The Pulse

Optimizing Head, Neck and Trunk Positioning to Impact Swallow Performance and Safety

Posted by ACP on Nov 15, 2018 9:59:00 AM
Swallow efficacy and safety are influenced by more than oropharyngeal muscle strength and performance. Head and neck positioning and posture can have a significant impact on an individual’s ability to effectively and safely swallow. Poor positioning can develop as a result of advanced age, neurologic impairment, and musculoskeletal involvement. The incidence of postural malalignment of the head, neck, and shoulders is increasing as a result of repetitive poor positioning with the use of computers and hand-held devices.
  • 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.1
  • Malalignment of head and neck positions had an immediate and negative impact on respiratory function. Slumped and kyphotic posture has been shown to increase intra-abdominal pressure making movement of the diaphragm difficult, leading to reduced lung capacity and inspiratory flow.2
    • This may lead to a weak cough which compromises the ability to expel any food or liquid that enters the airway.
  • The fibers of several facial muscles align in a serial fashion and create a muscular “oral sling” which encircles the oropharyngeal space. This sling must be active to create and maintain adequate positive pressure during the propulsion of the food bolus. With a forward head posture the anatomy does not “line-up” correctly and this “sling” is not supported appropriately. This can lead to:
    • Decreased lip closure
    • Pocketing of food
    • Poor anterior to posterior propulsion in the oral cavity (related to decreased positive pressure)
    • Drooling
    • Open mouth posture
  • The forward head posture also impacts the distance between the back of the tongue and the posterior pharyngeal wall. The contact of these two structures creates the needed environment to move the bolus into the esophagus as well as tilt the epiglottis and protect the airway. With a forward head posture, the distance between the tongue base and posterior wall is increased. In turn, tongue pressure may be reduced, limiting the patient’s ability to move the bolus into the oropharynx, pharynx, and esophagus. This can lead to dysphagia.

PENS for Improved Head, Neck, and Trunk Positioning
Patterned electrical neuromuscular stimulation (PENS) protocols can be used to facilitate improvements in patients with a head forward and rounded shoulder (protracted) posture when applied prior to or during exercise and postural retraining activities.3
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References:
1. Ahmad H: Effect of posture on swallowing. African Health Sciences. 17(1):133-137; Mar 2017.
2. Zafar H: Effect of Different Head-Neck Postures on the Respiratory function in Healthy Males. Biomed Res Int. 12;2018:4518269; Jul 2018
3. ACP’s Patterned Electrical Neuromuscular Stimulation (PENS) OmniStim® and OmniVersa® Lab

Topics: Clinical Tip, Dysphagia