Head Lifting Strength is Associated with Pharyngeal Residuals in Older Inpatients with Suspected Dysphagia

Head lifting strength can be easily measured without special equipment. The relationship between head lifting strength and dysphagia is well-established. However, its association with Pharyngeal residuals-a risk factor for aspiration-has not yet been explored. This study aimed to determine the association between head lifting strength and Pharyngeal residuals, as assessed through a Videofluoroscopic swallowing study (VFSS), in older inpatients with suspected dysphagia. A total of 50 patients who underwent VFSS for suspected dysphagia were included. Head lifting strength was measured as the number of repetitions of maximum head lifting and the time to maintain maximum head lifting. The Normalized Residue Ratio Scale (NRRS) was scored at the valleculae (NRRSv) and piriform sinus (NRRSp) while swallowing 3 ml of a moderately thick liquid during the VFSS. Univariate and multiple regression analyses examined the relationship between head lifting strength and NRRSv and NRRSp. The time to maintain maximum head lifting and the number of repetitions of maximum head lifting were significantly negatively correlated with the NRRSv and NRRSp. However, in the adjusted multiple regression analysis model, only the number of repetitions of maximum head lifting was related to NRRSv and NRRSp. This study implies that a simple head lifting strength test can be implemented in the clinic to determine the risk of pharyngeal residuals after swallowing and, consequently, the possibility of aspiration.