A Self-Sensing Instrument for Investigation of Rheology in Dysphagia

Lead Research Organisation: University College London
Department Name: Mechanical Engineering

Abstract

Dysphagia is the term used to describe disorders that affect our ability to swallow. This problem affects most stroke patients, people suffering cancers of the head or neck, and is also often found in the general elderly population. The potential problems of choking, pneumonia, malnutrition and dehydration can be potentially fatal for these vulnerable patients. Fortunately, these risks can be minimised by controlling a patient's diet: some patients have particular difficulties with thin, watery, liquids, and often semi-solid foods can be problematic. Specialist Speech and Language Therapists (SLTs) examine individual patients to identify a range of consistencies that can be swallowed safely. So, the dysphagic patient's safety depends on the consistency of their diet. However, it is difficult to mix drinks to the right thickness when judging the consistency by eye, even with specialist training. The issue is further confused because the SLTs have to rely on descriptive terms to convey this consistency information. Phrases like honey thick , can be drunk through a straw are inexact and subject to varying personal interpretation. Away from specialist care, there is no means of controlling consistency.This project will use engineering research to create an accurate and reliable device (a rheometer ) which can be used to measure the flow properties of drinks and fluid foods . The aim of this is to ensure that the patients only receive consistencies that they can swallow safely. The device will enable SLTs to be precise in their analysis and treatment of patients; SLTs in different locations will be able to communicate and make meaningful comparisons, which will enable the start of scientific research into the relationship between dysphagia and fluid consistency. The fluids used (e.g. thickened drinks, smoothies) have complex behaviours, for example their viscosity strongly depends on the rate at which they are flowing. Some also show elastic, jelly-like, behaviour. The rheometer will be able to quantify these effects for greater understanding, promoting new collaborative research between engineers and SLTs, and establishing the UK as a leader of this brand new research area. This research will also provide the potential to specifically design food products that are particularly easy and safe to swallow / of enormous benefit to an industrial partner in dysphagia products: Fresenius-Kabi Ltd.The engineering research that is required to create this rheometer involves using new design techniques to create a unique electromagnetic actuator. This actuator will be optimised for use in a self-sensing mode / where the actuator both provides torque and motion, while at the same time measuring that torque and motion. This emerging technique removes the need for separate sensors and means the device can be small, simply constructed, robust and reliable. These characteristics are perfectly suited to creating a device for mass production, and portable use around dysphagic patients in hospitals, care homes or at home. A patent will be pursued for this device.The novel design techniques used will include finite element modelling of the interrelations between non-linear electromagnetic, mechanical and thermal behaviour of the actuator. This research will dramatically improve the capabilities of electromagnetic devices, which will be of great interest to scientists and industrialists. As well as enabling new types of miniature devices, the work will produce improvements that are applicable to existing devices. This will specifically support and enhance current research being carried out for the materials testing machine company, Instron Ltd.There is enormous potential for improving health and quality of life if the problems associated with dysphagia can be avoided by controlling diet consistency; this device will allow that work to start.

Publications

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O'Leary M (2011) Variation of the apparent viscosity of thickened drinks. in International journal of language & communication disorders

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O'Leary MT (2010) A portable self-sensing rheometer for investigation and therapy of swallowing disorders. in Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference

 
Description We have quantified the flow properties of a variety of products which are currently used in medical nutrition, and shown them to have potential for helping individuals who have difficulty swallowing conventional foods & drinks.
We have created a miniature device to quantify flow properties and this has been used to test fluids outside the lab; it is possible to measure drinks where they are used in nursing homes & hospital wards.
Exploitation Route The findings are being used by manufacturers of medical dietary products (Fresenius Kabi Ltd) to shape the design of their future products. The findings will form part of international standards being created to unify healthcare practises for managing swallowing disorders.
Sectors Agriculture, Food and Drink,Healthcare

URL http://www.benhanson.com/
 
Description The scientific results of the funded research were disseminated in the 5 journal papers listed. The work aims to improve the standards of care for individuals who have problems swallowing (this is typically the elderly in nursing homes and stroke survivors but can affect any age). The grant funded studies of the rheology of thickened drinks which can be effective in managing swallowing, and the outputs have been well-received by clinicians and dieticians as well as Fresenius Kabi, who have funded additional research through consultancy contracts and a studentship. As a result of becoming known as an expert in the field I have been asked to speak at several international conferences (some on behalf of the industrial partner of this grant: Fresenius Kabi Ltd). The other major company in this area is Nestle, who have also engaged me to perform research, to speak at their international research centre and participate in an international training event for health professionals. As a result of becoming known as an expert in the field I have been asked to speak at several international conferences (some on behalf of the industrial partner of this grant: Fresenius Kabi Ltd) and at special interest groups for the NHS. I have recently (2013) been asked to join a new international initiative to create global standards for the dietary care of those with difficulties swallowing. We have just published a systematic review of the efficacy of "texture modification" on physiological and health outcomes, and are soon to draft guidelines based on rheological measures.
First Year Of Impact 2008
Sector Agriculture, Food and Drink,Healthcare,Pharmaceuticals and Medical Biotechnology
Impact Types Societal,Economic

 
Description IDDSI Board membership
Geographic Reach Multiple continents/international 
Policy Influence Type Participation in a guidance/advisory committee
URL http://www.iddsi.org
 
Description Consultancy research contracts for Fresenius Kabi 
Organisation Fresenius Kabi Ltd
Country United Kingdom 
Sector Private 
PI Contribution I have carried out several research projects / investigations for Fresenius Kabi, under consultancy contracts through UCLConsultancy Ltd. This includes 5 studies on the rheology of drinks for medical purposes, plus 8-10 invited presentations at training sessions / hosted seminars at conferences internationally.
Collaborator Contribution Fresesnius Kabi have provided expertise on their products and manufacturing techniques, the market and healthcare preferences.
Impact This collaboration is closely associated with all outputs from EPSRC grant G00/1200/1, as Fresenius Kabi were the industrial partner on that grant.
Start Year 2008
 
Title iPhone app to simulate thick drinks 
Description I have created an iPhone app which simulates a glass of liquid, using the iPhone's accelerometer to sense motion and control the liquid motion appropriately. 4 different levels of thickness can be simulated. The aim is that this app can be used as a visual standard instead of verbal descriptors of thickness (e.g. double-cream). 
IP Reference  
Protection Copyrighted (e.g. software)
Year Protection Granted 2014
Licensed Yes
Impact The app is to be published / available in December 2014.