**My apologies to the Beastie Boys for copying their song title but it was just too fitting!
This weekend, I spent a fair amount of time on a kayak in the middle of a lake with a relaxing beverage or two. At one point, I was pretty reclined and sipping continually through a straw… all the things we tell patients not to do, right? And…. I was ok. (Better than ok, but this isn’t about my nice sunny weekend). We spend a lot of time telling patients what NOT to do, we hear a lot of chat about being the “food police” and getting exasperated with patients because we walk in to see them lying in bed while eating. But really, is this the golden rule with regard to “safest/best” positioning?
Today’s clip is a great example of how sometimes reclining a patient can actually be helpful. In this patient’s case, the gravity used was helpful for both increasing the ease of movement of bolus through the oral cavity, as well as airway protection. The patient was struggling with oral manipulation, and had started eating less, stating it was “too hard”. This posture, for this patient, with this deficit and complaint, was highly effective and the patient made several happy comments about how much “easier” this reclined posture felt. Furthermore, there is some research (not perfect studies, but worth thinking about) that shows in certain patients the reclined posture can result in reduced penetration and aspiration, and improve clear of the bolus through the UES.
It is worth mentioning, for at LEAST the 20th time, that there just is no “one size fits all” recommendation, and that even the “safe” guidelines we throw around should be considered critically for each patient. See below for more reading!