To Tuck or Not to Tuck
The chin tuck. I’m not talking about Chin Tuck Against Resistance (CTAR), I’m talking about the compensatory strategy. That strategy that we’ve taught so well that nurses, respiratory therapists and doctors all tell patients, if you’re having trouble swallowing, just tuck your chin. Somewhere down the road, we’ve made the chin tuck the end-all be-all in therapy, just after thickening liquids and diet modification.
We use the chin tuck with patients for a variety of reasons. We have patients use a chin tuck to widen the valleculae, push the tongue base back placing the epiglottis more posterior and to narrow the airway, according to the research.
We often have patient tuck their chin to eliminate vallecular residue and to help in the prevention of laryngeal penetration or aspiration.
One study (Robbins and Hind 2008) compared using a chin tuck with thin liquids vs. nectar thick liquids and honey thick liquids. The study found more aspiration with the chin tuck group than with the thickened liquid group, however there were more adverse effects with the group on thickened liquids (dehydration, UTI, fever).
Studies (Robbins et al 2005, Shaker et al 2002) found the chin tuck to be effective in 72% of the patients studied. They found it may be contraindicated in patients with weak pharyngeal contraction pressure as it decreased pharyngeal contraction pressure and duration.
In my own practice, I have seen the chin tuck as both effective and ineffective. It has been effective at times in prevention of laryngeal penetration or aspiration. I have also seen exactly the opposite where patients tried the chin tuck to eliminate vallecular residue. The patients had no penetration or aspiration until a chin tuck was introduced, which was when the patient aspirated.
The moral to the story: Don’t assume the chin tuck will always work because it won’t. Make sure to observe multiple trials of the chin tuck under fluoro to ensure that it is effective in your patient. Not all patients will benefit from a chin tuck. Just because Tom does well with the chin tuck and it is very effective for him, does not mean it will be the same for Rick.