[Dysphagia] Chin tuck etc

[vstefans at george.ach.uams.edu (Vikki Stefans)]

I think this statement is key - there is no way I would expect ANY 
strategy, maneuver, or consistency applied in a blanket way to a group of 
patients with dysphagia to "work" whether the endpoint was better 
butrition and hyration, or occurrence of pneumonia. Swallowing physiology 
to some degree, and pathophysiology to a great degree, varies from person 
to person and what is helpful to one might be harmful to the next. The 
tilt forward, chin tuck, or head on neck flexion basically widens 
vallecular space which may be an advantage or disadvantage depending on 
the situation, in addition to other effects on laryngeal function that 
have been mentioned. In fact, this individual variation is one of the 
biggest reasons to do videofluoroscopic studies.

People looking for shortcuts to the complex business of individualized 
dysphagia management are destined to be disappointed in their results and 
are serving their patients badly.

True controlled research on any given maneuver would unfortunately have to 
go something like this: identify a group who appear to benefit from the 
maneuver, apply it randomly to half of them, and watch outcomes. Single 
subject designs with prolonged baseline phases might be a reasonable 
substitute. But if someone goes off and applies chin tuck or thickened 
liquids to a large group without individual validation, and finds it 
"doesn't work" that is hardly going to prove anything (though people will 
probably think so.)

Vikki Stefans, M.D., pediatric physiatrist (rehab doc for kids) at UAMS
and Arkansas Children's Hospital.  Working Mom of Sarah T. and Michael C.,
and wife of Henry Stefans. Every mom is a working mom!- OK, dads too.

On Wed, 29 Nov 2006, JANET Finger wrote:

> I am not a believer in the chin tuck as a cure-all, but every so often I do
> find (during instrumental study) a pt who benefits from chin tuck.