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Effect of Spinal Sagittal Alignment in Sitting Posture on Swallowing Function in Healthy Adult Women: A Cross-Sectional Study

Abstract

Swallowing function is both directly and indirectly related to postures, such as head and cervical angle and body position. However, the effects of different sitting postures on oropharyngeal swallowing have not been investigated. This study aimed to investigate whether the change in thoracolumbar alignment affected the oropharyngeal swallowing. A total of 58 healthy adult women (mean age 22.2 ± 1.67 years) without dysphagia were enrolled in this cross-sectional study. Participants were positioned in three sitting postures: comfortable sitting (CS), thoracic upright sitting (TUS), and slump sitting (SS). In each sitting posture, the kyphosis index (using a flexicurve), head and cervical angles (using a digital camera), swallowing speed (100-ml water swallowing test), and oral and articulatory function [by maximum tongue pressure (MTP) and oral diadochokinesis (ODK)] were evaluated. SS showed the largest kyphosis index and was associated with a greater anterior translation of the head. Swallowing speed was significantly decreased in SS compared with CS (p = 0.002) and TUS (p = 0.020) and ODK was significantly decreased in SS compared with other postures, for both /ta/ (p = 0.004) and /ka/ (p < 0.001) syllables. Further, MTP tended to decrease in SS compared with TUS (p = 0.064). Our results suggest that changes in sitting posture with different thoracolumbar alignments affect swallowing speed and oral and articulatory function. Consequently, adjustments to reduce sitting postural kyphosis may improve swallowing speed and oral and articulatory function.

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References

  1. Milidonis MK, Kraus SL, Segal RL, Widmer CG. Genioglossi muscle activity in response to changes in anterior/neutral head posture. Am J Orthod Dentofacial Orthop. 1993;103:39–44.

    CAS  PubMed  Google Scholar 

  2. Paris-Alemany A, Proy-Acosta A, Adraos-Juárez D, Suso-Martí L, La Touche R, Chamorro-Sánchez J. Influence of the craniocervical posture on tongue strength and endurance. Dysphagia. 2021;36:293–302.

    PubMed  Google Scholar 

  3. Leigh JH, Oh BM, Seo HG, Lee GJ, Min Y, Kim K, Lee JC, Han TR. Influence of the chin-down and chin-tuck maneuver on the swallowing kinematics of healthy adults. Dysphagia. 2015;30:89–98.

    PubMed  Google Scholar 

  4. Matsubara K, Kumai Y, Kamenosono Y, Samejima Y, Yumoto E. Effect of three different chin-down maneuvers on swallowing pressure in healthy young adults. Laryngoscope. 2016;126:437–41.

    PubMed  Google Scholar 

  5. Iizumi T, Magara J, Tsujimura T, Inoue M. Effect of body posture on chewing behaviours in healthy volunteers. J Oral Rehabil. 2017;44:835–42.

    CAS  PubMed  Google Scholar 

  6. Inagaki D, Miyaoka Y, Ashida I, Ueda K, Yamada Y. Influences of body posture on duration of oral swallowing in normal young adults. J Oral Rehabil. 2007;34:414–21.

    CAS  PubMed  Google Scholar 

  7. Shiino Y, Sakai S, Takeishi R, Hayashi H, Watanabe M, Tsujimura T, Magara J, Ito K, Tsukada T, Inoue M. Effect of body posture on involuntary swallow in healthy volunteers. Physiol Behav. 2016;155:250–9.

    CAS  PubMed  Google Scholar 

  8. Rosen SP, Abdelhalim SM, Jones CA, McCulloch TM. Effect of body position on pharyngeal swallowing pressures using high-resolution manometry. Dysphagia. 2018;33:389–98.

    PubMed  Google Scholar 

  9. Yoshikawa M, Nagakawa K, Tanaka R, Yamawaki K, Mori T, Hiraoka A, Higa C, Nishikawa Y, Yoshida M, Tsuga K. Improper sitting posture while eating adversely affects maximum tongue pressure. J Dent Sci. 2021;16:467–73.

    PubMed  Google Scholar 

  10. Uesugi Y, Ihara Y, Yuasa K, Takahashi K. Sole-ground contact and sitting leg position influence suprahyoid and sternocleidomastoid muscle activity during swallowing of liquids. Clin Exp Dent Res. 2019;5:505–12.

    PubMed  PubMed Central  Google Scholar 

  11. Moon IY, Yi CH, Park IW, Yong JH. Effects of sitting posture and bolus volume on activation of swallowing-related muscles. J Oral Rehabil. 2020;47:577–83.

    PubMed  Google Scholar 

  12. Lau KT, Cheung KY, Chan KB, Chan MH, Lo KY, Chiu TT. Relationships between sagittal postures of thoracic and cervical spine, presence of neck pain, neck pain severity and disability. Man Ther. 2010;15:457–62.

    PubMed  Google Scholar 

  13. Quek J, Pua YH, Clark RA, Bryant AL. Effects of thoracic kyphosis and forward head posture on cervical range of motion in older adults. Man Ther. 2013;18:65–71.

    PubMed  Google Scholar 

  14. Holland T, Babyar S, Carroll B, Hunt S, Sheeleigh Albright K, Wnukowski M. A preliminary study of the influence of sagittal plane neck alignment on mylohyoid activity during oropharyngeal swallowing: a surface electromyographic analysis. Cranio. 2020;38:43–9.

    PubMed  Google Scholar 

  15. Suzuki M, Koyama S, Kimura Y, Ishiyama D, Ohji S, Otobe Y, Nishio N, Kunieda Y, Ichikawa T, Ito D, Ogawa H, Yamada M. Relationship between tongue muscle quality and swallowing speed in community-dwelling older women. Aging Clin Exp Res. 2020;32:2073–9.

    PubMed  Google Scholar 

  16. Wu MC, Chang YC, Wang TG, Lin LC. Evaluating swallowing dysfunction using a 100-ml water swallowing test. Dysphagia. 2004;19:43–7.

    PubMed  Google Scholar 

  17. Wakabayashi H, Kayashita J. Translation, reliability, and validity of the Japanese version of the 10-item Eating Assessment Tool (EAT-10) for the screening of dysphagia. J Jpn Soc Parenter Enter Nutr. 2014;29:871–6 (in Japanese).

    Google Scholar 

  18. Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, Thomas DR, Anthony P, Charlton KE, Maggio M, Tsai AC, Grathwohl D, Vellas B, Sieber CC, MNA-International Group. Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status. J Nutr Health Aging. 2009;13:782–8.

    CAS  PubMed  Google Scholar 

  19. O’Sullivan PB, Dankaerts W, Burnett AF, Farrell GT, Jefford E, Naylor CS, O’Sullivan KJ. Effect of different upright sitting postures on spinal-pelvic curvature and trunk muscle activation in a pain-free population. Spine. 2006;31:E707–12.

    PubMed  Google Scholar 

  20. Audette I, Dumas JP, Côté JN, De Serres SJ. Validity and between-day reliability of the cervical range of motion (CROM) device. J Orthop Sports Phys Ther. 2010;40:318–23.

    PubMed  Google Scholar 

  21. Milne JS, Lauder IJ. Age effects in kyphosis and lordosis in adults. Ann Hum Biol. 1974;1:327–37.

    CAS  PubMed  Google Scholar 

  22. Teragaki Y, Araya K, Sueki K, Iriuchijima K, Yamauchi J, Usuda S. Reliability validity of the index kyphosis on sitting. Rigakuryouhou Kagaku. 2004;19:137–40 (in Japanese).

    Google Scholar 

  23. Raine S, Twomey LT. Head and shoulder posture variations in 160 asymptomatic women and men. Arch Phys Med Rehabil. 1997;78:1215–23.

    CAS  PubMed  Google Scholar 

  24. Oguchi K, Saitoh E, Mizuno M, Baba M, Okui M, Suzuki M. The repetitive saliva swallowing test (RSST) as a screening test of functional dysphagia (1) normal values of RSST. Jpn J Rehabil Med. 2000;37:375–82.

    Google Scholar 

  25. Niimi M, Hashimoto G, Hara T, Yamada N, Fujigasaki H, Ide T, Abo M. The 2-minute spontaneous swallowing screening predicts independence on enteral feeding in patients with acute stroke. J Stroke Cerebrovasc Dis. 2020;29: 104508.

    PubMed  Google Scholar 

  26. Utanohara Y, Hayashi R, Yoshikawa M, Yoshida M, Tsuga K, Akagawa Y. Standard values of maximum tongue pressure taken using newly developed disposable tongue pressure measurement device. Dysphagia. 2008;23:286–90.

    PubMed  Google Scholar 

  27. Maeda K, Akagi J. Decreased tongue pressure is associated with sarcopenia and sarcopenic dysphagia in the elderly. Dysphagia. 2015;30:80–7.

    PubMed  Google Scholar 

  28. Watanabe Y, Hirano H, Arai H, Morishita S, Ohara Y, Edahiro A, Murakami M, Shimada H, Kikutani T, Suzuki T. Relationship between frailty and oral function in community-dwelling elderly adults. J Am Geriatr Soc. 2017;65:66–76.

    PubMed  Google Scholar 

  29. Tanaka T, Takahashi K, Hirano H, Kikutani T, Watanabe Y, Ohara Y, Furuya H, Tetsuo T, Akishita M, Iijima K. Oral frailty as a risk factor for physical frailty and mortality in community-dwelling elderly. J Gerontol A Biol Sci Med Sci. 2018;73:1661–7.

    PubMed  Google Scholar 

  30. Yamaguchi S, Ishida M, Hidaka K, Gomi S, Takayama S, Sato K, Yoshioka Y, Wakayama N, Sekine K, Matsune S, Otsuka T, Okubo K. Relationship between swallowing function and breathing/phonation. Auris Nasus Larynx. 2018;45:533–9.

    PubMed  Google Scholar 

  31. Ko EJ, Chae M, Cho SR. Relationship between swallowing function and maximum phonation time in patients with Parkinsonism. Ann Rehabil Med. 2018;42:425–32.

    PubMed  PubMed Central  Google Scholar 

  32. Kent RD, Kent JF, Rosenbek JC. Maximum performance tests of speech production. J Speech Hear Disord. 1987;52:367–87.

    CAS  PubMed  Google Scholar 

  33. Knuijt S, Kalf J, Van Engelen B, Geurts A, de Swart B. Reference values of maximum performance tests of speech production. Int J Speech Lang Pathol. 2019;21:56–64.

    PubMed  Google Scholar 

  34. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–8.

    CAS  PubMed  Google Scholar 

  35. Hughes TA, Wiles CM. Clinical measurement of swallowing in health and in neurogenic dysphagia. QJM. 1996;89:109–16.

    CAS  PubMed  Google Scholar 

  36. Nathadwarawala KM, Nicklin J, Wiles CM. A timed test of swallowing capacity for neurological patients. J Neurol Neurosurg Psychiatry. 1992;55:822–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  37. Patterson JM, McColl E, Carding PN, Kelly C, Wilson JA. Swallowing performance in patients with head and neck cancer: a simple clinical test. Oral Oncol. 2009;45:904–7.

    PubMed  Google Scholar 

  38. Suzuki M, Kimura Y, Otobe Y, Kikuchi T, Masuda H, Taguchi R, Tanaka S, Narita Y, Shino S, Kusumi H, Yamada M. Relationship between sarcopenia and swallowing capacity in community-dwelling older women. Gerontology. 2020;66:549–52.

    PubMed  Google Scholar 

  39. Chen YC, Chen PY, Wang YC, Wang TG, Han DS. Decreased swallowing function in the sarcopenic elderly without clinical dysphagia: a cross-sectional study. BMC Geriatr. 2020;20:419.

    PubMed  PubMed Central  Google Scholar 

  40. Neel AT, Palmer PM. Is tongue strength an important influence on rate of articulation in diadochokinetic and reading tasks? J Speech Lang Hear Res. 2012;55:235–46.

    PubMed  Google Scholar 

  41. Takeuchi N, Sawada N, Ekuni D, Morita M. Oral diadochokinesis is related to decline in swallowing function among community-dwelling Japanese elderly: a cross-sectional study. Aging Clin Exp Res. 2021;33:399–405.

    PubMed  Google Scholar 

  42. Kado DM, Prenovost K, Crandall C. Narrative review: hyperkyphosis in older persons. Ann Intern Med. 2007;147:330–8.

    PubMed  Google Scholar 

  43. Okada S, Saitoh E, Palmer JB, Matsuo K, Yokoyama M, Shigeta R, Baba M. What is the chin-down posture? A questionnaire survey of speech language pathologists in Japan and the United States. Dysphagia. 2007;22:204–9.

    PubMed  Google Scholar 

  44. Caneiro JP, O’Sullivan P, Burnett A, Barach A, O’Neil D, Tveit O, Olafsdottir K. The influence of different sitting postures on head/neck posture and muscle activity. Man Ther. 2010;15:54–60.

    PubMed  Google Scholar 

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Acknowledgements

I would like to thank Naoya Obama and Yuhei Kodani for useful discussions. This work was conducted with the support of Kawasaki University of Medical Welfare.

Funding

This research did not receive any grants from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors

Contributions

KN contributed to the protocol design, data collection and analysis, and writing of the manuscript. SN contributed to the protocol design, data collection and analysis, writing of the manuscript, and supervised the study. CK contributed to the protocol design and the review of the manuscript. SH performed the data collection and reviewed the manuscript. MN contributed to the data collection and the review of the manuscript. MI, JY, TY, and SK contributed to the review of the manuscript. SF contributed to the protocol design, data collection and analysis, and writing of the manuscript.

Corresponding author

Correspondence to Shinsuke Nagami.

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The authors declare that they have no conflicts of interest.

Ethics Approval and Consent to Participate

All study protocols were approved by the Ethics Committees of the Kawasaki University of Medical Welfare (approval No. 20-020) and all participants provided written informed consent.

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Nakamura, K., Nagami, S., Kurozumi, C. et al. Effect of Spinal Sagittal Alignment in Sitting Posture on Swallowing Function in Healthy Adult Women: A Cross-Sectional Study. Dysphagia (2022). https://doi.org/10.1007/s00455-022-10476-8

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  • DOI: https://doi.org/10.1007/s00455-022-10476-8

Keywords

  • Swallowing speed
  • Oral function
  • Kyphosis index
  • Sitting posture
  • Deglutition
  • Dysphagia