Ann Rehabil Med.  2018 Jun;42(3):416-424. 10.5535/arm.2018.42.3.416.

Changes in Hyolaryngeal Movement During Swallowing in the Lateral Decubitus Posture

• Oh BM
• Lee JH
• Seo HG
• Lee WH
• Han TR
• Jeong SU
• Jeong HJ
• Sim YJ

• KMID: 2417833
• DOI: http://doi.org/10.5535/arm.2018.42.3.416

Abstract

OBJECTIVE
To investigate the differences in hyolaryngeal kinematics at rest and during swallowing in the upright sitting (UP) and the lateral decubitus (LD) postures in healthy adults, and delineating any potential advantages of swallowing while in the LD posture.
METHODS
Swallowing was videofluoroscopically evaluated in 20 healthy volunteers in UP and LD postures, based on the movements of hyoid bone, vocal folds, and the bolus head. Parameters included the Penetration-Aspiration Scale (PAS), horizontal and vertical displacement, horizontal and vertical initial position, horizontal and vertical peak position, time to peak position of the hyoid bone and vocal folds, and pharyngeal transit time (PTT).
RESULTS
Nine participants were rated PAS 2 in the UP and 1 was rated PAS 2 in the LD (p=0.003) at least 1 out of 3 swallows each posture. The hyoid and vocal folds showed more anterior and superior peak and initial positions in the LD. In addition, swallowing resulted in greater vertical and smaller horizontal displacement of the hyoid in LD posture compared with UP. Time to peak position of the hyoid was shorter in LD. The maximal vertical and horizontal displacement of the vocal folds, and PTT were comparable between postures.
CONCLUSION
The results showed that the peak and initial positions of the hyoid and larynx and the pattern of hyoid movement varied significantly depending on the body postures. This study suggests that the LD posture was one of the safe feeding postures without any increased risk compared with UP posture.

Keyword

Deglutition disorders; Posture; Biomechanical phenomena; Hyoid bone; Vocal cords

MeSH Terms

Adult
Biomechanical Phenomena
Deglutition Disorders
Deglutition*
Head
Healthy Volunteers
Humans
Hyoid Bone
Larynx
Posture*
Swallows
Vocal Cords

Figure

• 

  Fig. 1. The coordinate axes of kinematic analysis. The zero point (A) is defined as the anterior-inferior margin of the fourth cervical vertebral body. The vertical axis is defined as the straight line connecting the zero point with the anterior-inferior margin of the second cervical vertebral body (B). The horizontal axis is the axis perpendicular to the vertical axis at the zero point. The movement of the hyoid bone (arrow) is measured with these coordinate axes.

• 

  Fig. 2. (A) An exemplary hyoid bone trajectory and the kinematic parameters. Maximal displacement is defined by the difference between the minimal and maximal positions of each structure during swallowing. The maximal 2D displacement is defined as the farthest displacement from the resting position. The 2D displacement may be smaller than the maximal horizontal or vertical displacement because the resting position may not be the lowest or the posteriormost location. (B) The vertical position of the hyoid, vocal folds, and bolus head over time in a representative swallow. The bolus head is already outside of the recorded video coverage when the vocal folds reach the peak vertical position (arrowhead). Instead, the time point 60% of the way between the time points corresponding to the initial and peak vertical positions is used.

• 

  Fig. 3. Average trajectories of the hyoid bone during upright sitting posture (UP) and lateral decubitus posture (LD). In the Cartesian plane at the right upper corner, the asterisk (*) shows the anterior end of the hyoid bone.

• 

  Fig. 4. Average trajectories of the vocal folds during swallowing in the upright sitting posture (UP) and lateral decubitus posture (LD). In the Cartesian plane in the right upper corner, the arrowhead shows the anterior superior point of the subglottic airway column.

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