Effectiveness of chin-down posture to prevent tracheal aspiration in dysphagia secondary to acquired brain injury. A videofluoroscopy study.
BACKGROUND
The chin-down posture is generally recommended in patients with neurogenic dysphagia to prevent tracheal aspiration; however, its effectiveness has not been demonstrated.


OBJECTIVE
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).


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
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.
Functional Digestive Rehabilitation Unit, Institut Guttmann, Neurorehabilitation Hospital, University Institute affiliated with the Autonomous University of Barcelona, Badalona, Spain. rterre@guttmann.com
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Terré
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Mearin
D000293:Adolescent; D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D001930:Brain Injuries / Q000150:complications*; D006259:Craniocerebral Trauma / Q000150:complications; D018592:Cross-Over Studies; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000209:etiology* / Q000517:prevention & control*; D005260:Female; D005471:Fluoroscopy; D005772:Gastrointestinal Transit / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000503:physiopathology; D011015:Pneumonia, Aspiration / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control*; D011187:Posture / Q000502:physiology*; D020521:Stroke / Q000150:complications*; D055815:Young Adult