Mealtime Partners, Inc.

Specializing in Assistive Dining and Drinking Equipment

January 2022 Independent Eating and Drinking Newsletter

	January Topic: Revisiting the Impact of a Chin Tuck
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Revisiting the Impact of a Chin Tuck

For as long as Mealtime Partners has published newsletters we have discussed the pros and cons of using a “chin tuck” or “head down” position, as a compensatory strategy, for people who are at risk of choking or aspiration when they eat or drink. Research has been ongoing throughout the period providing new insights into the impact of this position upon swallowing and eating in general. Today, the value of using a chin tuck is still a controversial issue. Yet it is generally agreed that a postural change that lowers the head by flexing the vertebrae in the neck and brings the chin closer to the chest modifies the internal structure of the throat and narrows the entrance to the airway, thus reducing the likelihood of food or liquid “going down the wrong way” for many individuals. When food does go down the wrong way, if the food incursion is limited to above the vocal folds, it is referred to as “penetration”; however, if it passes deeper into the airway it is classed as “aspiration”.

The exact characterization of a chin tuck or head down position remains unclear because different researchers use somewhat different definitions for a chin tuck, or head down position. Some studies even suggest that many clinicians have their own, distinctive, positioning for patients that they refer to as a chin tuck.

All of this uncertainty is exacerbated because a chin tuck does not help everyone who is dysphagic (a condition in which there is difficulty in swallowing). In fact, in some cases a chin tuck may have an adverse effect on a patient. Yet it is common for people who have developed dysphagia to be told to use a chin tuck by healthcare professionals when they eat and drink, without a formal assessment of their chewing and swallowing capabilities. A Videofluoroscopic Study (VFS) of oral motor function is the gold standard for assessing an individual’s swallow risks. Even though a VFS only assesses a brief period of time, and a small number of swallows (due to limiting radiation exposure), it nevertheless provides a visualization of what happens to a bolus during the swallowing process allowing a speech language pathologist (SLP) to see if food/liquid is aspirated, if the mouth and throat are functioning properly, what posture is best for safe swallowing, and also the types and textures of food and drink that can be swallowed safely.

Because this issue continues to lack clear definition about exactly the correct execution of a chin tuck, or the impact that is generated by the structural changes of the mouth and throat created by a chin tuck, it is not always clear who should and who shouldn’t be advised to use it. It is important that healthcare professionals who are specifically trained in swallowing interventions evaluate patients who are having problems with eating, drinking and swallowing in general. They will be able, through a series of examinations and tests to recommend an appropriate strategy for each person. This may include food and liquid texture modification, positioning for safe swallowing, possibly exercises to strengthen the persons swallow, etc. However, it should be remembered that this is by no means a one size fits all therapy and that each patient should be regularly reevaluated to be sure the prescribed strategy is working for them.

Over the years research has identified some of the strengths and shortcomings of using a chin tuck or head down position to be safe when eating and drinking. However, there is still a significant amount of information to be clarified regarding the subject. As more and more research is conducted and the findings published Mealtime Partners will continue to provide updates to their readers. 

 

The Hydration Backpack with Drinking Tube Positioning for Slide-Track (Part No. 6557)

The Hydration Backpack with Drinking Tube Positioning for Slide-Track is designed to mount on powered wheelchairs that have mounting tracks or rails as an integral part of them. The Attachment Holder, which is part of the drinking system, mounts to the back of the wheelchair using a T-nut that fits into the wheelchair slide-track. The Flex Tubing, through which the drinking tube is threaded, fits into the Attachment Holder and allows the drinking tube to be positioned appropriately for easy access by the user.

Easy to install and remove from the wheelchair to fill or clean.

Hands-free drinking, 70 fluid ounces of water available for people on the go!

For more information about this product or to order, click here, or call us at 800-996-8607.

 

Did You Know? Did you know that hospitals all over the country are experiencing an acute shortage of blood which is the worst shortage in over a decade? According to Dr. Baia Lasky, medical director for the American Red Cross, the resurgence of Covid-19 along with winter weather has caused a significant drop in blood donations. This has resulted in a crisis with dangerously low blood supplies. In some cases hospitals have less than a day’s supply of critical types of blood. Hospitals are having to make very difficult decisions about who does and who does not get a blood transfusion and some surgeries are being delayed because of the lack of blood. The Red Cross are asking everyone who is able to donate blood, to do so. For more information about donating you can contact: 1-800-RED-CROSS (1-800-733-2767) or email support@redcrosstraining.org.