Bulow et al., (2001) tested patients with moderate to severe dysphagia.May reduce aspiration if the epiglottis is tilted backward and diverts material away from the top of the airway.They noted that chin-down eliminated aspiration in only 50% of patients with a pharyngeal delay Shanahan et al., (1993) studied the chin-down posture in 30 patients with neurological impairment who had aspiration before the swallow. Increases probability material will sit in valleculae if the pharyngeal swallow is delayed.Widens the valleculae space in some patients.Narrows the laryngeal vestibule/airway entrance.May help if tongue-base retraction is reduced, as the tongue base is closer to the pharyngeal wall.Pushes the tongue base and the epiglottis back.Pushes the anterior wall of the pharynx back.(Per Welch et al., 1993 who used the term chin tuck Logemann, 1993 who used the term chin down in her text Shanahan et al., 1993 who used the term chin-down) Good thing there is instant replay! Why to use a Chin Tuck and/or Chin Down: He takes a sip of his drink, tucks his chin, hears “ he shoots,” and he swallows while the TV shouts: “ he scores!” Insert 4-letter word of choice. Here is a scenario to ponder: an 80 year-old hockey fan eats his dinner on a tray table in front of the TV. We better make sure that this safe-swallow technique works before we mandate someone look down all throughout a meal! Imagine being told to use a chin tuck every time you drink. However, if a technique works once, the clinician should double check the effectiveness over at least 2-3 trials. The Modified Barium (MBSS) and the Fiberoptic/Flexible Endoscopic Evaluation of Swallowing (FEES) provide ways to evaluate the effectiveness of postural techniques. Yes, the chin tuck can make the swallow less safe! I will share evidence in this blog that the chin tuck/chin down posture may actually cause aspiration and worsen the swallow for some patients. However, making a recommendation without any evidence to support its efficacy is an unethical practice. ![]() These professionals mean well and ultimately are trying to help prevent aspiration. No other safe-swallowing technique gets over-recommended as much as the chin tuck or chin down, or whatever you call it!Įvery week on the job, I hear doctors and nurses instructing patients to use this very specific postural technique.
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