RehaIngest measurements for Dysphagia

RehaIngest measurements for Dysphagia

RehaIngest  for Measurement and Visualisation of Swallowing

RehaIngest is a new portable Certified medical device manufactured in Germany by Hasomed GmbH for the measurement and visualisation of laryngeal activity during swallowing. It supports diagnostics and treatment in patients with dysphagia, particularly but not exclusively after stroke, traumatic brain injury, cervical spinal cord injury and tumor diseases.

Why this Matters

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Swallowing is one of the body’s most complex actions, which means plenty can go wrong. It’s so complicated, in fact, that experts don’t yet agree on all of the essential components, though some estimate that 22 muscle pairs and 7 of the 12 cranial nerves take part.  Dysphagia cuts across so many diseases and age groups, its true prevalence in adult populations is not fully known and is often underestimated.

Up to 50% of all neurological patients and nearly all patients with larynx cancer suffer from swallowing disorders (dysphagia). RehaIngest is designed to support therapists or examiners in dysphagia therapy and diagnostics, e.g. in clinics, rehabilitation centers or outpatient clinics.

The exact epidemiological numbers by condition or disease also remain poorly defined. This, in part, is due to the concomitant medical conditions being reported and the timing and type of diagnostic procedures being used to identify swallowing disorders across neurological populations.  For example, a systematic review by Martino and colleagues (2005) found that the incidence of dysphagia in stroke populations was as low as 37% when identified using cursory screening procedures and as high as 78% when identified using instrumental assessments.  Simple, reliable measurements are an important part in getting to grips with the true picture.

See - Martino, R., Foley, N., Bhogal, S., Diamant, N., Speechley, M., & Teasell, R. (2005). Dysphagia after stroke: Incidence, diagnosis, and pulmonary complications. Stroke, 36, 2756–2763.

What makes RehaIngest so exciting is that it offers a non-invasive and repeatable method of quantifying and visualising the act of swallowing

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Some Key Aspects of RehaIngest for the Clinician

The electrode placements with RehaIngest

It's one of a kind
The world‘s first system with simultaneous EMG and bioimpedance measurement.  Unlike previous technologies, head and tongue movements, cough or speech DO NOT influence the results.

Reliability
The automatic swallowing detection system was developed with numerous standard data from healthy volunteers and has an accuracy of over 90%.

Clinically relevant
The measured data and the real-time swallowing detection provided by RehaIngest objectively supports or confirms the clinicians first impression of the patient. The pre-post comparison helps to evaluate the therapy effectiveness.

User friendly
Valuable information for examiners without palpation or interference to the patient. You get feedback on the swallowing speed, the duration and extent of the larynx elevation related with reference data

Portable
Easy to transport and quick to install

How RehaIngest Works

RehaIngest measures BOTH bioimpedance (BI) and electromyography (EMG) at the throat for swallowing detection. The results can be used to support diagnostics, therapy and monitoring patients with swallowing disorders.

RehaIngest measures both the activity of the submental muscles (EMG) which help to elevate the larynx and the change in the resistance (bioimpedance) in the pharynx via surface electrodes.

EMG measurement used by itself often results in incorrect results due to  head movements, coughing or throat clearing during the measurement.  A prerequisite for measuring bioimpedance is the input of current into the body.

Electrode Placement

A template guides electrode placement

During a swallow, the biosignals show a typical pattern. The change in bioimpedance correlates with the movement of the hyoid and larynx during the swallowing. 

At the lateral end of the hyoid a measuring electrode is attached between the hyoid and thyroid cartilage on both sides.

The two current electrodes are placed on both sides of the neck of the sternocleidomastoid muscle.

There is an additional reference electrode at the level of the right or left cheekbones. A template was developed to ensure accurate placement of the electrodes.

How are the Swallow-Specific Parameters Measured?

During an examination, the measurement curves are displayed in the RehaIngest software.  An algorithm running in the background performs a pattern detection in real-time. Detected swallows are marked directly on the measurement curves. 

A graphical feedback on the swallowing speed as well as the duration and extent of the larynx elevation is displayed in parallel. The color marks on the feedback provide information about the ratio of the swallowing compared to healthy reference swallows.

Benefits

The RehaIngest Process

Realtime swallowing detection provides direct performance feedback.  During the therapy even the smallest therapeutic progress becomes visible to patients and therapists without using costly or invasive equipment.

RehaIngest can support therapists or examiners in dysphagia therapy and diagnostics. It allows easy measurement of the larynx elevation of patients, without palpation and without having to observe the patient too much.

Measurement Playback Screen

Direct feedback can improve the first clinical examination (screening). Objectively measured data and the real-time swallowing detection carried out with rehaIngest supports or confirms the first impression of the patient.

Detailed Measurement Results are available

A 3D animation of swallowing can assist with an explanation of the anatomy

The pre-post comparison helps to evaluate the effectiveness of therapy. A report shows the measurement results as tables and graphs, supplemented by notes of the therapist.  All reports can be exported as pdf-documents. A 3D-animation of the pharyngeal swallowing phase helps to explain the function of the involved anatomical segments.  The interplay of the tongue, larynx, hyoid and epiglottis correlate to the displayed data

RehaIngest System

A complete RehaIngest system consists of the following:-

  • An Acer or equivalent Windows tablet with RehaIngest software
  • RehaIngest measurement device
  • Electrode cable
  • Connection cable between Tablet computer and measurement device
  • Electrode placement aid
  • Chargers for Tablet computer and measurement device
  • Pack of disposable electrodes
  • Aluminium carry case
  • Quick start guide and manual

For the latest prices please contact us via the contact page

Contraindications

The following contraindications exclude clients from applying RehaIngest

  • Open wounds in the area of the application site
  • Myasthenia Gravis
  • Neurological disorders with severe impairment of cognition and alertness
  • Progressive dementia

NOTE: that we will supply UK and Ireland clients directly and outside of these areas we will connect you to your closest dealer

RehaIngest Research Background

Multisensor Classification System for Triggering FES in Order to Support Voluntary Swallowing.
Riebold, B., Nahrstaedt, H., Schultheiss, C., Seidl, R. O., & Schauer, T. (2016).
European Journal of Translational Myology, 26(4).
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Automated Detection and Evaluation of Swallowing Using a Combined EMG/Bioimpedance Measurement System. Schultheiss, C., Schauer, T., Nahrstaedt, H., & Seidl, R. O. (2014).  The Scientific World Journal, 2014, e405471.
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Bioimpedance- and EMG-Triggered FES for Improved Protection of the Airway During Swallowing.
Nahrstaedt, H., Schultheiss, C., Schauer, T., & Seidl, R. O. (2013). Biomedical Engineering / Biomedizinische Technik.
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Evaluation of an EMG bioimpedance measurement system for recording and analysing the pharyngeal phase of swallowing. Schultheiss, C., Schauer, T., Nahrstaedt, H., & Seidl, R. O. (2013).  European Archives of Oto-Rhino-Laryngology, 270(1), 2149–2156.  
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Swallow Detection Algorithm Based on Bioimpedance and EMG Measurements.
Nahrstaedt, H., Schultheiss, C., Seidl, R. O., & Schauer, T. (2012).  In B. Balazs (Ed.), Biological and Medical Systems (Vol. 8, pp. 91–96). Budapest: Elsevier.
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Bioimpedance based measurement system for a controlled swallowing neuro-prosthesis.
Nahrstaedt, H., Schauer, T., & Seidl, R. O. (2010). In Proc. of 15th Annual International FES Society Conference and 10th Vienna Int. Workshop on FES (pp. 49–51).
Go to Study »

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