Effects of head flexion posture in patients with dysphagia

Abstract

Background The chin‐down posture is often used as a compensatory manoeuvre for patients with dysphagia. This posture presumably involves flexion of the head and/or neck, but this is not clearly defined. Objective This study aimed to assess the effects of head flexion posture in a retrospective study of videofluoroscopic examination of swallowing (VF). Methods A total of 73 patients who underwent VF both with and without head flexion posture in the lateral projection were included in the analysis. The head and neck angles at the initiation of the swallowing reflex, penetration–aspiration scale (PAS), nasopharyngeal closure time, stage transition duration, duration of laryngeal closure, time from swallowing reflex to laryngeal closure and to the opening of upper oesophageal sphincter (UES), duration of UES opening, location of the bolus leading edge at swallowing reflex, and bolus transition time were evaluated. Results The head flexion angle increased (p < 0.001), but the neck flexion angle did not change in the head flexion posture. Moreover, PAS improved (p < 0.001), aspiration was reduced (p < 0.001), the time between the swallowing reflex and the onset of laryngeal closure was shortened (p = 0.006), and the leading edge of the bolus at swallowing reflex became shallower (p = 0.004) in the head flexion posture. Other parameters did not significantly change. Conclusion The head flexion posture resulted in earlier laryngeal closure and a shallower position of the leading bolus edge at swallowing reflex, resulting in PAS improvement and decreased aspiration.

The effectiveness of chin‐down manoeuvre in patients with dysphagia: A systematic review and meta‐analysis

“…studies. 6,8,9,[20][21][22][23][24][25][26][27][28][29] Four studies were published in Korea, four studies were published in the United States of America and the rest in Japan. Included studies were published between 1993 and 2022.…”

“…Three studies did not have specific figure, 8,21,23 so only five of studies were included for data analysis. 9,20,26,28,29 The pooled data revealed moderate heterogeneity among studies (I 2 = 71%，p = .009), so we used random-effects model. The results showed that swallowing in chin-down position had a significant effect on decreasing the risk of aspiration compared with neutral position, whether thin liquid or thick liquid, and this difference was statistically significant [MD = −1.35, 95% CI (−2.25, −0.44), Z = 2.92, p < .01] (see Figure 4).…”

“…Four of the included studies reported upper oesophageal sphincter opening duration. 10,20,23,27 One study 10…”

“…Two of the included studies reported stage transition duration. 10,20 One study 10 measured stage transition duration with chin-down position and neutral position, and found that the time increased in chin-down position (2262.33 vs 973.50, p = .006). The second study showed no statistically significant difference between head flexion posture and neutral posture.…”

“…The second study showed no statistically significant difference between head flexion posture and neutral posture. 20…”