[Dysphagia] Chin tuck etc

[mbuckie at dmc.org (Buckie,Marcia)]

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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