Impact of Head and Neck Posture on Swallowing Kinematics and Muscle Activation: A Systematic Review.

Abstract

Swallowing is a complex neuromuscular process involving the coordination of anatomical structures in the central and peripheral nervous systems. The posture of the head and neck plays a critical role in the biomechanics of swallowing, especially in populations with dysphagia. This systematic review aims to explore the impact of head-neck posture on swallowing kinematics and muscle activation, providing a multidisciplinary perspective for optimizing dysphagia management.A comprehensive literature search was conducted across three databases: PubMed, Web of Science, and LILACS, adhering to the PRISMA guidelines. Studies that specifically addressed swallowing and posture were included, with 25 studies selected for analysis. The results indicate that cranio-cervical flexion ("chin-down" posture) improves laryngeal vestibule closure and reduces aspiration risk, while cranio-cervical extension ("chin-up posture") delays hyoid elevation and increases the risk of pharyngeal residue and aspiration. Additionally, excessive cervical muscle tone alters the kinematics of the hyoid bone, compromising the safety and efficiency of swallowing.Postural interventions, such as chin-tuck maneuvers and head rotations, have shown effectiveness in reducing aspiration and improving swallowing efficiency. However, factors such as muscle fatigue and long-term adherence may limit their effectiveness. Individualized approaches that consider the severity of dysphagia and the patient's functional capabilities are essential.This review highlights the need for further research with large-scale randomized controlled trials to better understand the complex interaction between posture and swallowing. A multidisciplinary approach, involving physiotherapists, speech therapists, and neurologists, is crucial for improving therapeutic outcomes in dysphagia rehabilitation.