Hitoshi KAGAYA & et all
Body positions that minimize aspiration include the reclining position, chin down, head rotation, side inclination, the recumbent position, and combinations of these. Patients with severe dysphagia often use a 30° reclining position. But in reality, the patient must be more than 60° higher than a supine position in order to eat without assistance. There are 3 types of “chin down” positions: head flexion, neck flexion, and compound flexion (head flexionneck flexion). Patients whose pharynx are more paralyzed on either side can turn their head toward the paralyzed side to narrow the piriform fossa on the paralyzed side or use the force of gravity from a side-lying or recumbent position to guide a food bolus to the non-paralyzed side. Training methods include cervical range of motion exercises, thermal-tactile stimulation, supraglottic swallow, the Mendelsohn maneuver, head raising exercises, balloon training, respiratory physiotherapy, training for activities of daily living, and physical strength training. There is no one best body position or training method that is effective for all patients, so it is crucial that effectiveness be confirmed before use.
