Abstract
Objective: To assess how postural adjustment affects subjective swallowing difficulty during swallowing rehabilitation. Subjects: Sixteen normal volunteers. Design: Three screening tests – repetitive saliva swallowing, water swallowing, and food swallowing – were performed in 7 positions: upright, backrest, slouching, reclining 60° supine, reclining 60° lateral, reclining 30° supine, and reclining 30° lateral. Subjective swallowing difficulty was assessed using a visual analogue scale (VAS; 0 - 10). Results: Patients indicated minimum difficulty while upright, and responses showed that the further from perpendicular was the reclining angle, the more difficulty they reported in swallowing. During food swallowing in supine positions, when reclining 60° VAS score was 3.06, and at 30° was 4.62. In lateral positions, VAS score increased along the same lines. Results were similar for all three swallowing tests. Conclusion: Postural adjustment nduced considerably higher subjective swallowing difficulty. When imposing postural adjustment, clinicians should be aware of the subjective difficulty that patients have in swallowing.
Highlights
As in most other advanced countries, in Japan the rapidly increasing geriatric population has become a serious social issue
Patients indicated minimum difficulty while upright, and responses showed that the further from perpendicular was the reclining angle, the more difficulty they reported in swallowing
visual analogue scale (VAS) score increased along the same lines
Summary
As in most other advanced countries, in Japan the rapidly increasing geriatric population has become a serious social issue. Diet modification (e.g., use of food pastes) and postural adjustment (e.g., reclining) are commonly advised in Japan [4,5]. The food masticated, that is, chewed and mixed with saliva, and formed into a bolus of a size that can pass into the pharynx, a shared pathway leading to discrete entrances to the respiratory (trachea) and digestive (esophagus) systems. When the body is reclining, the relative position of the esophagus shifts to beneath the trachea. In this way, postural adjustment is thought to be effective against aspiration during swallowing because gravity helps the food bolus to pass though esophagus when the body is reclined [5,7,8]
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