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

Abstract

AimThe chin‐down posture is a widely used compensatory manoeuvre for patients with dysphagia. The aim of this study was designed to systematically measure the effectiveness of chin‐down manoeuvre application.MethodologyWe retrieved the PubMed, Web of Science, Embase, Cochrane Library, EBSCO, Medline, CNKI, WANFANG, VIP and SinoMed databases from inception to 30 August 2022. Raters independently screened literature according to inclusion and exclusion criteria. The quality of the included literature was evaluated, and data were extracted. The software Review Manager software 5.3 was used for statistical analysis.ResultsFourteen studies with a total of 571 patients were included in this meta‐analysis. The meta‐analysis indicated that chin‐down manoeuvre could significantly reduce the risk of aspiration (MD = −1.35, 95% CI [−2.25, −0.44], Z = 2.92, p < .01), decrease the chin angle (MD = −12.20, 95% CI [−14.61, −9.79], Z = 9.91, p < .001), shorten oral transit time (MD = −0.81, 95% CI [−1.20, −0.43], Z = 4.17, p < .001), reduce the maximum swallowing pressure at upper oesophageal sphincter (MD = −82.07, 95% CI [−112.77, −51.37], Z = 5.24, p < .001) and decrease pharyngeal residue.ConclusionsExisting evidence indicated that chin‐down manoeuvre could reduce the risk of aspiration and pharyngeal residue, decrease the maximum swallowing pressure at UES. More large‐sample, high‐quality clinical trials are still needed in the future to further ascertain the results of this research.

User-centred design, validation and clinical testing of an anti-choking mug for people with Parkinson’s disease

“…The mechanisms by which the aspirations were reduced were likely to be several, first related to a more effective posture of the individuals as shown by a significantly larger neck flexion angle in those using anti-choking mugs compared to those with sham mugs. As the evidence suggests that oral transit time is shortened with chin-down manoeuvre 13 , a significantly longer drinking time demonstrated in our study with anti-choking mugs is likely to reflect an effective control of water flow within the mug due to the curved surface of the inside slope and the half-circular hole, located at the cup's edge that regulates the water flow rate and the sip volume. The revised version of the prototype also includes other supportive mechanisms include increased stability of individuals with PD when holding anti-choking mugs as a result of ergonomically designed handles that incorporate anthropometric changes of hand grip in PD and a hidden pill dispenser (Fig.…”

“…Employing the chin-down manoeuvre when drinking was shown in a systematic review and meta-analysis to reduce the risk of aspiration, pharyngeal residue, and to decrease the maximum swallowing pressure at upper oesophageal sphincter in individuals with dysphagia, including those with PD 13 . However, these compensatory strategies are not effective in everyone with PD and should be evaluated on a case-by-case basis 8 .…”