Effects of Chin-Down Maneuver on Pharyngeal Pressure Generation According to Dysphagia and Viscosity

• Published in: Annals of rehabilitation medicine 2020, 44(6), , pp.493-501
• Main Authors: Lee, Sun Myoung, Lee, Ban Hyung, Kim, Jung Woo, Jang, Joon Young, Jang, Eun Gyeong, Ryu, Ju Seok
• Format: Article
• Language: English
• Subjects: deglutition; deglutition disorders; manometry; Original; viscosity; 재활의학
• ISSN: 2234-0645; 2234-0653
• DOI: 10.5535/arm.20016

To demonstrate the effects of chin-down maneuver on swallowing by using high-resolution manometry (HRM). HRM data of 20 healthy subjects and 64 dysphagic patients were analyzed. Participants swallowed 5 mL of thin and honey-like liquids in neutral and chin-down positions. HRM was used to evaluate maximal velopharyngeal pressure/area, maximal tongue base pressure/area, maximal pharyngeal constrictor pressure, pre-/post-swallow upper esophageal sphincter (UES) peak pressure, minimal UES pressure, UES activity time, and nadir duration. Compared to the neutral position, the chin-down maneuver significantly increased tongue base pressure in both normal and dysphagic groups as well as for both honey-like and thin viscosities, although the honey-like liquid did not reach statistical significance in the dysphagic group. Regarding pharyngeal constrictors and pre-swallow peak UES pressure, the healthy group showed a significant decrease in thin liquid swallowing and decreasing tendency in honeylike liquid swallowing. UES nadir duration was significantly decreased for honey-like liquid swallowing in the dysphagic group and for both thin and honey-like liquids in the healthy group. UES nadir duration of honey-like and thin flow swallowing in the dysphagia group was 0.26 seconds after the chin-down maneuver, which was severely limited. This study showed a different kinetic effect of the chin-down maneuver between the healthy and dysphagic groups, as well as between thin and honey-like viscosities. The chin-down maneuver increased tongue base pressure and decreased UES nadir duration, which the latter was severely limited in dysphagic patients. Therefore, appropriate application of the chin-down maneuver in clinical practice is required.