Modified Monday: It’s Just So Easy.
It’s such an easy thing to teach, to demonstrate, to bust out of your clinical toolbox. Most of us have had a fond affection for the chin tuck at one time or another. But.. how helpful is it really? Under what circumstances can it be effective? Are we even instructing patients properly?
Years ago, while working in a SNF, I learned my lesson with this easy fall back. I sent a patient out for an MBS study, she came back with a recommendation to use the chin tuck. When she asked me about it, I threw out a quick “Oh, it just makes your swallow safer!” Two days later, I was walking by the dining room and saw every resident at my patient’s table with their head down. (Nope, they weren’t praying.) Since then, I have learned that it is really important to convey all the relevant information about this posture to patients (and nursing, dining staff, physicians, other SLPs, family members who are also STNAs….).
The chin tuck is effective at preventing or decreasing severity of aspiration ONLY about half the time, less with thicker consistencies, and less with more severe dysphagia. It can also increase the severity of aspiration in patients with impaired pharyngeal contraction. This clip is a great example of this. You can see the patient with and without chin tuck use-the patient has increased pharyngeal residue with the use of the chin tuck, which subsequently is aspirated. For all of these reasons, it is ESSENTIAL to assess the use of the chin tuck during an instrumental study BEFORE recommending it’s use in ANY patient. Even if they don’t cough with the chin tuck (see our earlier post regarding inconsistent cough response). Even if they say it feels better. Even if the love it so much that they teach all their friends how to do it at lunch.
P.S. There is also a fair amount of evidence that shows quite a variation in how SLPs teach this positioning, with differences between “chin down” and “chin tuck”. See links below for more!