventions for weak pharyngeal swallows typically involve performing swallows of increased effort. In considering these clinical approaches to swallowing rehabilitation, it seems reasonable to propose that neuroprostheses could be utilized both for priming afferent pathways for swallowing and to enhance the contractile force of muscles responsible for pharyngeal swallow strength and hyoid excursion. Therefore, the electrical stimulation-based swallowing rehabilitation neuroprotheses to breakthrough the bottleneck of the dysphagia patient’s restoring swallowing function and rehabilitation of swallowing muscle will be developed. The aim of this research is to develop electrical stimulation-based swallowing rehabilitation neuroprotheses, the component of hardware design includes swallowing function restoring electrical stimulation module, microcontroller module, Bluetooth transmitter, electromyography (EMG) module, status display module and power supply module. The firmware programmer and software includes swallowing function restoring electrical stimulation parameter selection programme, swallowing function restoring electrical stimulation module control programme, Bluetooth transmission programme and user administration interface. Once the prototype of the electrical stimulation-based swallowing rehabilitation neuroprotheses were developed, system integration and validation test will be performed. This research project will be the first time to successfully integrate the electrical stimulator, Bluetooth technology for swallowing function restoring. In addition, such innovation will make a significant contribution to promoting rehabilitation industry, and widespread application on clinical treatment, enhancing the dysphagia’s functional capability. |
