2010 Volume 14 Issue 1 Pages 11-16
[Purpose] Head rotation is one of the postural interventions available for patients with dysphagia, reducing post-swallow residue in the pharynx by head rotation towards the weakened side. However, maintaining the head in a rotated position for an entire meal may lead to fatigue, so a comfortable feeding posture with optimal head rotation is desired. In the present study, we systematically examined the effects of various head rotation angles on the side of bolus flow through the hypopharynx in healthy adults.
[Methods] Videofluorography (VF) at an anterior-posterior projection was performed on 30 healthy volunteers (12 male and 18 female, mean age 26 years old) during the ingestion of 3 ml liquid barium. Head rotation angles were classified as no rotation (zero degrees; control), 15, 30, and 45 degrees, and maximum rotation (right side, 61.9±4.4 degrees; left side, 66.7±6.2 degrees) for both right and left sides. The side of bolus flow through the hypopharynx during the pharyngeal stage of swallowing was then evaluated on digitized VF images. We tested if bolus flow on the rotated side was altered by different head rotation angles.
[Results] The barium passed through both sides of the hypopharynx with comparable incidence in all subjects with no head rotation. With 30 degrees of head rotation, the barium passed through the rotated side of the hypopharynx in seven subjects (23%) with right rotation, and 12 subjects (40%) with left rotation. The percentage of subjects with no barium passage through the rotated side was significantly lower with 30 degrees of head rotation or more than with control (p＜0.01). With maximum rotation, the bolus passed through the rotated side of the hypopharynx in only one subject (3.3%) with right rotation and in four (13%) with left rotation.
[Conclusion] The present study demonstrated that the percentage of subjects with bolus passage through the rotated side significantly decreased with 30 degrees of head rotation or more. Postural interventions for dysphagic individuals should have adequate safety, comfort, and effectiveness during feeding posture. In clinical settings, the efficiency of head rotation is usually determined with VF or videoendoscopy. The findings in this study imply that 30 degree head rotation would be deserved to be evaluated its efficiency during instrumental examinations for swallowing.
