Simulação computacional para treinamento perceptivo-visual da classificação dos resíduos faríngeos na videoendoscopia da deglutição

Abstract

The accumulation of pharyngeal residues relates to swallowing efficiency and can be visualized using fiberoptic endoscopic evaluation of swallowing (FEES). Training to classify this visual-perceptual parameter increases the reliability of the classification and is recommended in the literature. Using computer simulators can contribute to professional training by making it possible to automatically evaluate the participant's performance through situations that replicate real experiences in the clinical context, potentially improving the quality of pharyngeal residue classification. This thesis argues that it is possible to provide and measure training for the classification of pharyngeal residues in FEES through computer simulation. Therefore, this study aimed to propose and develop a perceptual-visual training computer simulator capable of evaluating the user's ability in classifying pharyngeal residues in FEES. To achieve this, information reviewed in the literature was used to understand how traditional training is conducted and to identify important aspects for the development of computer-based training. The necessary requirements for such training were identified and used to propose and to implement a decision model to assess the user's perceptual-visual ability. Additionally, the extraction of variables and values for training was based on the processing of videos and the classification of a database of pharyngeal residues in FEES by experts. The outcome of this research resulted in the development of the DeglutSIM simulator to train the classification of pharyngeal residues in FEES, using video clippings labeled by experts and a performance index based on intra-rater reliability and accuracy. DeglutSIM was implemented with a rule-based system (RBS) based on classical logic as an intelligent decision model for evaluating user performance, based on classification made by experts. The simulator has two evaluation stages for evaluation: leveling, where cases that are easier to classify are presented; and practice, in which all types of cases are presented. The simulator's usability was assessed using the System Usability Scale (SUS) questionnaire. As a result of the usability evaluation, an average SUS score of 92.7 was obtained out of a maximum score of 100, classified as the "best possible". Inter-rater reliability, as measured by the weighted Kappa test, was moderate to perfect in most of the comparisons, which demonstrates the consistency of the system's usability evaluation among users. In this way, DeglutSIM proved to be a tool with the potential to help perceptual-visual training in the classification of pharyngeal residues in FEES, with a high degree of usability and agreement between the evaluators, which shows the validity of the evaluation.