Effectiveness of Chin-tuck Maneuver to Facilitate Swallowing in Neurologic Dysphagia

Abstract

Introduction The chin-tuck maneuver is the most frequently employed postural maneuver in the treatment of neurogenic oropharyngeal dysphagia caused by encephalic vascular strokes and degenerative diseases. Objective The purpose of this study was to investigate the effectiveness of this maneuver in patients with neurogenic dysphagia and factors that could interfere in it. Methods In this retrospective cohort, we analyzed the medical files and videofluoroscopy exams of 35 patients (19 male – 54% and 16 female – 46%; age range between 20 and 89 years old; mean = 69 years). Results The results suggest that the effectiveness of chin-tuck maneuver is related to the overall degree of dysphagia: the more severe the dysphagia, the less effective the maneuver. Conclusion Chin-tuck maneuver should benefit dysphagic patients with delay in the swallowing trigger, reduced laryngeal elevation, and difficulties to swallow liquids, but is not the best compensatory strategy for patients with severe dysphagia.

The Effect of Chin-Down Position and Bolus Volume on Swallow-Induced Respiratory Measures in Young Healthy Adults

“…This study made a similar attempt but included deglutition episodes, and found prolonged swallow-induced respiratory apnoea with chin-down position with the differences reaching statistical significance in higher bolus volumes. Increased duration of swallow apnoea may be a functional consequence of altered anatomical dimensions of pharyngeal structures with chindown [23,39] and may be one of the factors that effectively augment airway decoupling in persons with dysphagia [40,41]. However, this finding implies that this posture may not be effective in persons with respiratory insufficiency, and associated swallowing difficulties.…”

Changes in the coordination between respiration and swallowing from suckling through weaning

“…Muscle activity and tongue kinematics differ during head-down drinking compared with suckling in infant pigs [1], and food consistency has been found to alter motor patterns and kinematics during feeding [9,10]. Similarly, head posture affects the coordination of swallowing and breathing: the 'chin tuck' is a common practice to alter swallowing kinematics and reduce aspiration in adult humans [11][12][13]. Changes in food texture and food acquisition occur across the weaning process and influence muscle function and kinematics.…”

Sole‐ground contact and sitting leg position influence suprahyoid and sternocleidomastoid muscle activity during swallowing of liquids

“…In the treatment of patients with dysphagia, compensatory techniques and rehabilitation strategies to improve dysphagic swallows by altering bolus flow have been widely designed and used (Ohmae et al, ; Solazzo et al, ). Postural adjustments are one such compensatory technique, improving dysphagic swallows by changing the angle and position of the head and body, thereby resulting in changing the velocity and direction of bolus flow (Ertekin et al, ; Park, Seo, Ko, & Park, ; Saconato, Chiari, Lederman, & Gonçalves, ; Shanahan, Logemann, Rademaker, Pauloski, & Kahrilas, ). Both the reclining (Park et al, ) and the chin‐tuck position (Saconato et al, ) reduce aspiration in dysphagic patients.…”

“…Postural adjustments are one such compensatory technique, improving dysphagic swallows by changing the angle and position of the head and body, thereby resulting in changing the velocity and direction of bolus flow (Ertekin et al, ; Park, Seo, Ko, & Park, ; Saconato, Chiari, Lederman, & Gonçalves, ; Shanahan, Logemann, Rademaker, Pauloski, & Kahrilas, ). Both the reclining (Park et al, ) and the chin‐tuck position (Saconato et al, ) reduce aspiration in dysphagic patients. The clinical benefits of applying postural adjustments singly or in combination are effective in 80–90% of dysphagia patients(Logemann, Rademaker, Pauloski, & Kahrilas, ).…”

“…Both the reclining (Park et al, 2013) and the chin-tuck position (Saconato et al, 2016) reduce aspiration in dysphagic patients. The clinical benefits of applying postural adjustments singly or in combination are effective in 80-90% of dysphagia patients (Logemann, Rademaker, Pauloski, & Kahrilas, 1994).…”