Ask an answerable question (PICO)：
More than 55% of stroke survivors have a clinical problem of difficulty swallowing (dysphagia). Aspiration Pneumonia occurs when foreign materials (food, liquids vomit or saliva) are breathed into the lungs or airways to the lungs; approximately 25% of stroke-related dysphagia can lead to aspiration pneumonia following stroke, and the estimated mortality rate was 46%. The health-care professionals have a role in analyzing the level of dysphagia, providing individual preventative measures to prevent and reducing the incidence of aspirations and pneumonia in stroke patients. This article was conducted a systematic review aiming to identify the empirical application of the chin-down posture in the improvement of dysphagia in stroke patients.
The Method and Analysis of Literature Review：
Electronic databases including, including PubMed Clinical Queries, CINAHL, The Cochrane Library, ProQuest, EMBASE and Airiti library were retrieved for relevant articles. In this systematic review research, keywords included 腦中風stroke、下巴下壓chin-down、下巴內縮chin-tuck、吞嚥困難Dysphagia、吞嚥障礙Dysphagic、一般照護usual care were selected, a total of 22 articles that preliminary the search criteria were extracted. Finally, three randomized controlled trials (RCT) were selected as the final studies after screening the topics and deletions repetitions .
Critical Appraisal：
The Critical Appraisal Skills Programme(CASP, 2014) was used to appraise the quality of the reviewed studies. According to Gao and Zhang (2017), a significant difference between “Shaker exercise” and “Chin-Tuck Against Resistance (CTAR)” in dysphagia following cerebral infarction patients was reported. Chin-Tuck Against Resistance (CTAR) was an effectiveness of dysphagia intervention in in stroke patient with dysphagia, a significant positive correlation was found between Functional Dysphagia Scale (FDS)”and Penetration-Aspiration Scale (PAS)” (p<.05) (Park, et al., 2018). The choking and coughing frequency in the experimental group were decreased after Chin-down swallowing posture intervention (at least 3 times a day), a significant difference was revealed in the swallowing questionnaire and the Eating Assessment Tool (EAT-10) (p< .05).
Results, Conclusions and Recommendations：
The chin-tuck or chin-down postural maneuver, a non-invasive and cost-effective technique, can improve swallowing performance, reduce the chance of choking while eating or drinking. However, it was not recommend for patients with sitting problems, impaired consciousness or poor cough reflex .
