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[Dysphagia] Chin tuck etc
I would also. I'd also like to know just what type of movement was used by
studies on the efficicacy of chin tuck. Was it a chin tuck or chin tilt to
the chest? Seems to me each would do different things anatomically.
JoAnn
----- Original Message -----
From: "Buckie,Marcia" <mbuckie at dmc.org>
To: "JoAnn Eaton" <joanneaton at charter.net>; "Nancy Burnett"
<NBurnett at cmh.org>; <dysphagia-bounces at b9.com>; "Suzanne Morris"
<sem at new-vis.com>; <dysphagia at b9.com>
Sent: Wednesday, November 29, 2006 9:12 AM
Subject: Re: [Dysphagia] Chin tuck etc
> Yes, I think that had been discussed before, we are actually mis-using
> the term chin tuck.
>
> The movement the PTs are talking about had been prescribed to me ( I had
> a herniated disc at c5-6 and this help elongate my c-spine and open up
> the vertebral spaces..) I would be interested in knowing how that effect
> the swallow physiology.
>
> Marcia
>
> -----Original Message-----
> From: JoAnn Eaton [mailto:joanneaton at charter.net]
> Sent: Wednesday, November 29, 2006 09:40
> To: Nancy Burnett; dysphagia-bounces at b9.com; Suzanne Morris;
> dysphagia at b9.com; Buckie,Marcia
> Subject: Re: [Dysphagia] Chin tuck etc
>
> Have to weigh in now, even though I'm not Suzanne (Who by the way gave
> great
> examples of how positioning affects swallow physiology. Thanks!)
> According
> to my physical therapist sources, a true chin tuck is NOT tipping your
> chin
> down. If you think about it, that will open the valleculae up and do
> nothing
> to protect the airway, but will offer a space at the front of the oral
> cavity to organize the bolus (liquid or solid) before initiating the
> transportation of the bolus. This is just what most elderly need time
> for.
> However, a true "chin tuck" is keeping the head in neutral position and
> bringing the chin backwards. Remember the "walk like an Egyptian"
> movement?
> The backward movement beyond neutral is a real chin tuck. That would
> appear
> to reduce the valleculae speace. It's not an easy movement to achieve
> because of scoliosis in most elderly and I don't think most SLPs are
> using a
> true chin tuck in therapeutic approaches, but are rather using a
> chin-to-chest movement.
> JoAnn Eaton
> ----- Original Message -----
> From: "Nancy Burnett" <NBurnett at cmh.org>
> To: <dysphagia-bounces at b9.com>; "Suzanne Morris" <sem at new-vis.com>;
> <dysphagia at b9.com>; <mbuckie at dmc.org>
> Sent: Wednesday, November 29, 2006 7:46 AM
> Subject: Re: [Dysphagia] Chin tuck etc
>
>
>> Thank you so much for your wonderful comments Suzanne and for sharing
> such
>> down-to-earth examples of activities!
>> One question - is the amount of chin tuck used "when tipped slightly
>> down...as if...nodding slightly when saying 'yes'" the same degree of
> chin
>> tuck used as a strategy? I always thought the strategic chin tuck was
> more
>> pronounced.
>>
>> Nancy Burnett,
>> Speech-Language Pathologist,
>> Cambridge Memorial Hospital,
>> 700 Coronation Blvd.,
>> Cambridge, Ontario.
>> N1R 3G2
>> Telephone: 519 - 621 - 2330 ext 1126/Pager 1104
>> Fax: 519 - 740 - 4978 Attention Nancy Burnett 3BN
>> Email: nburnett at cmh.org
>>
>>
>> -----Original Message-----
>> From: dysphagia-bounces at b9.com [SMTP:dysphagia-bounces at b9.com] On
> Behalf
>> Of Suzanne Morris
>> Sent: November 28, 2006 3:06 PM
>> To: dysphagia at b9.com; mbuckie at dmc.org
>> Subject: Re: [Dysphagia] Chin tuck etc
>>
>> The practicality of encouraging a "chin tuck" to improve swallowing
>> skills has interested me since I first began working with children
>> with feeding and swallowing difficulties. I'd like to add a common-
>> sense perspective to the debate. In recent years therapists and
>> researchers have tried to justify encouraging a chin tuck in patients
>> because of debatable anatomical reasons and as ways to prevent
>> aspiration and pneumonia. The argument is made that there is no clear
>> research that shows that swallowing is improved or aspiration is
>> reduced when the chin tuck is used. When I was introduced to the
>> strategy back in the early 60s the reason cited was to increase the
>> overall efficiency with which the oral-pharyngeal mechanism could
>> function. When the head is tipped back, even slightly, there is a
>> slight drag on the larynx and hyoid. As the head goes further back
>> into capital extension, the tongue and lips/cheeks also tend to pull
>> back as the muscles are placed at a greater disadvantage. This is
>> related to the mechanical relationship of the different body parts.
>> it's not that we can't suck and swallow with the head in
>> hyperextension. We can, but it takes more muscle effort to
>> compensate for the need to counteract the backward pull of the
>> muscles and structure. If a client has a neurological problem that
>> increases the strength of reflexive extensor patterns, there may also
>> be an increase in muscle tone that makes swallowing efficiently even
>> more of a challenge.
>>
>> There are several personal explorations that i use when I am teaching
>> parents or workshop groups. These activities allow others to
>> appreciate subtle differences and build greater awareness of the
>> swallowing mechanism. 1) Begin with the head and neck in good upward
>> alignment with the back of the neck straight and the chin tipped
>> slightly down toward the chest (i.e. a chin tuck) as if the head were
>> nodding slightly when saying "yes". Drink water with the head in
>> this position and simply notice the feeling of the muscles and the
>> overall coordination and speed of the jaw, tongue, lips/cheeks and
>> the larynx/hyoid. Secondly, drink the water as you very slowly tip
>> the chin up toward the ceiling. Notice the point where there is a
>> very slight change in the feeling of these same muscles and muscle
>> groups. Continue tipping the chin upward as far as possible;
>> finally bend the neck back into full hyperextension while drinking.
>> As a third exploration, begin with the head in full hyperextension
>> and very slowly bring it forward into the well-aligned head and neck
>> position with the chin tuck. It is very easy for most people to
>> experience the difference and the way in which they make certain
>> internal adjustments to be able to continue drinking safely. 2) A
>> second experiment is to explore the same basic head and neck
>> alignment activity while repeating the syllable sequence of /
>> mamamamama/. In this activity you experience more of the impact on
>> the jaw and the lips (as they are connected to the jaw). This is a
>> great activity to do in a group. Get everyone to repeat the /
>> mamama/ sequence as fast as they can and keep it going as long as
>> they can with the head in good chin tuck alignment. Then have them
>> do it as the chin begins to point up toward the ceiling. In the
>> first exploration the syllables are very fast and well sustained.
>> However, in the second exploration as the chin tips upward, the jaw
>> is more biased toward opening and there is a very slight pull-back of
>> the lips. The whole group suddenly begins to slow down in their
>> syllable repetition. It can lead to a very dramatic awareness of how
>> head position is related to the efficiency of the oral mechanism.
>>
>> Many years ago I was invited to present a workshop that was held in
>> one of the old traditional medical school amphitheaters. The rows of
>> seats were very steep and it was a challenge to maintain eye contact
>> with the whole group. When I teach I rely heavily on eye contact
>> with the group to create an interactive connection and also to be
>> aware of group non-verbal feedback that allows me to make slight
>> modifications in how I teach. I have learned to pace myself in
>> teaching so that my voice never gets tired or strained even when
>> speaking continuously for 3-4 days in a row. However, during this
>> particular workshop, I developed a slight laryngitis by the end of
>> the first day and I was very tired. I knew I wasn't coming down
>> with a cold, which could have accounted for the vocal strain. I
>> realized that I had spent the entire day teaching with my chin tipped
>> up and my head in slight hyperextension in order to use eye contact
>> with those in the upper rows. So the next day, I very consciously,
>> kept my head in good chin tuck alignment and dissociated my upward
>> eye gaze from my head and neck position. I had no problems with my
>> voice for the last 2 days of the workshop. It was amazing to me to
>> see how a very small tip-back of my head could place my larynx at
>> enough of a disadvantage that vocal strain developed.
>>
>> So my common sense question is: do we really need to create fancy
>> explanations for a chin tuck technique in relationship to pneumonia
>> or other conditions that have many many coexisting variables? Could
>> we simply talk about how the body just functions more efficiently
>> when its parts are in alignment and don't have to work so hard? This
>> is a concept that is very familiar to anyone who appreciates sports,
>> dance or other activities involving physical coordination. It is so
>> easy to demonstrate how this works for nurses and care providers, who
>> once they understand the principle in their own body are more likely
>> to implement the strategy with others.
>> __________________________________
>> Suzanne Evans Morris, Ph.D.
>> Speech-Language Pathologist
>> New Visions
>> 1124 Roberts Mountain Rd.
>> Faber, VA 22938
>> (434) 361-2285 ext. 5
>> www.new-vis.com
>>
>>
>> >
>> > mbuckie at dmc.org wrote:
>> >
>> > I haven't looked at this study in depth, but I have long seen the
>> > chin
>> > tuck as the "magic bullet" by nurses, therapists and the summary
>> > that
>> > was posted said patients who use chin tuck still got pneumonia. I
>> > wasn't
>> > aware that was the purpose of the chin tuck..that's a pretty big
>> > leap to
>> > make.
>> > *** That has been the response I have always received when I
>> > asked about the reason for its use due to the belief that
>> > aspiration inevitably leads to pneumonia and "chin tuck prevents
>> > aspiration". That, I submit, is the "big leap."
>>
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