SafeSwallow: A Compact Closed-Loop Wearable Neuroprosthesis for Oropharyngeal Dysphagia—Architecture, Algorithms, Experimental Design, and Dual-Track Evaluation

Oropharyngeal dysphagia impairs oral and/or pharyngeal swallowing and can produce aspiration, residue, delayed onset, and incomplete hyolaryngeal elevation; esophageal dysphagia is outside the present scope. This paper presents SafeSwallow, a compact wearable neuroprosthesis for oropharyngeal assistance focused on hyolaryngeal/pharyngeal elevation. The architecture integrates around-ear/glasses EEG for anticipatory arming, submental sEMG, laryngeal bioimpedance (BI), contact acoustics, and IMU, with across-swallow iterative learning control under a Tier-0 safety supervisor. Evaluation used two non-clinical tracks: (i) synthetic closed-loop experiments for implementation verification, hard-plant multi-seed uncertainty, and timing-margin analysis; and (ii) public VFSS-aligned HRCA data (N_subj = 12) for real-signal detection/scheduling without BI/EEG/FES. Easy seed-7 is paper-matched (Q1 = 1.0; elev_err = 0.116). Across 20 hard-plant seeds, TinyML AUC = 0.978 ± 0.008; among detections Q1|detected = 0.963 ± 0.072, while unconditional Q1 ≈ 0.295 given miss = 0.694 ± 0.035, and false_stim = 0.216 ± 0.037—infeasible by the paper’s own criteria. On HRCA, improved detect 0.949 → 0.983 (Δ = +3.39 pp). Clinical translation requires paired multimodal data, measured EMD, and prospective human validation.