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Quantitative classification of pediatric swallowing through accelerometry
Celeste Merey1, Azadeh Kushki, Ervin Sejdić
1Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada. celeste.merey@utoronto.ca
Insights
Dual-axis accelerometry shows promise for non-invasively detecting unsafe swallows in children with dysphagia. This portable method could offer a cost-effective alternative to traditional radiation-based assessments.
Area of Science:
- Biomedical Engineering
- Pediatric Medicine
- Clinical Diagnostics
Background:
- Pediatric dysphagia significantly impacts child health and development.
- Videofluoroscopy, the current standard, involves radiation and specialized resources, limiting frequent assessments.
- Swallowing accelerometry offers a non-invasive, portable, and potentially cost-effective bedside alternative.
Purpose of the Study:
- To evaluate the efficacy of dual-axis swallowing accelerometry for detecting unsafe swallows in pediatric patients.
- To assess the potential of this non-invasive technique as a screening tool in children with neurogenic dysphagia.
Main Methods:
- Collected dual-axis accelerometric signals simultaneously with videofluoroscopy in 29 pediatric participants with neurogenic dysphagia.
- Analyzed swallows of various consistencies using feature extraction from time, frequency, and information theoretic domains.
- Reduced feature space dimensionality and employed a support vector machine classifier for discrimination.
Main Results:
- Achieved an adjusted accuracy of 89.6% ± 0.9 in discriminating between safe and unsafe swallows (airway entry).
- Utilized 8-fold cross-validation with 16-17 dimensions and an RBF kernel support vector machine.
- Demonstrated the potential of accelerometric signal analysis for identifying aspiration events.
Conclusions:
- Dual-axis accelerometry shows significant merit for the non-invasive detection of unsafe swallows in children.
- This technology warrants further investigation as a valuable pediatric medical device for dysphagia assessment.
- Offers a promising radiation-free alternative for routine swallowing function monitoring in pediatric populations.
Background:
Dysphagia or swallowing disorder negatively impacts a child's health and development. The gold standard of dysphagia detection is videofluoroscopy which exposes the child to ionizing radiation, and requires specialized clinical expertise and expensive institutionally-based equipment, precluding day-to-day and repeated assessment of fluctuating swallowing function. Swallowing accelerometry is the non-invasive measurement of cervical vibrations during swallowing and may provide a portable and cost-effective bedside alternative. In particular, dual-axis swallowing accelerometry has demonstrated screening potential in older persons with neurogenic dysphagia, but the technique has not been evaluated in the pediatric population.
Methods:
In this study, dual-axis accelerometric signals were collected simultaneous to videofluoroscopic records from 29 pediatric participants (age 6.8 ± 4.8 years; 20 males) previously diagnosed with neurogenic dysphagia. Participants swallowed 3-5 sips of barium-coated boluses of different consistencies (normally, from thick puree to thin liquid) by spoon or bottle. Videofluoroscopic records were reviewed retrospectively by a clinical expert to extract swallow timings and ratings. The dual-axis acceleration signals corresponding to each identified swallow were pre-processed, segmented and trimmed prior to feature extraction from time, frequency, time-frequency and information theoretic domains. Feature space dimensionality was reduced via principal components.
Results:
Using 8-fold cross-validation, 16-17 dimensions and a support vector machine classifier with an RBF kernel, an adjusted accuracy of 89.6% ± 0.9 was achieved for the discrimination between swallows with and with out airway entry.
Conclusions:
Our results suggest that dual-axis accelerometry has merit in the non-invasive detection of unsafe swallows in children and deserves further consideration as a pediatric medical device.
