Why chin tuck dysphagia

Appropriate body position can minimize the risk of aspiration and is essential for patients with a diagnosis of dysphagia to reduce their likelihood of inhaling materials into the lungs.

The first steps towards a safe mealtime should be taken well before a meal. The person who is going to eat should be well rested before starting to eat. They should also have time to become calm and not be over stimulated.

Tiredness and over stimulation can both lead to swallowing difficulties. Additionally, in preparation for mealtime, they should be wearing their glasses that should be clean , and their hearing-aid and false teeth if any of these items are needed. Being able to see, hear and chew properly greatly enhances the safety and enjoyment of mealtimes and yet these items are frequently overlooked, especially for people who are fed.

This is called a gastrostomy tube , or G-tube. Because it is inserted by way of an endoscope, it is commonly known as a PEG-tube , for percutaneous endoscopic gastrostomy.

Keep in mind that even with tube feeding a person can aspirate. The combination of saliva, bacteria, and a faulty swallowing mechanism can result in aspiration pneumonia. Diet modification and tube feeding can serve as a bridge to the future — a future with a functional, relatively safe swallow. Many stroke patients, for example, will be able to resume eating a normal diet within a few weeks to a few months.

So be patient. Follow the treatment plan. While healing and therapy are underway, your understanding and support as a loving caregiver can help prevent dangerous slip-ups. It could cost him his life.

Prostheses and Surgery In some patients with head and neck cancer, a prosthetic soft palate can be designed to prevent nasal regurgitation. For palatal paralysis after a stroke, surgical attachment of the paralyzed portion to the throat can reduce nasal regurgitation and lessen the risk of aspiration. Direct injection of botulinum toxin into the lower esophageal sphincter can cause it to relax, allowing for months of symptomatic benefit.

Surgical procedures include stretching or cutting the LES to widen it. The mouth, gums, and dentures provide a fertile environment for germs that can make their way from mouth to lungs to cause life-threatening aspiration pneumonia.

Oral care includes the use of a toothbrush manual or electric for teeth and dentures; swabs to moisturize and soothe the lips, tongue, and cheeks; mouth rinses containing antibacterial agents as directed by the dentist ; and suctioning of pooled saliva, which is likely to be teeming with bacteria.

They touch upon the following:. Not all suggestions will apply to every situation. Highlight those you consider most useful, or transfer to another sheet of paper. Check with your swallowing specialist as to what suits your particular circumstances. Post your list in the kitchen, dining room, or other eating area.

Copy and share with other caregivers. Ongoing Evaluation and Treatment Treatment of swallowing problems is an ongoing process. Several sessions over several months may be required to meet treatment goals. The initial plan may not be the final plan. The swallowing specialist will follow the patient over time, monitoring progress at the bedside or in the office. She will arrange for further testing as needed and make necessary adjustments to the diet. If you think the treatment plan is no longer suitable, let them know in what way as soon as possible.

In the next chapter, we will show you how to put your questions, observations, and concerns to use in getting help for your loved one. Please remember, we are not able to give medical or legal advice.

If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only. They are trained to assist in releasing the restrictions that are inhibiting swallowing. The best special cup we bought for my sister was RiJe Dysphagia Cup.

We adjusted it to dispense the portion size she likes and it dispenses exactly that, one sip at a time. She loves the red color and the big handles very comfy for her. It is available on Amazon, is filled with information about dysphagia and includes all the puree recipes I prepared for my mom when she could no longer swallow properly. Arlington, VA E-mail Phone: Related Content:. Overview of Causes of Swallowing Difficulty Preparatory Loss of smell or taste sensation; lack of saliva; weak chewing muscles; painful gums, cheeks; poorly-fitting dentures; poor tongue control; mouth-breathing Oral Part of tongue missing, impaired tongue control, sensory loss Pharyngeal Absent or delayed reflex, muscle paralysis or weakness, sensory loss, diverticula, lack of coordination with breathing Esophageal Malfunction of upper and lower esophageal sphincters achalasia, GERD ; lack of esophageal motility; stiffness, stricture, or compression of esophagus A Structural, Neurologic, or General Disease Process Can Act at Any Phase.

The goals of treatment are: to get to a state where swallowing accomplished as safely as possible minimizing the risk of choking or aspiration , to ensure adequate nutrition and hydration, and to accomplish the first two goals as pleasantly as possible. By this point, you should have a basic knowledge of swallowing, a sense of where things can go wrong, and why: a medical condition congestive heart failure or pulmonary disease , a neurologic disorder stroke or Parkinson disease , a structural problem cancer surgery removing part of the tongue , and complicating effects of medication dry mouth or altered sense of smell.

Investigation of compensatory postures with videofluoromanometry in dysphagia patients. Chin-down posture effect on aspiration in dysphagic patients. Arch Phys Med Rehabil ;74 7 we investigated factors that could interfere with the effectiveness of this maneuver in patients with neurogenic dysphagia.

The exams were performed between June and August , in a major Brazilian university hospital. All patients were under treatment in the Clinic for Functional Rehabilitation of Swallowing Disorders of the University Hospital, and have signed a formal consent to participate in this study.

We eliminated any incomplete and unintelligible files and poor quality videofluoroscopic images. From the physical exams we considered the presence of abnormalities in oropharyngeal functions, which are defined by alterations in mobility, sensibility, tonus, muscular strength, movement amplitude of the lips, tongue, soft palate and mandible. To perform the videofluoroscopic exams, patients are requested to remain seated and swallow barium-contrasted food in different consistencies: thin liquid, liquid thickened to consistencies of nectar, honey, and pudding 5ml and 10ml , and solid.

In the pharyngeal phase, we evaluated laryngeal elevation using the four finger method, by which the index finger is placed submentally, the middle finger is placed on the hyoid, and the last two fingers are placed on the superior and inferior borders of the thyroid cartilage.

Poor laryngeal elevation may indicate reduced laryngeal elevation. The triggering or onset of pharyngeal swallowing is considered normal below 0. It is delayed whenever laryngeal elevation and closure of the laryngeal aditus occur after the bolus transit through the region between the oral cavity and the oral portion of the pharynx.

Neurogastroenterol Motil ;24 5 , e 11 11 Logemann JA. World J Gastroenterol ;18 23 The prevention of airway invasion during swallowing is laryngeal vestibule closure, which is achieved when the hyoid and larynx approximate.

The approximation of these two structures results in the compression of the median thyrohyoid tissue, which bulges backward as a result, closing the laryngeal entrance. J Speech Lang Hear Res ; 57 4 Laryngeal penetration and tracheal aspiration are the presence of contrasted food immediately above or below the vocal folds, respectively.

The Dysphagia Outcome and Severity Scale. Dysphagia ;14 3 Airway penetration midway to cords with one or more consistency or to cords with one consistency but clears spontaneously. Or aspiration with one or more consistency, no cough and airway penetration to cords with one or more consistency, no cough. Table 1 shows the videofluoroscopic abnormalities in the study group. The following changes were observed: delayed swallowing trigger, laryngeal elevation alteration, oropharyngeal functions alteration, liquid penetration, nectar penetration, pudding penetration, liquid aspiration, nectar aspiration and pudding aspiration.

Thumbnail Table 2 Videofluoroscopic abnormalities in the study group according to prevention or not prevention during chin-down maneuver. Table 3 shows the relationship between degree of dysphagia and CTM effectiveness. In this study we observed that the presence of alterations in oropharyngeal structures was a significant interference factor for the effectiveness of the CTM.

Indeed, especially in cases of reduced strength of facial and masticatory muscles with weak or incomplete lip sealing during swallowing causing extra-oral spills, this maneuver can be extremely difficult to perform. Some patients with reduced intra-oral sensibility and reduced tongue mobility may present poor oral motor control of the bolus, which also causes problems when performing the CTM. Some authors advocate that the anticipated flow of bolus toward the piriforms recesses may also interfere with the effectiveness of the CTM.

Arch Phys Med Rehabil ;74 7 Displacement, angle, and velocity for the hyoid, epiglottis, and vocal cords were calculated and compared. To determine intra-rater reliability, each rater analyzed the same cases twice at an interval of 1 month. Although there was an interval of just 1 month, the brightness characteristics of the images were slightly modified and the case names were changed prior to the second analysis.

A repeated-measure analysis of variance RM-ANOVA was used to compare variables among the posture subgroups using the within-subject effect. Variability in the size of body structures might have influenced the results, but did not reject the sphericity assumption of all variables. When there were significant differences among the groups, a Bonferroni-corrected pairwise comparison was used for the post hoc analysis according to the homogeneity of the variables.

To evaluate intra-rater reliability, an intraclass correlation coefficient ICC was used. Statistical analyses were performed with SPSS Values are given as the mean standard deviation. Mean displacement magnitudes and standard deviations of the hyoid bone and larynx in NEUT were similar to data reported in previous kinematic analysis studies [ 14 ].

Table 1 shows the changes in spatial variables for each posture. However, the maximal vertical displacement of the hyoid bone was not significantly different among the three postures. Figure 4 shows an example of the change in trajectory of the hyoid bone in each posture. The pooled average trajectories of the hyoid bone and epiglottic base left column. Arrow heads in each trajectory indicate the starting point. The hyoid movement trajectories during swallowing in a neutral a , a comfortable chin-down b , and a strict chin-tuck c posture are shown.

The chin-tuck posture shows a marked reduction in hyoid excursion in the horizontal direction and a slight increase in the vertical direction c. Right column. The trajectories of the epiglottic base during swallowing in a neutral d , a comfortable chin-down e , and a strict chin-tuck f posture are shown.

The backward retraction and elevation of the epiglottic base is distinctively enhanced f. Table 2 shows the velocities of the swallowing structures. During swallowing, the epiglottic base moves upward and backward, to the nasopharynx and posterior pharyngeal wall, respectively.

In the determinations of the two raters, all measurements, except for the maximal horizontal velocity of the hyoid bone 0. Inter-rater tests of the measurements also showed comparable reliabilities from 0.

In the present study, we demonstrated that the movements of the pharyngeal and laryngeal structures during swallowing are differentially influenced by head and neck postures. We evaluated not only the maximal excursion distances and velocities, but also the trajectories of the major structures. The in-depth analysis in this study revealed that the forward flexion of head and neck in the TUCK posture reduced the anteroposterior distance of the oropharynx as well as the laryngeal inlet at rest; whereas the DOWN posture had no effect on these distances.

In terms of dynamic motions during swallowing, TUCK restricts the maximal horizontal excursion of the hyoid bone, epiglottic base, and larynx. The peak velocity of the horizontal excursion of the hyoid bone was also reduced in the TUCK posture. The maximal vertical and 2D displacements of the epiglottic base were significantly increased in the TUCK posture.

In addition, the horizontal excursion of the epiglottic base was increased in the DOWN posture. The most unique feature of the present study was that our method presented the locations of the major anatomical structures at each time point during swallowing in different head and neck postures. In this way, our study demonstrated the trajectories of the structures as well as vertical and horizontal components of the movements, which have not been previously reported with regard to these postures.

The epiglottic movements during swallowing, including the tilt angle and base movement, were also novel findings. The distance from the epiglottic base to the arytenoid, which represents the laryngeal inlet, is one of the most important markers for airway protection [ 15 , 16 ].

In addition, our results suggest that TUCK may ease swallowing in patients with weak tongue-base retraction by reducing the width of the oropharynx. The TUCK posture inhibited horizontal hyoid bone movement. This can be explained by the tongue and submental muscles being compressed by the mandible in the TUCK posture. Another explanation is that a reduced excursion distance can result from decreased resting muscle length. Muscle operates with greatest contractile force when close to its resting length in an anatomical position [ 17 ].

The reason why the maximal horizontal velocity of the hyoid bone was reduced significantly may be understood in this way. On the other hand, DOWN had no significant effect on hyoid bone movement, which suggested that this comfortable posture did not compress or shorten these muscles. We suppose that the epiglottic base can, at least in part, play a role as a surrogate marker for tongue base movement, because it is located at the lower end of the tongue base.

In NEUT, the epiglottic base initially moved upward and backward, then descended toward the anterior Fig. The initial upward and backward movement may represent tongue base retraction in the pharyngeal phase of swallowing. According to a previous study concerning the mechanism of epiglottic tilt, a superior movement of the thyroid cartilage compresses the pre-epiglottic fat pad, which limits the downward movement of the epiglottic base during swallowing [ 19 ].

TUCK may enhance the dynamic compression of the fat pad, which leads to increases in the vertical and 2D movement of the epiglottic base. As the tongue base is known as a major pressure generator in swallowing [ 20 ], great and rapid tongue base retraction in TUCK can exert a higher pressure on the descending bolus.

Reduced hyolaryngeal elevation is usually considered a negative finding that can cause impaired airway protection [ 21 , 22 ]. Because the laryngeal inlet was shortened in TUCK, reduced laryngeal motion might be sufficient to protect the airway from aspiration.

Therefore, TUCK may be helpful for dysphagic patients with decreased laryngeal motion. In terms of pressure, previous studies that measured the pressure of pharyngeal constriction and pharyngoesophageal space by manometry give us clues to pressure changes in accordance with neck posture changes [ 8 , 23 — 25 ].

Recently, McCulloch [ 23 ] and Balou [ 25 ] examined manometric studies on both chin-down and chin-tuck postures, which revealed that a more tucked posture increased the duration of relaxation and decreased UES pressure.