What is the Chin down posture

An analysis of questionnaire to the speech therapists in Japan

Abstract

The “Chin down” maneuver is a postural technique used widely for treatment of individuals with dysphagia．However，its precise anatomical meaning has not been defined．Flexion can occur at the various points in the cervical spine (and atlanto-occipital joints)，and the resulting postures may have differing effects on swallow physiology．We studied the current practice of speech therapists in Japan with a questionnaire survey regarding the chin down posture．The questionnaire addressed anatomical postures and terminology， and was circulated to 34 speech therapists，each with five or more years of experience in dysphagia rehabilitation；the response rate was 88％．There were five main findings，as follows： 1）There were five Japanese terms for the chin down posture，including “Ago-hiki” in 57％ and “Keibu-zenkutsu-i” in 20％ of respondents．There were no significant differences in terminology based on duration of clinical experience or number of the patients they treated per month． 2） We included five photographs showing a variety of head and neck positions．Three out of five of these pictures were selected by respondents as showing the “Chin down” posture： Head flexion on the neck position (53％)，Neck flexion position (30％)，and combined Head and neck flexion position (17％)．3）There was no clear relationship between the five pictured positions and the various terms used by respondents to describe them：each position was named by multiple terms，and multiple positions were named by the same term．4）The name of “Chin down” was more popular than “Chin tuck.” 5）Some respondents did not recognize differences in either terminology or in the pictured neck and head positions．In summary，there is poor agreement about the meaning of the chin down posture in this sample of Japanese speech therapists．There are several possible explanations for this： the posture has never been precisely defined in the literature，and clinicians and investigators have overlooked the fact that flexion may occur at various points in the cervical spine and atlanto-occipital joints．We suggest that a clear definition of the chin down is critical because the various postures may have differing effects on swallow physiology．