title: The effectiveness of the head-turn-plus-chin-down maneuver for eliminating vallecular residue.
abstract: Purpose When swallowing efficiency is impaired, residue accumulates in the pharynx. Cued or spontaneous swallows in the head neutral position do not always successfully clear residue. We investigated the impact of a novel maneuver on residue clearance by combining a head turn with the chin down posture. Methods Data were collected from 26 participants who demonstrated persistent vallecular residue after an initial head neutral clearance swallow in videofluoroscopy. Participants were cued to perform a head-turn-plus-chin-down swallow, with the direction of head turn randomized. Pixel-based measures of residue in the vallecular space before and after the maneuver were made on still frame lateral images using ImageJ software. Measures of % full and the Normalized Residue Ratio Scale (NRRS) were extracted. Univariate analyses of variance were used to detect significant reductions in residue. Results On average, pre-maneuver measures showed residue filling 56-73% of the valleculae, depending on stimulus consistency (NRRS scores: 0.2-0.4). More than 80% of pre-swallow measures displayed NRRS ratios > 0.06, a threshold previously linked to increased risk of post-swallow aspiration. Conclusion The head-turn-plus-chin-down maneuver achieved significant reductions in residue for thin and nectar-thick fluids, suggesting that this maneuver can be effective in reducing persistent vallecular residue with these consistencies.
authors.affiliation: Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Nagy
authors.affiliation: Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
authors.forename: Melanie
authors.initials: M
authors.lastname: Peladeau-Pigeon
authors.affiliation: Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
authors.forename: Teresa Josephine
authors.initials: TJ
authors.lastname: Valenzano
authors.affiliation: Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
authors.forename: Ashwini Marini
authors.initials: AM
authors.lastname: Namasivayam
authors.affiliation: Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
authors.forename: Catriona Margaret
authors.initials: CM
authors.lastname: Steele
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002680:Chin / Q000502:physiology; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000503:physiopathology* / Q000517:prevention & control*; D004825:Epiglottis / Q000503:physiopathology*; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000503:physiopathology; D011187:Posture; D015203:Reproducibility of Results; D053120:Respiratory Aspiration / Q000517:prevention & control; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult