Research Reports - Effectiveness of chin-down posture to prevent tracheal aspiration in dysphagia secondary to acquired brain injury. A videofluoroscopy study

Neurogastroenterol Motil. 2012 May;24(5):414-9

Terré R, Mearin F.

Background  The chin-down posture is generally recommended in patients with
neurogenic dysphagia to prevent tracheal aspiration; however, its effectiveness
has not been demonstrated. Aim  To videofluoroscopically (VDF) assess the
effectiveness of chin-down posture to prevent aspiration in patients with
neurogenic dysphagia secondary to acquired brain injury. Methods  Randomized,
alternating, cross-over study (with and without the chin-down posture) in 47
patients with a VDF diagnosis of aspiration [31 stroke, 16 traumatic brain injury
(TBI)] and 25 controls without aspiration (14 stroke, 11 TBI). Key Results 
During the chin-down posture, 55% of patients avoided aspiration (40% preswallow
aspiration and 60% aspiration during swallow). The percentage was similar in both
etiologies (58% stroke and 50% TBI). Fifty-one percent of patients had silent
aspiration; of these, 48% persisted with aspiration while in the chin-down
posture. A statistically significant relationship was found between the existence
of pharyngeal residue, cricopharyngeal dysfunction, pharyngeal delay time and
bolus volume with the persistence of aspiration. The chin-down posture did not
change swallow biomechanics in patients without aspiration. Conclusions &
Inferences  Only half the patients with acquired brain injury avoided aspiration
during cervical flexion; 48% of silent aspirators continued to aspire during the
maneuver. Several videofluoroscopic parameters were related to inefficiency of
the maneuver. Therefore, the indication for chin-down posture should be evaluated
by videofluoroscopic examination.

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