I have a patient that recently received instruction from a Speech Therapist after failing her swallow study.  She had been aspirating and he instructed her to look down toward her navel when she swallows.  I thought about this as I assessed what changes occurred as she did this.  It appeared to me that the cervical extension occurring to “level the eyes” as a result of the increased thoracic kyphosis was the problem. By having her look down toward her navel he was essentially getting her cervical region to a neutral position.  I took a photo of her from the side and showed her the degree to which her neck was tilting back.  It as apparent that this amount of extension would be equivalent to sitting with a straight spine and tilting the head back to look at the ceiling.  I think I would have difficulty swallowing correctly with my head tilted back as well.

Every year there are many elderly that die of Aspiration Induced Pneumonia.  Physical Therapists should be keenly aware of the postural changes that could be playing a part in this occurrence and should work to train patients and caregivers in proper positioning and posture to avoid this problem.