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    Effect of Posture On Swallowing

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    This study examined the effect of different body postures on perceived swallowing difficulty in 186 healthy adults. Participants swallowed water in four postures - sitting upright, sitting with head/neck flexed, head/neck extended, and lying supine - and rated difficulty on a scale of 0-10. Swallowing was easiest when sitting upright, and difficulty increased in the order of flexed, extended, and supine postures. All posture comparisons showed statistically significant differences in perceived difficulty, suggesting that posture modification may help rehabilitation of patients with dysphagia.

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    Effect of Posture On Swallowing

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    marcelonoris
    43 views5 pages
    This study examined the effect of different body postures on perceived swallowing difficulty in 186 healthy adults. Participants swallowed water in four postures - sitting upright, sitting with head/neck flexed, head/neck extended, and lying supine - and rated difficulty on a scale of 0-10. Swallowing was easiest when sitting upright, and difficulty increased in the order of flexed, extended, and supine postures. All posture comparisons showed statistically significant differences in perceived difficulty, suggesting that posture modification may help rehabilitation of patients with dysphagia.

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    AFHS1701-0133

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    This study examined the effect of different body postures on perceived swallowing difficulty in 186 healthy adults. Participants swallowed water in four postures - sitting upright, sitting with head/neck flexed, head/neck extended, and lying supine - and rated difficulty on a scale of 0-10. Swallowing was easiest when sitting upright, and difficulty increased in the order of flexed, extended, and supine postures. All posture comparisons showed statistically significant differences in perceived difficulty, suggesting that posture modification may help rehabilitation of patients with dysphagia.

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    © All Rights Reserved
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    43 views5 pages

    Effect of Posture On Swallowing

    Uploaded by

    marcelonoris
    This study examined the effect of different body postures on perceived swallowing difficulty in 186 healthy adults. Participants swallowed water in four postures - sitting upright, sitting with head/neck flexed, head/neck extended, and lying supine - and rated difficulty on a scale of 0-10. Swallowing was easiest when sitting upright, and difficulty increased in the order of flexed, extended, and supine postures. All posture comparisons showed statistically significant differences in perceived difficulty, suggesting that posture modification may help rehabilitation of patients with dysphagia.

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    Effect of posture on swallowing.

    Ahmad H. Alghadir, Hamayun Zafar, Einas S. Al-Eisa, Zaheen A. Iqbal

    Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, KSA.

    Abstract
    Background: Swallowing is a systematic process. Any structural, physiological or neurological disturbance in this process may
    cause dysphagia. Although there are studies that report head/neck movements during mastication, there are fewer studies that
    show the effect of different head/neck postures on difficulty while swallowing.
    Objectives: To observe the effect of different body postures on the self-perceived difficulty while swallowing in normal healthy
    subjects.
    Methods: Participants were asked to swallow 25 ml of water in one go while sitting upright, sitting with head/neck flexed, head/
    neck extended and lying supine. Following this, they had to rate their self-perceived difficulty while swallowing on a scale of 0-10,
    0 being most easy and 10 being most difficult.
    Results: 186 subjects with mean age 32.7 SD 9.04 participated in this study. It was found to be least difficult to swallow when
    subjects were asked to swallow in upright sitting position. Statistically significant differences were found between sitting upright,
    sitting with head/neck flexed, head/neck extended and lying supine.
    Conclusion: Postural modification may help in rehabilitation of patients with dysphagia by affecting bolus flow to improve
    speed and safety of swallowing by closure of airways to prevent aspiration.
    Keywords: Swallowing, posture, dysphagia.
    DOI: https://dx.doi.org/10.4314/ahs.v17i1.17
    Cite as: Alghadir AH, Zafar H, Al-Eisa ES, Iqbal ZA. Effect of posture on swallowing. Afri Health Sci. 2017;17(1): 133-137. https://
    dx.doi.org/10.4314/ahs.v17i1.17

    Introduction been proposed to improve the swallowing function that


    Swallowing involves a predictable and systematic process.1 can improve patient’s quality of life.2,8
    Any structural, physiological or neurological disturbance Mandibular movements during mastication have been
    in this process may cause dysphagia.2 Approximately, 33 shown to cause head movements.9,10 Chewing induces
    to 73% of patients are reported to suffer dysphagia fol- head extension due to co-contraction of sternocleido-
    lowing stroke, motor neuron disease, Parkinson’s disease, mastoid and trapezius muscles along with jaw muscles.11,12
    cerebral palsy, etc.3,4 It can further lead to aspiration pneu- These movements facilitate effective chewing of the bo-
    monia, dehydration, malnutrition and other serious com- lus,13 in preparation for swallowing. Although there are
    plications.5 Clinical presentation may vary from patient studies that report head/neck movements during masti-
    to patient and that needs to be taken into consideration cation, there are fewer studies that show the effect of
    while planning rehabilitation.6,7 Various techniques have head/neck position on difficulty while swallowing. Head
    flexion and extension has been shown to decrease the
    opening of airways and esophagus.14 Modification of
    body position can help to improve rehabilitation of such
    Corresponding author: patients. In this study, we decided to see the effect of
    Zaheen A. Iqbal, different body postures while sitting and lying on swal-
    Rehabilitation Research Chair RRC, lowing in normal healthy subjects.
    King Saud University,
    P.O. Box 10219, Methods:
    Riyadh 11433, KSA Two hundred healthy adult males, aged between 20-40
    Tel.: +966569086528; years, were invited to participate in this study. They were
    Fax: +96614693589 assessed for any neurological or musculoskeletal pain and
    E-mail address: [email protected] excluded if any sign or symptom was found to be present.

    133 African Health Sciences Vol 17 Issue 1, March, 2017


    They were informed about the nature of study and re- Statistical difference was tested by Friedman test non-
    quired to provide informed consent. This study was con- parametric repeated measures ANOVA using Graph-Pad
    ducted after receiving ethical clearance from institutional Instat 3.0 GraphPad Software Inc., CA, USA. The dif-
    review board. ference was considered significant for p values less than
    Participants were asked to swallow 25 ml of water in one 0.05.
    go while sitting upright, sitting with head/neck flexed, Results
    head/neck extended and lying supine. Following this, After testing for inclusion and exclusion criteria, 186 sub-
    they had to rate their self-perceived difficulty while swal- jects with mean age 32.70 SD 9.04 participated in this
    lowing on a scale of 0-10, 0 being most easy and 10 being study. Mean SD for self-perceived difficulty while swal-
    most difficult. lowing has been presented in table 1.

    Table 1 – Self-perceived difficulty while swallowing on scale of 0-10,


    0 being most easy and 10 being most difficult

    Sitting Sitting with Sitting with head/neck lying supine


    upright head/neck flexed extended
    Mean 0.52 2.79 4.69 6.96
    SD 0.75 1.22 1.53 1.59

    In comparison of all tested postures, self-perceived diffi- were found between sitting upright, sitting with head/
    culty for swallowing was found to be least while subjects neck flexed, head/neck extended and lying supine. Table
    were sitting upright. Statistically significant differences 2.

    Table 2 – Comparison of swallowing during different postures

    Postures Significance
    Upright sitting vs head/neck flexion ***
    Upright sitting vs head/neck extension ***
    Upright sitting vs supine lying ***
    Head/neck flexion vs head/neck ***
    extension
    Head/neck flexion vs supine lying ***
    Head/neck extension vs supine lying ***
    *** Extremely significant, p<0.001
    Discussion There are individual differences in swallowing and dys-
    We saw the effect of different body postures on the phagia limit depending on individual condition, prefer-
    self-perceived difficulty while swallowing in normal ences and habits. However, different head and neck posi-
    healthy subjects. It was found to be least when subjects tions can facilitate the process of swallowing to eliminate
    were asked to swallow in upright sitting position. Statis- aspiration; etc.15,16 that can help patients with various dys-
    tically significant differences were found between sitting functions. Various changes occur in mechanism of swal-
    upright, sitting with head/neck flexed, head/neck extend- lowing with aging, including slowing of oral stage and
    ed and lying supine. trigger of pharyngeal swallow.17
    African Health Sciences Vol 17 Issue 1, March, 2017 134
    It has been shown that while swallowing different vol- and lying supine, swallowing was easiest while sitting up-
    umes of water, healthy adults didn’t experience piecemeal right and head/neck flexed. Postural modification may
    deglutition or aspiration; however while swallowing with help in treatment of dysphagia by affecting bolus flow
    head in extension physiologic dysphagia was seen.18,19 to improve speed and safety of swallowing by closure of
    Similarly, our results also show that subjects reported airways to prevent aspiration.
    maximum difficulty in swallowing while sitting with head
    and neck in extension. During neck extension, there is Limitations
    mechanical widening of laryngeal vestibule and narrow- Our study was done in normal subjects who had a fixed
    ing of valleculae, leading to decrease in upper esophageal pattern of swallowing. Most of the studies available in lit-
    sphincter relaxation and difficulty in its closure.20,21 Thiserature use video fluoroscopy, manometry and other elec-
    position should be avoided while training patients with trophysiological investigations as outcome measures27,30
    various swallowing disorders. in dysphagia patients. Due to ethical reasons we could not
    expose our subjects to such radiation; hence we used only
    Chin tuck position makes the vallecular space wide and self-perceived difficulty while swallowing as an outcome
    airway entrance narrow to prevent aspiration.22,23 It also measure. Similar studies in dysphagia patients, who pres-
    decreases pharyngeal contraction to decrease dysphagia ent with individual variation in the process, would reveal
    limit.24,25 There is reduction in all the measured distances a better picture on how a specific posture can affect swal-
    in the pharynx with flexion of head and neck.24 Swallow- lowing pattern.
    ing with chin tuck is one of the commonly used tech-
    niques to facilitate swallowing and prevent aspiration.23,24 Conflict of interest
    Our results show that swallowing while sitting with head/ Authors have no Conflict of interest to declare.
    neck flexed was comparatively easier than that in exten-
    sion position but more difficult than while sitting upright. Acknowledgement
    This could be due to increased muscle tension in this po- The authors are grateful to the Deanship of Scientific
    sition. Tension leads to shortening of muscles of base of Research, King Saud University for funding through Vice
    tongue that lifts the hyoid bone and decreases laryngeal Deanship of Scientific Research Chairs
    elevation.24
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