Mealtime Partners, Inc.

Specializing in Assistive Dining and Drinking Equipment

July 2015 Independent Eating and Drinking Newsletter

	July Topics: New Information about the Importance of Using a Chin-Tuck General Information about Chin Positioning when Eating and Drinking
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New Information about the Importance of Using a Chin-Tuck

For many years, people with swallowing problems have been encouraged to eat and drink with their head in a chin-tuck position. Numerous studies have been conducted to evaluate whether or not this position decreases the risk of choking or aspiration for those who have dysphagia. Results have consistently indicated that eating and drinking with one’s head in a downward position reduces the risk of aspirating. However, a definitive description of how to execute a chin-tuck has not been established. This article will discuss findings from a study that evaluated the movement of the structures in the throat during a swallow with the chin in three discrete positions: neutral; chin-down; and, chin-tucked. The findings provide insight into chin positioning for safe swallowing for those with dysphagia.

The Influence of the Chin-Down and Chin-Tuck Maneuver on the Swallowing Kinematics of Healthy Adults study was conducted by researchers at the Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea. The study was conducted to evaluate the impact upon swallowing of a chin-tuck position and to develop instructions on the specific position that should be assumed for those who are at risk of aspirating. The study is unique in that it identified the location of the major anatomical structures of the head and neck throughout a swallow and recorded their location and movement during swallowing.

The study was undertaken while the head was in the three different positions. Videofluoroscopic recordings were made of study participants while they swallowed a barium laced solution. Each participant was recorded swallowing with their head in a neutral position, which would be typical of how the majority of people hold their head while taking a drink. The Participants were simply instructed to hold their heads in a “normal and comfortable” position. Secondly, they swallowed with their chin down. The instructions that were provided were to “move your chin down”. Lastly, participants swallowed with their chin pulled as close to their chest as possible, in what is called a chin-tuck position. Instructions provided were “intentionally bring or touch your chin to your chest”. The last position is not typically assumed while eating or drinking. It is not a natural position to assume because it requires muscle tension to maintain it; and, secondly, it does not allow you to see what is going on around you during the swallow.

Findings revealed that the neutral and chin-down positions had no significant impact upon movement, tilt or angle, of the various anatomical components of the throat which impact how swallowing occurs. However, in comparison, the chin-tuck position provided meaningful airway protection, and greater tongue base retraction than the other two positions. The chin-tuck position limited the horizontal movement of the hyoid bone, epiglottic base and larynx. The study concluded that patients with severe swallowing difficulties should be instructed how to precisely position their head and chin to protect their airway by using the chin-tuck position that was used during the conduct of the study.

For anyone who has a condition that puts them at significant risk of aspirating during intake of solids or liquids, these findings provide direction as to the safest position in which consumption should be undertaken.

 

The Mealtime Partner Dining System

Serving a Variety of Textures and Volumes of Food and the Pace of Eating is User Controlled

For those individuals who have chewing and swallowing difficulties, the Mealtime Partner Dining System can serve foods of a wide-range of textures. The device can serve regular table food that have been cut up, or it can serve chopped, minced, or pureed foods. The amount of food present for each bite can be controlled from a level spoonful to a rounded or heaped spoonful. Thus small bites can be provided for those who should eat a small amount at a time. Food volume is controlled by the unique Bowl Covers that are attached to the bowls.

Additionally, because the user controls when they take a bite of food from the spoon, they can pace how quickly or slowly they eat each bite of food.

The Mealtime Partner Dining Device Presenting a Bite of Food

Because the Mealtime Partner is such a flexible device, it can meet the dining needs of a diverse group of individuals! For complete information about the Mealtime Partner Dining System, click here.

 

General Information about Chin Positioning while Eating and Drinking

The first article in this month’s Newsletter described very specific information about the impact of head and chin positioning while swallowing for those individuals who have significant swallowing difficulties. However, it is always wise, even for those who do not have any swallowing problems, to follow some simple guidelines for eating and drinking. For this reason we are going to revisit a Mealtime Partners Newsletter article that was originally released in April 2013 that provided some basic information about good mealtime practices to encourage safe swallowing.

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.

There are three commonly used techniques for a chin-tuck. The first involves head flexion that bends the cervical spine at its highest point C1 through C2. Head flexion moves the chin against the neck. The eyes will be directed downward when this position is assumed and the person will have to raise their eyes to see their mealtime partner. This type of chin-tuck is used to reduce residual particles of food pocketing in the epiglottic valleculae. The epiglottic valleculae are two depressions situated between the base of the tongue and the epiglottis, one on each side of the median glosso-epiglottic ligament. (Diverticulum of the epiglottic valleculae: Report of two cases) Their normal function is to collect saliva prior to a swallow, and for people without swallowing difficulties, they do not collect food particles during a bolus being swallowed.

The second type of chin-tuck is created using neck flexion and is instigated by flexing the cervical spine at C4 through C6. This position is helpful for those who have poor initiation of a swallow. A compound flexion combines head and neck flexion and is helpful to avoid particles pocketing in the epiglottic valleculae and to improve swallow initiation. A compound flexion, or a variation of it, is typically what most people refer to as a chin-tuck.

In addition to the chin-tuck being used to improve the safety of swallowing, for those who have paralysis of part of the pharynx, due to conditions such as bulbar paralysis or stroke, head rotation is helpful in combination with a chin-tuck. The head is rotated to the weak or paralyzed side and this position expands the stronger side guiding the bolus to the healthy side of the throat.

In some cases of using a chin-tuck to help with swallowing food, the food can be put into the mouth and chewed prior to assuming a chin-tuck in anticipation of swallowing. The head is upright to receive a bite of food, the food is chewed and rotated in the mouth to form a bolus. Prior to swallowing, the chin is dropped into a chin-tuck and the swallow is initiated. This process is helpful for those who have difficulty with lip closure and keeping food in their mouth while they are chewing.

Regardless of the strategies that may be employed to facilitate the safest swallow possible, the texture of the food and liquid being consumed contributes greatly to how easy it is to swallow. Detailed information about food texture and thickening liquid is available in the April 2010 Newsletter if more information on this subject is of interest.

Did You Know? Did you know that mosquito bites can cause some very serious illnesses including West Nile virus, malaria, yellow fever and dengue fever? It is now mosquito season and at this time of year, it is important to protect everyone from being bitten. People often wonder why mosquito’s are specifically attracted to them. Mosquito’s are actually attracted to the smell of carbon dioxide (CO2) and mammals exhale CO2 with every breath. Therefore both people and animals are targets for them. They don’t simply smell someone, once they are aware of CO2 that is being exhaled, the mosquito starts looking for the source. When they see the source they move toward it. Once they are close, they use thermal sensing to detect body heat and to decide where they will land to have their snack! Regardless of how you choose to repel mosquito’s, make sure that you and your loved ones don’t get bitten. Repellents containing DEET are recommended by the National Institutes of Health but covering up with clothes that cover your arms and legs is also wise. Consumer Reports reviewed ways to repel mosquitoes and ticks and concluded that even though products containing 15% to 30% DEET work, alternatives are now available that offer even better protection and are safer. These newer products are plant based and contain Picaridin, or oil of lemon eucalyptus. Consumer Reports top recommendations are: Sawyer Fisherman’s Formula Picaridin, and, Repel Lemon Eucalyptus.