How an NYGH Research Chair is making a difference in ALS-connected Disorder
Every single day, we swallow at least 1,000 times and when we do, there are more than 100 separate neuro, biochemical and physiological events taking place to make it happen.
Although most of us aren’t aware of what goes on when we swallow, for those suffering from Amyotrophic Lateral Sclerosis or ALS (also known as Lou Gehrig’s disease), the inability to swallow properly is often a defeating and frightening symptom. ALS is a rare neurological disease involving the breakdown and eventual death of neurons which control the body’s voluntary muscles. The brain loses the ability to initiate and control movement, often resulting in an inability to eat, speak, move, and breathe. While there are treatments for ALS, there is no cure.
Unlocking the mystery of dysphagia
June is ALS Awareness Month. Here at North York General Hospital (NYGH), we are fortunate to have Ervin Sejdic, PhD and Research Chair in Artificial Intelligence for Health Outcomes, working on a specific part of the ALS puzzle – dysphagia, or difficulty swallowing. Swallowing problems appear later in the ALS journey and make choking a constant danger, even with saliva. This symptom is caused by the lack of control of the muscles used when swallowing.
Dr. Sejdic’s work on dysphagia began as so many medical discoveries do – with a hunch. When there is a suspicion of dysphagia, an X-ray is the single-most effective screening tool beyond giving liquids to patients to monitor their swallowing processes. After examining data compiled, Dr. Sejdic and his team at the Swanson School of Engineering at the University of Pittsburgh began to examine variables that might affect swallowing, including the actual sounds made in the process.
Using off-the-shelf sensors such as microphones and accelerometers, Dr. Sejdic’s team measured the sounds and vibrations in the neck during swallowing through an approach known as high-resolution cervical auscultation. While this had been attempted before by others, it didn’t yield the answers Dr. Sejdic and his team were looking for. They soon realized the sound frequencies used prior to their study were inaccurate and a different frequency would yield the answers he and his team were hoping to find.
These findings attracted the attention of many in the medical community interested in diagnosing dysphagia. The positive feedback allowed the work to continue and gave Dr. Sejdic the confidence that indeed he was ‘on to something’. The frequencies used prior to his work were wrong.They explored other frequencies that correctly captured the sounds and frequencies in those with dysphagia.
Award-winning work leads to partnerships
In 2016, Dr. Sejdic was presented the Presidential Early Career Award for Scientists and Engineers – the highest honour bestowed by the United States government on outstanding scientists and engineers in the early stages of their independent research careers. The award, given to him for his work on dysphagia, bolstered him. As an electrical engineer, specializing in algorithms, his work gained the support of speech and language pathologists and allowed him to enter into collaborative discussions and partnerships with dysphagia study groups at both Baycrest and Sunnybrook.
Dr. Sejdic is the first to admit he never imagined applying his education in electrical engineering to health care, but it didn’t take long for him to understand that his expertise could lead to breakthroughs with patients in a very real way. The biggest surprise came when his theories could have real world impact for people. Now, he’s inspired to push through to find much-needed solutions.
Screening now 90 per cent accurate
While Dr. Sejdic and his team of 10 have made tremendous progress unlocking the mystery of dysphagia, more study is still needed. At present, screening for the swallowing disorder is 90 per cent accurate. They plan to create a smart phone app so that screening can be put into the hands of health care workers in areas where access to X-ray technology is limited, such as in long-term seniors’ homes and remote northern communities. Accurate screening can then allow patients to seek management treatments sooner, such as swallowing rehabilitation and more appropriate meal planning.
On the horizon, Dr. Sejdic sees the creation of a diagnostic device for those suffering from dysphagia, but that will take more time and study. In the meantime, his work is improving screening accuracy for ALS patients, a major achievement to support their care.
