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Dysphagia Swallowing Therapy – Chin Tuck Against Resistance (CTAR) with Rubber Ball

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Yoon Wai Lam

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Video on CTAR by using the rubber ball

Singapore Swallowing Specialists (SSS) network has just released their very first swallowing therapy video on Chin Tuck Against Resistance (CTAR) by using the rubber ball (Series 1). We plan to produce more series on CTAR and other swallowing therapy exercises / strategies and translate all the videos to different languages from around the world. SSS hopes to reach out to benefit more people worldwide.

The following is the CTAR exercise instructions. You may download a PDF copy of these instructions at the bottom of this page.

For clinicians, you may download the above QR code and print it on your exercise handouts to facilitate clients’ search for the above YouTube Video.

Chin Tuck Against Resistance (CTAR) with a Rubber Ball

Purpose: To strengthen the suprahyoid muscles used in swallowing. The suprahyoid muscles are important to open your upper food pipe sphincter (upper esophageal sphincter) to allow food to enter your stomach.

Equipment: a)Rubber ball, b)Air pump and ball pump needle valve (optional) – to increase diameter and pressure of the ball

Instructions:

Part 1: Sustained CTAR (Isometric)

  1. Sit / stand upright and pull your shoulders back. Maintain this posture during the exercise.
  2. Hold the ball under your chin with your hand and keep it in position during the exercise.
  3. Sustain chin tuck against the ball as hard as possible; for the duration of _______ sec.
  4. Repeat _______ sets as recommended by your speech therapist / pathologist.
  5. Rest for 1 minute in between each set of the exercise.

Part 2: Repetitive CTAR (Isokinetic)

  1. Sit / stand upright and pull your shoulders back. Maintain this posture during the exercise.
  2. Hold the ball under your chin with your hand and keep it in position during the exercise.
  3. Tuck your chin in, as hard as possible against the ball; then lift your chin.
  4. Repeat the above steps for ________ times and ________ sets as recommended by your speech therapist / pathologist.
  5. Rest for 1 minute in between each set of the exercise.

Click on the following to download the exercise instructions and/or the QR code to access the YouTube video:

CTAR using Rubber Ball – Exercise Instructions (ENGLISH)
QR code to access CTAR YouTube video

YouTube video URL: https://youtu.be/zBoZSr19zWo

CTAR with Rubber Ball Exercise videos are available in the following languages:

* Click to view CTAR videos in the following languages.

Chin Tuck Against Resistance (CTAR) exercise is suitable for most patients with swallowing difficulties / dysphagia:

  • dysphagia or swallowing difficulties following strokes,
  • dysphagia following head and neck cancer,
  • dysphagia following Parkinson’s disease,
  • dysphagia due to late effect of radiotherapy e.g. nasopharyngeal cancer
  • etc.

Comments

12 responses to “Dysphagia Swallowing Therapy – Chin Tuck Against Resistance (CTAR) with Rubber Ball”

  1. Marie Boucher Avatar
    Marie Boucher

    Very interesting video! Thanks for sharing!
    It would be very appreciated if you considered videos in French 🙂 Thank you very much!
    (M-F.Boucher, Qc, Canada)

    Reply
    1. Yoon Wai Lam Avatar
      Yoon Wai Lam

      Hi Marie, thank you very much for your interest. Would love to create videos in French, however I do not have any French contacts to have with translation. Currently I have volunteers from Japan and Taiwan to translate. Are you from France? Just wondering if you are keen to volunteer to help to translate to French? Would really appreciate if you can help. I am hoping that the dysphagia exercises video will reach out to as many people as possible around the world.
      Regards,
      Yoon

      Reply
  2. mishareads Avatar
    mishareads

    Interesting and informational video. I would love to volunteer to translate this video in Urdu for the Pakistani population.
    Thank you!

    Reply
    1. Yoon Wai Lam Avatar
      Yoon Wai Lam

      thank you very much for your interest. May i know how should i address you? May i have your email address? I will be producing more videos, would be grateful if you can help to translate this to Urdu. Currently there is another SLP from pakistan translating for this video. The next one, may i seek your help?
      Thank you.

      Reply
    2. Yoon Wai Lam Avatar
      Yoon Wai Lam

      Do you mind to send me an email at dysphagia.singapore@gmail.com ?

      Reply
    3. Yoon Wai Lam Avatar
      Yoon Wai Lam

      Or you can give me your email address? Thank you

      Reply
  3. Thao Huynh Avatar
    Thao Huynh

    Hi, May I volunteer to translate into Vietnamese. My email address is thao.hb@umc.edu.vn

    Reply
    1. Yoon Wai Lam Avatar
      Yoon Wai Lam

      Dear Huynh, thank you very much for your interest in translating CTAR video to Vietnamese. I will send you the details soon!
      Regards,
      Yoon

      Reply
  4. anisa Avatar
    anisa

    hi, this CTAR ball is very interesting! may i know about the size (diameter), ball pressure, and the ball material that used in the exercise?
    Thank you in advance!

    Reply
    1. Yoon Wai Lam Avatar
      Yoon Wai Lam

      Dear Anisa, thank you very much for your interest in CTAR. For the research, we used a 12cm diameter rubber ball to standardize the size across subjects. However, in therapy we need to take into consideration the length of the subject’s / patient’s neck. It has to be fit nicely between the chin and the upper chest bone, as such the diameter might vary.
      I think Rubber ball that can be inflated is better as you can pump up to increase the pressure or to reduce pressure. We did not measure the pressure of the ball. You may not want to restrict to just using ball to perform CTAR. Some clinicians have been using rolled towel, neckline slimmer and etc to perform CTAR. Hope I answered all your questions.
      All the best!
      Best regards,
      Yoon

      Reply
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