swallowing therapy

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

Yoon Wai Lam
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 hope to reach out to benefit more people worldwide.

The following is the CTAR exercise instructions. You may download a PDF copy of this 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 for 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 i.e. Nasopharyngeal cancer
  • etc.

Published by Yoon Wai Lam

Wai Lam is the director and founder of Speech Therapy Works LLP and Singapore Swallowing Specialists Network. He has more than 20 years of experience in adult speech, language and swallowing therapy. He is the inventor of the Chin Tuck Against Resistance (CTAR), a award winning swallowing therapy exercise that is currently practiced worldwide. He is a well known dysphagia trainer in the region and he has trained hundreds of speech therapists both locally and regionally. He is often consulted by speech therapists and other healthcare professionals for complex cases involving both speech and swallowing difficulties in Singapore and overseas. He is also a reviewer of the Dysphagia Journal.

10 thoughts on “Dysphagia Swallowing Therapy – Chin Tuck Against Resistance (CTAR) with Rubber Ball”

  1. 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)

    Liked by 1 person

    Reply

    1. 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

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

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    1. 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.

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  4. 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!

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    1. 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

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