The effect of reclining position on swallowing function in stroke patients with dysphagia

Abstract

Background Dysphagia is a common problem in patients with a history of stroke. In Japan, a reclined position is commonly used as a compensatory technique to address this problem. Objective To evaluate the effect of reclined position on swallowing function in patients with stroke who had dysphagia. Methods A retrospective analysis was carried out on the videofluoroscopic examination of swallowing (VF) of 4ml honey‐thick liquid swallows collected over 9 years. Penetration‐aspiration scale (PAS) and residue scores were compared for the following: a body position at 90° upright (90°U) and 60° reclining (60°R) groups, as well as 60°R and 45° reclining (45°R) groups. Results Two hundred and five records from 98 subjects were reviewed. These included patients with ischaemic stroke (62%), haemorrhagic stroke (32%) and subarachnoid haemorrhage (6%). PAS scores were lower when the body was in a more reclined position (P < .001). The amount of residue in the valleculae and pyriform sinus also reduced in the more reclined position (P < .001). The deeper bolus head at swallowing onset was positively correlated with severe PAS (P < .001). Conclusions These findings suggest that in patients with stroke who had dysphagia, a reclined position may be useful in reducing the risk of penetration and aspiration, and in decreasing the amount of residue in the pharyngeal area. The depth of the bolus head at the onset of swallowing increases the severity of penetration and aspiration.

Effects of head flexion posture in patients with dysphagia

“…VF was performed at 30 frames/s. VF is usually performed in the sitting position, but the reclining position was used as necessary to reduce the risk of penetration and aspiration 12 …”

“…VF is usually performed in the sitting position, but the reclining position was used as necessary to reduce the risk of penetration and aspiration. 12 When abnormalities such as aspiration or deep penetration were detected in patients, the head flexion posture was sometimes attempted at our institution. We instructed the patients to bring the chin as close as possible to the neck without flexing the neck as a head flexion posture.…”

The Contribution of Temporal Flat Lateral Position on the Mortality and Discharge Rates of Older Patients with Severe Dysphagia

“…Upon observation of a delay in swallowing or a swallowing dysfunction with no confirmed aspiration, the patients were diagnosed with dysphagia and rehabilitated by speech therapists. If aspiration was confirmed, they underwent a video fluoroscopic examination (VF) for the appropriate suggestion of food [23]. Dysphagia was defined based on the diagnosis of an otorhinolaryngologist.…”

Safety and performance of oropharyngeal muscle strength training in the treatment of post-stroke dysphagia during oral feeding: protocol for a systematic review and meta-analysis

“…The primary purpose of swallowing treatment is to reduce the incidence of aspiration and increase the level of oral feeding. Traditional dysphagia treatment includes oral facial massage,6 thermal tactile stimulation7 and various compensatory methods 8 9. Although they can help patients begin to attempt oral feeding promptly, they do not facilitate the recovery of neural networks in regions of the cerebral cortex associated with swallowing, and training efficacy is short-lived 10–12.…”

“…Traditional dysphagia treatment includes oral facial massage, 6 thermal tactile stimulation 7 and various compensatory methods. 8 9 Although they can help patients begin to attempt oral feeding promptly, they do not facilitate the recovery of neural networks in regions of the cerebral cortex associated with swallowing, and training efficacy is short-lived. 10–12 Modalities for improving oropharyngeal muscle strength such as tongue-to-palate resistance training (TPRT), 13 Shaker exercise, 14 Iowa Oral Performance Instrument (IOPI), 15 tongue-strengthening exercises (TSEs) 16 and chin tuck against resistance (CTAR) exercise 17 use isometric or isokinetic muscle contractions to improve the strength and endurance of swallowing-related muscles.…”