Digital Swallowing Workstation

An Integrated System for Clinicians & Researchers

The Digital Swallowing Workstation (DSW) is a powerful, multi-functional system containing a robust set of features that have been integrated into one platform for dysphagia clinicians and researchers. DSW can be used to assist with virtually every aspect of patient management, from initial assessment through rehabilitation.

Comprised of three separate modules (available separately), the complete workstation offers an unparalleled assortment of capabilities using established techniques that were previously available only as various instruments from many vendors. The workstation, which ergonomically integrates these disparate technologies, enhances clinical efficiency and contributes to evidence-based clinical practice. To the research community, the workstation provides both sophistication and flexibility for data acquisition, analysis, time-linked physiologic and video data, and the ability to export quantitative information into other analysis software.

No other system offers dysphagia clinicians and researchers the comprehensiveness and flexibility of DSW. Since its introduction in the mid-1990s (originally as an analog system), the workstation has evolved into the system of choice at the leading dysphagia clinics and research institutions worldwide.

Features:

· Digital video recording system for fluoroscopic and FEES exams

· Objective measurements of key physiologic parameters related to swallowing

· Real-time visual feedback for patients to assist with therapy goals

· Complete videoendoscopic (FEES) system for bedside evaluation

· Time-linked video and physiologic data for comprehensive assessment

· Fully integrated exam management system with patient database

· Report generator containing critical exam findings and images

· Mobile cart for all system components

Digital Video Recording System

A Powerful Motion Video System

The Digital Video System for Swallowing (DVSS) module records modified barium, videoendoscopic (FEES), ultrasound, and other video exam studies directly to computer storage media for immediate retrieval and playback. The professional video acquisition hardware (with audio) provides excellent image clarity at full video resolution without artifacts or skipped frames. DVSS is a self-contained digital video recording system, but can also be used in conjunction with the Swallowing Signals Lab (see below); when used in combination, these modules allow digital video and physiologic data to be recorded and played back concurrently for precise, time-linked data analysis.

Immediate Exam Review

In addition to superb image quality, dysphagia clinicians can take advantage of many conveniences and timesaving features provided with digital video recording. The system is housed on a mobile cart that can be rolled to radiology or to patient bedside to record a procedure. With instant exam retrieval, the clinician can quickly analyze any segment of the exam in real time, frame by frame, or in slow motion. The most revealing still images can be selected and labeled for automatic inclusion in the software’s report generator.

Simultaneous Playback of Two Exams

Two video recordings can be loaded concurrently and compared side by side. This unique feature facilitates accurate assessment and in-depth comparative analysis of patient performance over time (e.g., before and after therapy).

Modified barium studies can be reviewed frame by
frame, in slow motion, or in real time without motion
artifacts or skipped frames.

Exam Management System

The Kay system alleviates the clinician’s burden of exam management with a sophisticated patient database and exam-archiving system. The most recent exam recordings reside on the system’s hard drive for instant playback; older exams are archived to numbered storage media with a built-in tracking system. Regardless of when an exam was recorded, the system conveniently prompts the clinician with the appropriate storage disk to insert for exam review.

Report Generator

After the clinician has filled in appropriate database fields with key exam findings and selected the most revealing still images, the workstation generates a report as a Microsoft Word document. The system’s printer can make a hard copy of the report for patient records, a referring physician, or insurance filing.

Key Benefits

· Immediate access to excellent quality digital recordings

· Review procedures in real-time, frame by frame, or in slow motion

· Use built-in tracking system to locate exams

· Quick duration measurements of swallowing events

· Enhance images with zoom, contrast, and brightness controls

· Easily convert video clips to standard multimedia video formats

· Select exact stills to include in reports

· Export stills to other programs for further data analysis

Swallowing Signals Lab

Swallowing Physiology Assessment and Visual Feedback

The Swallowing Signals Lab is both a physiologic data acquisition and visual feedback system for dysphagic patients that provides real-time displays of critical parameters related to swallowing function. It consists of a custom external module with a PC interface card and an array of measurement tools (i.e., transducers), which have been described extensively in the dysphagia professional literature. Previously available as separate, stand-alone instruments, these transducers have been integrated into a single system for swallowing.

Coordination of breathing and swallowing can be viewed with sEMG
(top), respiratory phase (middle), and cervical auscultation (bottom)
data. Important measurements can be calculated on each data set.

All aspects of data sampling and signal conditioning (unique to each transducer), and the concurrent real-time display of any combination of these signals, are designed into the system. Additionally, when used in conjunction with the Digital Video System for Swallowing, these physiologic signals can be viewed and analyzed with video data (e.g., fluorographic of videoendoscopic).

The Swallowing Signals Lab integrates data acquisition
and display from five separate transducers 9with two
additional auxiliary channels) into a single system.

Multiple Transducers Rationale

Dysphagia can have an array of contributing factors, which a clinician may wish to address in patient assessment and treatment. Clinicians and researchers have reported a variety of techniques in books and professional journals. The Swallowing Signals Lab integrates many of these key techniques based on their reported usefulness and efficacy.

The system includes surface EMG (two channels), tongue pressure transducers (two- and three-channel configurations), solid-state pharyngeal/UES manometry (up to six channels), cervical auscultation, and respiratory phase (using a nasal cannula with pressure transducer). Each of these has been included in the Swallowing Signals Lab complete with appropriate signal conditioning.

For clinicians who wish to integrate other types of physiologic data (e.g., plethysmography) in conjunction with the standard signals provided, two auxiliary channels are supplied. Any combination of signals can be acquired concurrently. Standard measurements can be made on any of the data. For researchers, data can be easily exported as a text file for further analysis in other programs.

Strengthening exercised for the tongue can be enhanced with
real-time displays and objective measurements.

Key Benefits

· Help patients achieve therapy goals with real-time feedback

· Use objective measurements to assist with evidence-based practice

· Teach swallowing maneuvers with surface EMG (two channels)

· Measure tongue strength objectively and use for isometric exercises

· Show coordination of breathing and swallowing with effective real-time displays

· Acquire signal and video data concurrently (e.g., manofluorographic studies) for precise data correlation and comprehensive assessment

· Access built-in measurement functions for standard clinical practice

Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

A Complete Videoendoscopic System

The Digital Swallowing Workstation contains a complete videoendoscopic system for administering FEES exams at bedside. All components have been selected to provide excellent endoscopic images needed to evaluate swallowing function. The hardware consists of a xenon light source, a flexible endoscope, and a CCD camera with lens adapter. The swallowing cart houses all components and includes an optional caddy system for the endoscope(s). As an integrated part of the Digital Swallowing Workstation, FEES exams are digitally recorded for immediate exam review. Additionally, FEES procedures can be recorded concurrently with any combination of signals on the Swallowing Signals Lab.

FEES Procedure

FEES is an endoscopic technique used for the clinical evaluation of dysphagic patients. It can be performed in the clinic or the system can be rolled to the patient’s room for bedside evaluation. In the procedure, a flexible endoscope is passed transnasally, allowing the clinician to view laryngeal and pharyngeal structures during both swallowing and non-swallowing tasks. Swallowing function is observed endoscopically while feeding the patient various bolus consistencies and volumes, each colored with food dye to assist with exam interpretation.

In addition to its assessment function, FEES can be used to help educate patients and family about swallowing problems and also to demonstrate effective practice of compensatory techniques.

Key Benefits

· Perform FEES procedure at patient bedside

· No radiation exposure to patient

· Excellent visualization of secretions and penetration

· Allows experimentation of swallowing maneuvers and therapy planning

· During FEES exam, patients can ingest foods normally eaten

· Excellent complementary procedure to modified barium studies

Video data (FEES or fluorographic) can be acquired concurrently
with physiologic data for in-depth assessment and data correlation.

An Integrated Workstation

The Digital Swallowing Workstation is a comprehensive system designed to meet the extensive requirements of dysphagia clinicians and researchers. It has been installed at top facilities internationally because of its unmatched set of features and capabilities to analyze and treat swallowing problems. Each of the analysis techniques offered in the system has been validated by numerous peer-reviewed articles in medical journals (an extensive bibliography and collection of application notes are available on request). All components of the workstation are housed on a customized mobile cart for convenience and clinical efficiency.

For additional information on the Digital Swallowing Workstation or on other KayPENTAX products, please contact KayPENTAX or your local representative.

Click here for the PDF version of this document.