Technology-based Management of Swallowing Difficulties

Very few of us may be aware of the importance of swallowing when we are eating and drinking. However, swallowing difficulties may cause some food, liquid, or medicine, to go through our trachea instead of the esophagus, causing choking or even respiratory complications.

Our swallowing function changes with age. Elderly people need longer time for processing of food, longer transit time through throats, and have weaker esophageal function. An HKU research team, led by Dr Karen Man Kei Chan, Assistant Professor in the Division of Speech and Hearing Sciences, Faculty of Education, found that approximately 60% of the elderly in nursing homes and 40% of the elderly in day care centres have been suffering from swallowing difficulties, i.e. dysphagia. Many elderly people also have difficulty in communicating their swallowing difficulties to their carers. Furthermore, most carers such as frontline staff and relatives of the residents in those nursing homes and day care centres lack knowledge and skills in swallowing management.

Patients suffering from stroke, Parkinson's Disease, dementia or head and neck cancer may also suffer from dysphagia. Elderly people with dysphagia are at high risk of malnutrition, dehydration, and reduced quality of life.

In order to increase public awareness about dysphagia management and to look for alternatives to treat swallowing difficulties in the elderly, the research team has been working on the following:

• KOTE – A mobile app, 'Keep On Talking and Eating (KOTE)', is being developed to provide a self-help platform to people who have or are at risk of developing progressive neurological and/or radiation-induced swallowing and communication difficulties. The app contains useful information about swallowing and speech disorders, and features videos and audio clips of evidence-based oro-motor muscle strengthening exercises that could be done during swallowing rehabilitation.
• Repetitive Transcranial Magnetic Stimulation (rTMS) – rTMS is the use of electro-magnetic induction to induce current onto the brain, which is generally used in treatment for psychiatric disorders to stimulate nerve cells in the brain. The research team has been studying since 2011 the application of rTMS to improve the function of stroke patients' mouth and throat muscles so as to ease their swallowing difficulties.
• Acupuncture – There are multiple studies that have demonstrated positive treatment effects of using acupuncture in dysphagia management. Numerous acupuncture methods, such as body acupuncture, scalp acupuncture and tongue acupuncture, were reported to be effective in treating dysphagia. However, most of these studies either lacked objective outcome measurements or did not include pre- and post-assessment comparisons. The research team is therefore planning to conduct prospective, randomised and double-blinded studies with objective outcome measures in future.

The KOTE app is developed because only very few resources are available in educating and raising awareness of swallowing and communication difficulties in the Cantonese-speaking population in Hong Kong. For example, many post-irradiated nasopharyngeal cancer patients are often unaware that motor speech and swallowing side effects can arise from radiotherapy. As a result, they may not know how to access precautionary methods to prevent radiation-induced complications. It is hoped that the KOTE app will help enhance swallowing safety and communication between patients and their carers.

The team's research on using rTMS and acupuncture has potential to maximise the swallowing functions of patients by directly stimulating the affected brain regions and muscles. The ultimate goal is to develop evidence-based clinical solutions to treat swallowing problems in the elderly and to reduce medical and societal costs on managing complications resulting from poor swallowing management, which will eventually improve the quality of life of the elderly.