The effectiveness of the head-turn-plus-chin-down maneuver for eliminating vallecular residue

Ahmed Nagy, Melanie Peladeau-Pigeon, Teresa Josephine Valenzano, Ashwini Marini Namasivayam, Catriona Margaret Steele

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)


Purpose: When swallowing efficiency is impaired, residue accumulates in the pharynx. Cued or spontaneous swallows in the head neutral position do not always successfully clear residue. We investigated the impact of a novel maneuver on residue clearance by combining a head turn with the chin down posture. Methods: Data were collected from 26 participants who demonstrated persistent vallecular residue after an initial head neutral clearance swallow in videofluoroscopy. Participants were cued to perform a head-turn-plus-chin-down swallow, with the direction of head turn randomized. Pixel-based measures of residue in the vallecular space before and after the maneuver were made on still frame lateral images using ImageJ software. Measures of % full and the Normalized Residue Ratio Scale (NRRS) were extracted. Univariate analyses of variance were used to detect significant reductions in residue. Results: On average, pre-maneuver measures showed residue filling 56-73% of the valleculae, depending on stimulus consistency (NRRS scores: 0.2-0.4). More than 80% of pre-swallow measures displayed NRRS ratios > 0.06, a threshold previously linked to increased risk of post-swallow aspiration. Conclusion: The head-turn-plus-chin-down maneuver achieved significant reductions in residue for thin and nectar-thick fluids, suggesting that this maneuver can be effective in reducing persistent vallecular residue with these consistencies.

Original languageEnglish
Pages (from-to)113-117
Number of pages5
Issue number2
Publication statusPublished - 2016
Externally publishedYes


  • Deglutition
  • Deglutition Disorders,
  • Dysphagia
  • Image Analysis
  • Postures
  • Residue
  • Swallowing
  • Videofluoroscopy

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Language and Linguistics
  • Speech and Hearing


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