Accurate Screening Tools for Dysphagia in Amyotrophic Lateral Sclerosis (ALS)

NCT ID: NCT02710162

Last Updated: 2017-12-21

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

EARLY_PHASE1

Total Enrollment

21 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-04-30

Study Completion Date

2017-12-19

Brief Summary

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Individuals with th Amyotrophic Lateral Sclerosis are at high risk for swallowing impairment (dysphagia) which leads to malnutrition, decreased pulmonary health, aspiration and aspiration pneumonia. These sequelae necessitate timely identification of at risk individuals to ensure optimal management of oral intake and pulmonary function. The purpose of this study is to evaluate the discriminant ability of several non-invasive screening tools at detecting swallowing impairment in individuals with ALS.

Detailed Description

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This research study is being performed to determine how accurate different screening tools or tests are at identifying swallowing problems associated with Amyotrophic Lateral Sclerosis (ALS).

As a participant one evaluation will be performed at the University of Florida Swallowing Systems Core laboratory located at Shands Hospital, Gainesville will take place. This will take approximately two-hours. During this evaluation an videofluoroscopy (X-ray of swallowing), cough tests, tongue function test and questionnaires will be completed.

Conditions

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Amyotrophic Lateral Sclerosis

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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Screening

Participants enrolled will have the following test: Micro Mouth Pressure Meter, reflexive cough testing (with capsaicin used in blocks), lingual strength and endurance trials using the Iowa Oral Performance Instrument, Electrical Impedance Myography of the tongue, Pulmonary Function Testing, and a Videofluoroscopic Swallowing Study. In addition, the patient will complete the following surveys: Swallowing Related Quality of Life Questionnaire (SWAL-QOL), Eating Assessment Tool-10 (EAT-10), Functional Oral Intake Scale (FOIS), Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R), The Center for Neurologic Studies Bulbar Function Scale (CNS-BFS), and the Communicative Effectiveness Survey (CES).

Group Type EXPERIMENTAL

Micro Mouth Pressure Meter

Intervention Type DEVICE

The participant will be seated with the nose occluded using a nose clip. After inhaling to total lung capacity, the participant will place his or her lips around the mouthpiece and blow out as forcefully as possible. A flanged rubber mouthpiece will be used to overcome the inability of some individuals to create tight lip seal due to facial muscle weakness. Three trials will be performed and the patients highest maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) used.

Iowa Oral Performance Instrument

Intervention Type DEVICE

The Iowa Oral Performance Instrument (IOPI) is a device that measures the peak pressure performance of lingual strength and endurance via the action of a bulb placed on the hard palate.

Electrical Impedance Myography

Intervention Type DEVICE

The SFB7 Bioimpedance device measures the function of the tongue by calculating measures of reactance, resistance and phase once a custom electrode array is placed on the midline of the subject's tongue for approximately 2 seconds.

Capsaicin

Intervention Type DRUG

A capsaicin challenge with three randomized blocks of 0, 50, 100, 200, and 500 μM capsaicin. The capsaicin will be dissolved in a vehicle solution consisting of 80% physiological saline, and 20% ethanol. Participants will be given the instruction "cough if you need to" prior to capsaicin delivery.The solution will be administered automatically upon detection of an inspired breath and there will be a minimum of one minute between each trial. This is to test the reflexive cough testing for upper airway sensitivity and motor thresholds.

Videofluoroscopic Swallowing Study

Intervention Type PROCEDURE

Videofluoroscopic swallowing study will be performed to measure the oropharyngeal swallowing.

Pulmonary Function Testing

Intervention Type PROCEDURE

Pulmonary Function testing will be performed using conventional methods and will include the following outcomes: forced vital capacity (FVC), sniff nasal inspiratory pressure (SNIP), peak expiratory flow (PEF), forced expiratory volume (FEV1) expressed as a percentage of predicted values.

Swallowing Related Quality of Life Questionnaire

Intervention Type OTHER

Swallowing Quality of Life Questionnaire (SWAL-QOL) will be used for participant reporting of swallow-related quality of life.

Functional Oral Intake Scale

Intervention Type OTHER

The Functional Oral Intake Scale (FOIS) will be used for participants to report their food intake habits.

Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised

Intervention Type OTHER

The Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) will be used to track global disease progression in participants.

Eating Assessment Tool-10

Intervention Type OTHER

The Eating Assessment Tool-10 will be used for participant reporting of swallowing system severity.

Communicative Effectiveness Survey

Intervention Type OTHER

The Communication Effectiveness Survey (CES) will be used for participant reporting of communication abilities across different speech contexts.

The Center for Neurologic Studies Bulbar Function Scale

Intervention Type OTHER

The Center for Neurologic Studies Bulbar Function Scale (CNS-BFS) will be used to report bulbar function in study participants.

Interventions

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Micro Mouth Pressure Meter

The participant will be seated with the nose occluded using a nose clip. After inhaling to total lung capacity, the participant will place his or her lips around the mouthpiece and blow out as forcefully as possible. A flanged rubber mouthpiece will be used to overcome the inability of some individuals to create tight lip seal due to facial muscle weakness. Three trials will be performed and the patients highest maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) used.

Intervention Type DEVICE

Iowa Oral Performance Instrument

The Iowa Oral Performance Instrument (IOPI) is a device that measures the peak pressure performance of lingual strength and endurance via the action of a bulb placed on the hard palate.

Intervention Type DEVICE

Electrical Impedance Myography

The SFB7 Bioimpedance device measures the function of the tongue by calculating measures of reactance, resistance and phase once a custom electrode array is placed on the midline of the subject's tongue for approximately 2 seconds.

Intervention Type DEVICE

Capsaicin

A capsaicin challenge with three randomized blocks of 0, 50, 100, 200, and 500 μM capsaicin. The capsaicin will be dissolved in a vehicle solution consisting of 80% physiological saline, and 20% ethanol. Participants will be given the instruction "cough if you need to" prior to capsaicin delivery.The solution will be administered automatically upon detection of an inspired breath and there will be a minimum of one minute between each trial. This is to test the reflexive cough testing for upper airway sensitivity and motor thresholds.

Intervention Type DRUG

Videofluoroscopic Swallowing Study

Videofluoroscopic swallowing study will be performed to measure the oropharyngeal swallowing.

Intervention Type PROCEDURE

Pulmonary Function Testing

Pulmonary Function testing will be performed using conventional methods and will include the following outcomes: forced vital capacity (FVC), sniff nasal inspiratory pressure (SNIP), peak expiratory flow (PEF), forced expiratory volume (FEV1) expressed as a percentage of predicted values.

Intervention Type PROCEDURE

Swallowing Related Quality of Life Questionnaire

Swallowing Quality of Life Questionnaire (SWAL-QOL) will be used for participant reporting of swallow-related quality of life.

Intervention Type OTHER

Functional Oral Intake Scale

The Functional Oral Intake Scale (FOIS) will be used for participants to report their food intake habits.

Intervention Type OTHER

Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised

The Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) will be used to track global disease progression in participants.

Intervention Type OTHER

Eating Assessment Tool-10

The Eating Assessment Tool-10 will be used for participant reporting of swallowing system severity.

Intervention Type OTHER

Communicative Effectiveness Survey

The Communication Effectiveness Survey (CES) will be used for participant reporting of communication abilities across different speech contexts.

Intervention Type OTHER

The Center for Neurologic Studies Bulbar Function Scale

The Center for Neurologic Studies Bulbar Function Scale (CNS-BFS) will be used to report bulbar function in study participants.

Intervention Type OTHER

Other Intervention Names

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digital manometer Micro medical device IOPI EIM Hot pepper VFSS modified barium swallow (MBS) X-Ray of swallowing SWAL-QOL FOIS ALSFRS-R EAT-10 CES CNS-BFS

Eligibility Criteria

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Inclusion Criteria

* diagnosis of probable or definite ALS

Exclusion Criteria

* allergies to barium or capsaicin
* tracheotomy or mechanical ventilation
* absence of diaphragmatic pacer
* respiratory disease (COPD).
Minimum Eligible Age

21 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Florida

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Emily Plowman, Ph.D.

Role: PRINCIPAL_INVESTIGATOR

University of Florida

Locations

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University of Florida

Gainesville, Florida, United States

Site Status

Countries

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United States

Other Identifiers

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IRB201600163

Identifier Type: -

Identifier Source: org_study_id