Somatosensory entrainment of suck in preterm infants: NTrainer
Contents
1. window will appear on the main program window for the user to select the patient Highlight the patient s name you wish to test and click OK 17 NTrainer RT CNL U of Kansas C NTrainer RT Patienl s Tools Help STIMULUS PULSE f FirstName LastName Birth Date 0 i Good Sucker 5 5 2005 Doe 124 2006 Doe 1 26 2006 PatientIno i Patient ID Patient First Name Patient Last Name a DOB E j A N Trainer Cycles for Current Visit I Age at Test days Cumulative N Trainer Cycles for AIl Visits User Name Lawrence Figure 14 Main program window with the Patient List submenu option list displayed The user may Stop and Resume the patterned orosensory stimulus delivery by simply clicking on the window shown in Figure 15 The pacifier receiver of the NTrainer unit is instrumented with a wireless mouse Figure 16 which allows the user to remotely Start Stop and Resume stimulus delivery while attending to the infant In this way the user does not need to interrupt direct intervention or handling of the infant since program control can easily be directed from the wireless mouse 18 NTrainer RT STIMULUS PULSE f v o 100 p 1 i 1 1 1 1 1 1 1 1 1 40 40 5 4 415 42 425 43 43 5 44 44 5 45 Time s Jaw V 0 54 10 T T T T J T T T i 1 40 40 5 4 41 5 42 425 43 43 5 44 44 5 45 Time s Patient Info Visit Info Visit2. 2 Patient ID L2 Test Date 6 8 2006 mm dd pyyy Patient First Name Doe Age at Test 158 days Patient Last Name A DOB naz mm dd yy N Trainer Cycles for Current Visit 48 Cumulative N Trainer Cycles for All Visits 138 User Name Lawrence Figure 15 Example of an NTrainer RT main program 19 CNL U of Kansas NTrainer RT CNL U of Kansas Figure 16 Remote control for NTrainer RT Wireless Mouse and regular mouse User could control NTrainer by both of them 20 NTrainer RT CNL U of Kansas 2 3 Review an NTrainer data file using NTrainer RT Select Patient gt Open A Patient List will appear and the user can select the patient s file to review Figure 17 NTrainer RT Patient Settings Tools Help FirstName LastName Birth Date Good Sucker 174 2006 1 26 2006 Patient Info Patient ID Patient First Name Age at Test Patient Last Name DOB TA 72006 mm dd yyyy N Trainer Cycles for Current Visit I 66 Cumulative N Trainer Cycles for All Visits 156 User Name Lawrence Figure 17 Main window program of Patient List 21 GSI NTrainer RT Patient Settings Tools Help NTrainer RT STIMULUS PULSE V 36 1 36 5 37 37 5 38 38 5 39 SSURE cm H20 User Name Lawrence Figure 18 10 S 0 100 z i 1 1 1 1 1 1 1 1 1 1 35 35 5 36 36 5 37 37 5 38
3. 38 5 39 35 40 Time s Jaw V 0 5 4 104 T T T T T T T T T i 35 35 5 36 36 5 7 37 5 38 38 5 39 39 5 40 Time s 44 gt Patient Info Visit Into Visit Patient ID L2 Test Date 6 8 2006 Patient First Name Doe Age at Test 158 days Patient Last Name A DOB mazos mmddyy N Trainer Cycles for Current Visit 30 Cumulative N Trainer Cycles for All Visits 156 CNL U of Kansas mm dd ypyyy Main window of a patient s NTrainer data file After a patient file is selected all of the patient s personal parameters and the corresponding NTrainer data file will be shown as exemplified in Figure 18 Note that the user can select a previously completed NTrainer session file by simply choosing it at the Visit icon 22 NTrainer RT CNL U of Kansas 3 References Finan DS amp Barlow SM 1998 Mechanosensory modulation of non nutritive sucking in human infants Journal Early Human Development 52 2 181 197 Barlow SM Finan DS amp Park S Y 2004 Central pattern generation and sensorimotor entrainment of respiratory and orofacial systems In B Maassen W Hulstijn R Kent H F M Peters P H M M van Lieshout Eds Speech Motor Control in Normal and Disordered Speech Oxford University Press 211 224 Barlow SM amp Estep M 2006 Central pattern generation and the motor infrastructure for suck respiration and speech Invited paper J Communicative Disorders in press Barlow SM amp Finan DS 2
4. 006 A new therapeutic method for entraining the suck central pattern generator CPG in the premature infant Society Pediatric Research 3153 Barlow SM Finan DS Seibel L Chu S Poore M Zimmerman E Urish M Estep M 2006 Translational neuroscience using patterned somatosensory stimulation to entrain oromotor activity in premature infants 5th International Conference on Speech Motor Control June 7 10 Nijmegen The Netherlands 23
5. Cancel an days Cumulative N Trainer Cycles for All Visits Figure 10 Main window program of Stimulus Pulse Attributes 13 NTrainer RT CNL U of Kansas The Graph Settings submenu provides user access to Y axis and X axis display settings for Stimulus Pulse Intraluminal Suck Pressure and Jaw as shown in Figure 11 C NTrainer RT STIMULUS PULSE V SUCK PRESSURE cm H20 5 4 Graph Settings Graph Settings Stimulus Pulse Suck Pressure Y Axis Y Axis Min A y Min 333 333 cm H20 Max 50 V Max 333 333 cm H20 in 10 0 10 0 W Auto Scale W Auto Scale Auto Scale X Axis Period co Patient Info Visit Patient ID Test Date es mm dd yyyy Patient First Name el Age at Test ai days Patient Last Name a DOB ai mm dd yyyy N Trainer Cycles for Current Visit Cumulative N Trainer Cycles for All Visits User Name Lawrence Figure 11 Main program window with the Graph Settings menu option list displayed 14 NTrainer RT CNL U of Kansas The Change User submenu allows the user to choose the data collection sites i e NICU hospital test locations as shown in Figure 12 E NTrainer RT STIMULUS PULSE V Change User Select a User zz 5 4 1 k 1 iT 1 1 1 1 1 1 0 1 2 3 4 5 6 ch 8 9 10 Time s Patient Info Visit Info Visit Patient ID Test Date as mm dd yyyy Patient First N
6. Somatosensory entrainment of suck in preterm infants NTrainer R Vantipalli J Wang amp S M Barlow CNL Technical Research Report 2006 3 1 23 University of Kansas Lawrence Kansas USA Reprint available at www ku edu cnl NTrainer RT CNL U of Kansas Table of Contents 1 PN ED PAINE T RT Sep Secs tentoni e gort dated tech eee gee as oae sans 3 1 1 Hard Wales ee Beek ie ee Res Sele Gis REN area 3 1 2 OI NANTE I a oA E EEE 5 1 3 Program Installation ns osscar eein ia nii a Ea pE N E 6 2 User MA ental af seg eet lec Saas a a ot e ee R ai od a da 8 2 1 Overview of menu bar OptionS ssssssssssessesseseseressetesstesseesseesseeessseesseesseesseeeseet 9 2 2 Record new data using NTrainer RT sscssscacccsisssossestesseqetnaisaccassasecaeatiaaseossnateiaees 16 22L SOW 1O CLe ALG a Te W TLE oes 2c ccetes sna e aa aE ania 16 2 2 2 How to provide NTrainer RT neurotherapeutic oral stimulation 0 17 Zo Review an NTrainer data file using NTrainer RT eee eeeeeeeeceeeeeeeeceteeeeeneees 21 Drs Referenc Seisoin ueue aa E Ea aee Aa E GS E SEa 23 NTrainer RT CNL U of Kansas 1 NTrainer RT Setup NTrainer RT real time was created for simulation of suck pressure of non nutritive suck NNS which in turn is used to train the sucking ability of premature babies with no functional suck or at risk for developmental disabilities A biphasic square wave pulse pattern with a pulse frequency similar to NNS is writt
7. age at test and a cumulative history of stimulation parameters stimulus train characteristics amplitude frequency pulse width pulse rate pulse length train rate and number of pulses generated per session NTrainer RT CNL U of Kansas 1 3 Program Installation Uninstall any previous installed versions of NTrainer RT using Control Panel gt Add Remove Programs Install NTrainer RT by running setup exe from the installation package Note Normally it works with BNC 2090 Figure 3 To work with BNC 2110 Figure 4 BNC terminal box please make the following change Figure 4 BNC 2010 For BNC 2110 To work with BNC 2110 terminal configuration has to be in differential mode The Terminal configuration can be set to differential mode by modifying the parameter value of NTrainer RT CNL U of Kansas defaultAiTerminalConfig to 1 under lt systemConstants gt section in the file NTrainer exe config located in C Program Files Neuro Logic NTrainer RT Here is the line from NTrainer exe config that shows this parameter value lt add key defaultAiTerminalConfig value 1 gt defaultAiTerminalConfig can have the following values value 1 for Differential value 2 for Referenced single ended value 3 for Nonreferenced single ended By default the file NTrainer exe config contains value 3 for defaultAiTerminalConfig This setting is used to work with BNC 2090 Here is the line from NTrain
8. ame 4 Age at Test days Patient Last Name _ poe e vadia N Trainer Cycles for Current Visit Cumulative N Trainer Cycles for All Visits User Name Topeka Figure 12 Main program window of users 15 NTrainer RT CNL U of Kansas 2 2 Record new data using NTrainer RT 2 2 1 How to create a new file Select Patient gt New and fill in the response field for data file name and click OK A window message will appear on the main window screen to inform the user that the patient s information has been added into the database as shown below Figure 13 STIMULUS PULSE V URE cm H20 5 4 New Patient Details Patient Info 4 1 1 1 1 0 1 2 3 4 Siau Patient ID 10 Patient First Name 54 Patient Last Name a i f i i DOB 01 26 2006 mm dd yy 0 1 2 3 4 Patient Info Patient ID Test Date mm dd yyyy Patient First Name Age at Test days Patient Last Name DOB Coo AAA N Trainer Cycles for Current Visit Cumulative N Trainer Cycles for All Visits User Name Lawrence 16 NTrainer RT CNL U of Kansas NTrainer RT l Patient details added to database succesfully Figure 13 Main program window of New Patient Details 2 2 2 How to provide NTrainer RT neurotherapeutic oral stimulation After entering patient s information into the NTrainer RT database refer 2 2 1 the user can provide neurotherapeutic oral stimulation by selecting Patient gt Test A Patient List
9. ays Patient Last Name C DOB E i TEN N Trainer Cycles for Current Visit Cumulative N Trainer Cycles for All Visits User Name Lawrence Figure 7 Main program window of creating a new patient database Selection of New option will allow the user to insert the patient s information such as Patient ID Patient First Name Patient Last Name and DOB see Figure 7 10 NTrainer RT CNL U of Kansas OS NTrainer RT Patient EAUS Tools Help DAQ I Stimulus Pulse Graph ji Change User 4 1 1 1 1 1 I 1 1 1 1 0 2 3 4 5 6 7 8 9 10 SUCK PRESSURE cm H20 5 4 1 1 1 1 1 1 1 1 1 G 0 1 2 3 4 5 6 7 8 3 10 Time s Jaw V 10 54 0 1 1 I 1 1 1 1 1 1 1 0 1 2 3 5 6 7 8 3 10 Time s Patient Info Visit Into Visit Patient ID Test Date mm dd yy Patient First Name Age at Test days Patient Last Name DOB Eo mm dd yyyy N Trainer Cycles for Current Visit Cumulative N Trainer Cycles for All Visits User Name Topeka Figure 8 Main program window with the Settings menu option list displayed The Settings menu Figure 8 provides user access to DAQ Stimulus Pulse Graph and Change User User may adjust the parameters within each submenu s dialog box 11 NTrainer RT CNL U of Kansas The DAQ submenu allows the user to select the Device Type and map analog to digital channel ADC assignments for Stimulus Pulse Suck Pressure and Jaw as shown in Figure 9 Patie
10. en onto channel DACO of the NI 6052E PCI DAQ board At the same time up to three analog channels are sampled including the output of the DAC intraluminal nipple pressure and jaw kinematics or other desired channel i e oxygen saturation pressure 1 1 Hardware The Hardware for NTrainer includes gt A PC with Windows XP and 1 GB RAM gt NI DAQ 6052E PCI multifunction I O card gt Position Servo controller BioCom Electronics LLC gt Bridge amplifier s 2 channels gt Pneumatic pressure cylinder actuator gt Linear Motor gt Pressure transducer The hardware listed above is shown in Figure 1 Most of the hardware linear motor pneumatic pressure actuator power amplifier pressure transducer etc is concealed in a shielded cabinet within a wheeled cart which is position cribside in the NICU A detailed view of the linear motor actuator and air cylinder with pressure lines pressure transducer and Luer fittings is given in Figure 2 NTrainer RT CNL U of Kansas Figure 1 NTrainer RT hardware set up NTrainer RT CNL U of Kansas Figure 2 Linear Motor pneumatic actuator assembly 1 2 Software NTrainer RT is coded by C 5 448 coding lines This software performs the function of controlling the start and stop of the synthesized patterned orofacial somatosensory stimulation generating the impulse with NNS pattern and updating an integrated database of patient parameters including patient ID birth age
11. er exe config that shows this parameter value lt add key defaultAiTerminalConfig value 3 gt NTrainer RT CNL U of Kansas 2 User Manual To run NTrainer RT double click on the program icon The main program should appear with a menu bar along the top three blank waveform panels along the upper half of page patient s information on the bottom left side and patient s visit information displayed along the bottom right margin As shown below Figure 5 the menu bar has four active options including Patient Settings Tools and Help OS NTrainer RT Patient Settings Tools Help STIMULUS PULSE V SUCK PRESSURE cm H20 04 1 1 1 1 1 1 1 1 1 5 Time s 0 1 2 3 5 7 8 3 10 Time s Patient Info Visit Info Visit Patient ID Test Date mm dd yyyy Patient First Name Age at Test days Patient Last Name DOB A N Trainer Cycles for Current Visit Cumulative N Trainer Cycles for AII Visits User Name Topeka Figure 5 Main program window of the NTrainer RT user interface The bottom of the program window appears with the Patient s information and Visit information The Patient s information panel includes the Patient s ID First Name Last Name and Date of Birth DOB The Visit Information panel includes the total number of Ntrainer NTrainer RT CNL U of Kansas Visits Test Date Age at Test NTrainer Cycles for Current Visit and Cumulative NTrainer Cycles for All Vi
12. nt Info Patient ID Patient First Name DOB User Name Lawrence Patient Last Name DAQ Device A jao Sample Rate Buffer Size Channels Stimulus Pulse Al Channel Physical Unit Voltage A D Min A D Max STIMULUS PULSE V 1000 samples s 5 s Suck Pressure Al Channel fact I 10 em H20 Jos vy A D Min 10 10 v joo z i E I G s vy Boo v Physical Unit Voltage A D Max N Trainer Cycles for Current Visit P m Cumulative N Trainer Cycles for All Visits Jaw Al Channel Physical Unit Voltage A D Min A D Max ACH2 J 1 uv 1 v 10 10 v Figure 9 Main program window with the DAQ Settings submenu option list displayed 12 NTrainer RT CNL U of Kansas The Stimulus Pulse submenu contains scaling options for Pulse Rate Hz Pulse Train length number of pulses Pulse Amplitude Volts Pause Period seconds and Train Rate Hz as shown below Figure 10 STIMULUS PULSE fy Patient Info Patient ID Patient First Name DOB User Name Lawrence Patient Last Name m m m 4 5 Time s fv 1 1 4 5 Time s Visit h Ere Stimulus Pulse Attributes Stimulus Pulse Attributes Pulse Rate Pulse Train Pulse Amplitude Pause Period Train Rate Visit Test Date Age at Test N Trainer Cycles for Current Visit E a 08 2h 0 1875 Hz
13. sits 2 1 Overview of menu bar options As shown in Figure 6 selecting Patient allows the user to choose a New file name for the recording session EE NTrainer RT nas Settings Tools Help New Ctrl N Open Ctrl O Test Ctrl T Page Setup Print Ctrl P Exit Ctrlex 0 1 1 1 1 1 1 1 1 1 1 Time s 0 1 2 3 4 5 6 7 8 3 10 Time s Patient Info Visit Into Visit Patient ID Test Date mm dd pyyy Patient First Name Age at Test days Patient Last Name DOB e Quitters N Trainer Cycles for Current Visit Cumulative N Trainer Cycles for All Visits User Name Topeka Figure 6 Main program window with the Patient Info menu option list displayed This menu is divided into three function blocks The first block contains three options The first option for creating a new data filename the second option for opening an existing file for data analysis and the third option for opening an existing file for NTrainer RT stimulation The second block contains page setup and printing options The final block contains the Exit command NTrainer RT CNL U of Kansas C NTrainer RT STIMULUS PULSE f SUCK PRESSURE cm H20 54 New Patient Details Patient Info 4 1 1 1 1 0 1 2 3 4 Patient ID 10 Patient First Name A 54 Patient Last Name 0 i i i DOB 017017200 mm dd yy 0 1 2 3 4 cae Patient Info Patient ID Test Date mm dd pyyy Patient First Name Age at Test d
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