KMID : 1140920200440060493
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Annals of Rehabilitation Medicine 2020 Volume.44 No. 6 p.493 ~ p.501
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Effects of Chin-Down Maneuver on Pharyngeal Pressure Generation According to Dysphagia and Viscosity
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Lee Sun-Myoung
Lee Ban-Hyung Kim Jung-Woo Jang Joon-Young Jang Eun-Gyeong Ryu Ju-Seok
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Abstract
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Objective: To demonstrate the effects of chin-down maneuver on swallowing by using high-resolution manometry (HRM).
Methods: HRM data of 20 healthy subjects and 64 dysphagic patients were analyzed. Participants swallowed 5 mL of thin and honey-like liquids in neutral and chin-down positions. HRM was used to evaluate maximal velopharyngeal pressure/area, maximal tongue base pressure/area, maximal pharyngeal constrictor pressure, pre-/post-swallow upper esophageal sphincter (UES) peak pressure, minimal UES pressure, UES activity time, and nadir duration.
Results: Compared to the neutral position, the chin-down maneuver significantly increased tongue base pressure in both normal and dysphagic groups as well as for both honey-like and thin viscosities, although the honey-like liquid did not reach statistical significance in the dysphagic group. Regarding pharyngeal constrictors and pre-swallow peak UES pressure, the healthy group showed a significant decrease in thin liquid swallowing and decreasing tendency in honeylike liquid swallowing. UES nadir duration was significantly decreased for honey-like liquid swallowing in the dysphagic group and for both thin and honey-like liquids in the healthy group. UES nadir duration of honey-like and thin flow swallowing in the dysphagia group was 0.26 seconds after the chin-down maneuver, which was severely limited.
Conclusion: This study showed a different kinetic effect of the chin-down maneuver between the healthy and dysphagic groups, as well as between thin and honey-like viscosities. The chin-down maneuver increased tongue base pressure and decreased UES nadir duration, which the latter was severely limited in dysphagic patients. Therefore, appropriate application of the chin-down maneuver in clinical practice is required.
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KEYWORD
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Deglutition, Deglutition disorders, Manometry, Viscosity
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