Abstract
Ertekin C, Keskin A, Kiylioglu N, Kirazli Y, Yagiz On A, Tarlaci S, Aydoğdu I. The
effect of head and neck positions on oropharyngeal swallowing: a clinical and electrophysiologic
study. Arch Phys Med Rehabil 2001;82:1255-60. Objectives: To determine the clinical usefulness of an electrophysiologic method for evaluating
dysphagia and to identify the effects of various head and neck positions on oropharyngeal
swallowing. Design: Experimental, with control group. Setting: An electromyography laboratory. Participants: Patients with neurogenic dysphagia (n = 51) and healthy controls (n = 24). Patients were divided into 2 groups: those patients with unilateral lower
cranial lesions (n = 9) and those without laterality in the function of the oropharyngeal muscles (n = 42). Interventions: Subjects were instructed to swallow doses of water, gradually increasing in quantity
from 1 to 25mL under 5 conditions: neutral, chin up, chin tucked, head rotated right,
and head rotated left. Main Outcome Measures: Change in dysphagia limit through specified head and neck postures. Oropharyngeal
swallowing was evaluated by laryngeal movements that were detected by a piezoelectric
sensor and electromyography of the submental muscle complex. Laryngeal sensor signals
occurring within 8 seconds of a swallow were accepted as a sign of the dysphagia limit.
Results: In the control group, dysphagia limit did not change significantly with changes in
head and neck postures, except for the chin-up posture (p < .05) in which piecemeal deglutition occurred when subjects swallowed volumes less
than 20mL. Dysphagia limit improved significantly (p < .05) in 67% of the patients with unilateral lower cranial lesions when the head
was rotated toward the paretic side. In dysphagic patients with bilateral symptoms,
a significant (p < .01) improvement in dysphagia limit occurred in 50% of patients in chin-tuck position,
but in the chin-up position, 55% of the patients experienced a significant (p < .01) decrease in dysphagia limit. Conclusion: The electrophysiologic method of measuring dysphagia limit confirms neurogenic dysphagia
and its severity in the neutral head position. Changes in head and neck positions
do not significantly alter dysphagia limit in unimpaired subjects except for the chin-up
position. Although the results obtained were not compared with other techniques (eg,
videofluoroscopy), this simple electrophysiologic method for describing dysphagia
limit may have a place in the evaluation of dysphagia and its variability in various
head and neck positions. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy
of Physical Medicine and Rehabilitation
Keywords
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Article info
Publication history
Accepted:
November 16,
2000
Footnotes
☆Supported by the Turkish Scientific and Technological Research Council (grant no. SBAG-1739).
☆☆The author(s) has/have chosen not to select a disclosure statement.
★Reprint requests to Cumhur Ertekin, MD, Dept of Neurology, Ege University, Medical Schl Hospital, Bornova, 35100, Izmir, Turkey, e-mail: [email protected]
★★Supplier
♢a. Medelec Mystro MS-20e; Oxford Instruments Plc, Old Station Way, Eynsham, Witney, Oxfordshire, OX8 1TL, England.
Identification
Copyright
© 2001 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
