Influence of the Chin-Down and Chin-Tuck Maneuver on the Swallowing Kinematics of Healthy Adults

Abstract

The purpose of the study was to investigate the influence of the chin-tuck maneuver on the movements of swallowing-related structures in healthy subjects and formulate standard instructions for the maneuver. A total of 40 healthy volunteers (20 men and 20 women) swallowed 10 mL of diluted barium solution in a “normal and comfortable” position (NEUT), a comfortable chin-down position (DOWN), and a strict chin-tuck position (TUCK). Resting state anatomy and kinematic changes were analyzed and compared between postures. Although angles of anterior cervical flexion were comparable between DOWN (46.65 ± 9.69 degrees) and TUCK (43.27 ± 12.20), the chin-to-spine distance was significantly shorter in TUCK than in other positions. Only TUCK showed a significantly shorter anteroposterior diameter of the laryngeal inlet (TUCK vs. NEUT, 14.0 ± 4.3 vs. 16.3 ± 5.0 mm) and the oropharynx (18.8 ± 3.1 vs. 20.5 ± 2.8 mm) at rest. The maximal horizontal displacement of the hyoid bone was significantly less in TUCK (9.6 ± 3.0 mm) than in NEUT (12.6 ± 2.6 mm; p < 0.01) or DOWN (12.1 ± 3.0 mm; p < 0.01). TUCK facilitated movement of the epiglottic base upward (TUCK vs. NEUT, 15.8 ± 4.7 vs. 13.3 ± 4.5 mm; p < 0.01). In contrast, DOWN increased the horizontal excursion of the epiglottic base and reduced movement of the vocal cords. These results quantitatively elucidated the biomechanical influences of the chin-tuck maneuver including reduced horizontal movement of the hyoid bone, facilitation of vertical movement of the epiglottic base, and narrowing of the airway entrance. Comparing DOWN and TUCK, only TUCK induced significant changes in the airway entrance, hyoid movement, and epiglottic base retraction.

Swallowing markers in spinal and bulbar muscular atrophy

“…VFSS is also useful to evaluate the effects of adaptive swallowing methods, such as the chin‐tuck maneuver, the supraglottic swallow, and the effortful swallow. Given that the presence of pharyngeal residue is the most common finding in SBMA patients and a laryngeal penetration risk exists even in those without subjective dysphagia, we recommend the chin‐tuck maneuver and the effortful swallow as safe methods of swallowing for all SBMA patients with dysphagia 36, 37. We also reported that a 6‐week head lift exercise may improve swallowing dysfunction as measured by tongue pressure 38.…”

Swallowing Disorders in the Older Population

“…16 Postural changes, such as chin down (positioning the chin to the chest) or head turn (turning head over right or left shoulder), have been shown to change the biomechanics and pressure generation during swallowing and to reduce the occurrence of aspiration, depending on the swallow impairments present. [17][18][19][20][21] Additionally, swallowing maneuvers, such as the effortful swallow, also impact swallowing physiology and may have positive effects on pharyngeal pressure generation.…”

The effect of a wheelchair designed to prevent forward head posture on swallowing duration and integrated electromyography of suprahyoid muscles

“…[26]. This minimizes the vertical distance and increases the maximum acceleration of the hyoid bone [5], reducing both swallowing duration and iEMG.…”

“…Chin-up posture extends the suprahyoid muscle as well as opening the larynx. Therefore, even in healthy individuals, swallowing while in the chin-up posture increases the movement distance and decreases the maximum acceleration of the hyoid bone [5]. As a result, in healthy individuals, swallowing duration is prolonged and integrated electromyography (iEMG) of suprahyoid muscles is increased [6].…”