Special thanks to Mr Ahmet Erkut, The President of Speech Therapy Association of Turkey for invited Mr Yoon from Singapore Swallowing Specialists to present on this Zoom Workshop (2 & 9 April 2023) on “Dysphagia Management in Adult” for the Speech Therapy Association of Turkey. Attended by more than 140 enthusiastic Speech Therapists. Lots of great questions and discussions. We hope to have more collaboration in future.
The following Mandarin CTAR video and blog post are initiative of the Global Dysphagia Movement (GDM).
缩下巴抗阻运动能训练你的上舌骨肌群，以打开进食通道（上食道括约肌），让食物顺利的进入胃。
The Chin Tuck Against Resistance (CTAR) exercise works on strengthening the suprahyoid muscles, necessary for opening your upper food pipe sphincter (or known as the upper esophageal sphincter) to allow food to enter the stomach.
这个运动从袁伟琳先生于2013年创始后，就在国际间广为使用，我们希望这支影片可以提供更多执行运动的细节。我们计划将这只影片以及未来更多的影片翻成不同语言，提供世界各地使用。
Since CTAR was introduced in 2013, Mr Yoon (The CTAR inventor) has been receiving enquiries from clinicians from around the world. We hope that this video will provide the details to facilitate the carrying out of the exercise. There are plans to translate this video into different languages, so as to allow different people around the world to gain an understanding about the exercise and its proper usage.
如果你喜欢这个影片，请不吝按赞，同时记得分享及订阅我们的频道，以收看更多关于CTAR和吞咽的影片。 想知道更多吞咽困难处置的有用资讯和方法，请追踪我们的部落格https://dysphagia.sg/news-and-updates/
Please LIKE , SHARE and SUBSCRIBE to our channel for more upcoming CTAR series and swallowing exercises tips in different languages. Follow us at our blog at https://dysphagia.sg/news-and-updates/ for more useful informations and tips on dysphagia management.
下载CTAR运动指导的PDF，请点击下方的连结: (To download a PDF copy of the CTAR exercise instructions):
* Click to view CTAR videos in the following languages.
** Chin Tuck Against Resistance or CTAR is suitable for:
This Korean translated CTAR video and blog post are initiative of the Global Dysphagia Movement (GDM).
The Chin Tuck Againt Resistance (CTAR) exercise works on strengthening the suprahyoid muscles, necessary for opening your upper food pipe sphincter (or known as the upper esophageal sphincter) to allow food to enter the stomach.
저항성 턱 당기기 운동은 목뿔의근을 강화시켜 상부 식도 괄약근을 열어 음식이 위장에 들어갈수있게 해줍니다.
Since CTAR was introduced in 2013, Mr Yoon (The CTAR inventor) has been receiving enquiries from clinicians from around the world. We hope that this video will provide the details to facilitate the carrying out of the exercise. We plan to translate this and all our upcoming videos into different languages.
2013년 저항성 턱 당기기 운동이 소개 된 이후 운동 발명가 윤선생님께서는 전 세계에서 문의를 받고 있습니다. 이 동영상이 연습수행을 용이하게 하는데에 도움이 되길를 바랍니다. 이 동영상과 앞으로 나올 모든영상들은 여러 언어로 번역될 예정입니다.
The following is the CTAR exercise instructions. You may download a PDF copy of this instructions at the bottom of this page.
다음은 저항성 턱 당기기 운동 지침입니다. 이 페이지 하단에서 이 지침의 PDF사본을 다운로드 할 수 있습니다.
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.
치료사일 경우, 위 QR 코드를 다운로드 받은 후 유인물에 인쇄하면 환자가 위의 YouTube 동영상을 쉽게 검색 할수있습니다.
저항성 턱 당기기 고무공 사용법
목적: 삼키는데 사용되는 목뿔위근육을 강화시키기 위함. 상부 식도 괄약근을 열어 음식이 위장에 들어갈수 있도록 하려면 목뿔위근이 중요하다.
준비물: 1. 고무공 2. 공기 펌프, 공 펌프 니들 밸브 (추가 필요물) – 공의 직경과 압력을 높이기 위해
설명:
1부: 지속적인 저항성 턱 당기기 (등척성)
2부: 반복적인 저항성 턱 당기기 (등장성)
YouTube 동영상을 보시려면
-다음 링크를 https://youtu.be/CExiSYvpcSo 클릭하면 YouTube 동영상으로 바로 연결됩니다.
To download a PDF copy of the CTAR exercise instructions, please click on:
저항성 턱 당기기 운동 지침의 PDF 사본을 다운로드 하시려면 ?? 눌러주십시오.
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 or CTAR is suitable for:
This Taiwanese Minnan translated CTAR video and blog post are initiative of the Global Dysphagia Movement (GDM).
縮下巴阻抗運動能訓練你的上舌骨肌群，以打開進食通道（上食道括約肌），讓食物順利的進入胃。
The Chin Tuck Againt Resistance (CTAR) exercise works on strengthening the suprahyoid muscles, necessary for opening your upper food pipe sphincter (or known as the upper esophageal sphincter) to allow food to enter the stomach.
這個運動從袁伟琳先生於2013年創始後，就在國際間廣為使用，我們希望這支影片可以提供更多執行運動的細節。我們計畫將這隻影片以及未來更多的影片翻成不同語言，提供世界各地使用。
Since CTAR was introduced in 2013, Mr Yoon (The CTAR inventor) has been receiving enquiries from clinicians from around the world. We hope that this video will provide the details to facilitate the carrying out of the exercise.
如果你喜歡這個影片，請不吝按讚，同時記得分享及訂閱我們的頻道，以收看更多關於CTAR和吞嚥的影片。 想知道更多吞嚥困難處置的有用資訊和方法，請追蹤我們的部落格https://dysphagia.sg/news-and-updates/
Please LIKE , SHARE and SUBSCRIBE to our channel for more upcoming CTAR series and swallowing exercises tips in different languages. Follow us at our blog at https://dysphagia.sg/news-and-updates/ for more useful informations and tips on dysphagia management.
下載CTAR運動指導的PDF，請點擊下方的連結: (To download a PDF copy of the CTAR exercise instructions):
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 is suitable for individuals with:
This Japanese translated CTAR video and blog post are initiative of the Global Dysphagia Movement (GDM).
The following is the CTAR exercise instructions. You may download a PDF copy of this instructions at the bottom of this page.
下記にCTARの運動方法が記載してあります。このページの下でそのPDFがダウンロードできます。
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.
Translation:
目的：嚥下に使用する舌骨上筋群の筋力を強化するため。舌骨上筋群は食物が胃にはいるように導く道の上部（上部食道入口部）が開くために重要な働きをします。
Equipment: a)Rubber ball, b)Air pump and ball pump needle valve (optional) – to increase diameter and pressure of the ball
Translation:
道具：１）ゴムボール、２）エアポンプとボール用空気注入針（オプション：ボールの大きさや圧を増加させるため）
Instructions:
Part 1: Sustained CTAR (Isometric)
Part 1:持続CTAR（等尺性）
まっすぐに座るか立って、肩を軽く後ろに引きます。この姿勢を運動中は維持するようにします。
ボールを手で持って顎の下ではさんで、この姿勢を運動中は維持します。
ボールに向かって可能な限り強く顎を引き続けます。持続時間は_______秒です。
嚥下リハビリテーションの担当者の指示に基づいて_______セットを繰り返しましょう。
各セットの間は1分間の休憩をとりましょう。
Part 2: Repetitive CTAR (Isokinetic)
Part 2: 反復CTAR（等張性）
まっすぐに座るか立って、肩を軽く後ろに引きます。この姿勢を運動中は維持するようにします。
ボールを手で持って顎の下ではさんで、この姿勢を運動中は維持します。
ボールに向かって可能な限り強く顎を引いて、そして力を抜きます。
上記のステップを担当治療者の指示に基づいて________回、________セット繰り返します。
各セットの間は1分間の休憩をとるようにします。
To view the YouTube video, you may
scan on the following QR code with your mobile device camera access YouTube via https://youtu.be/E0qUYlihHNM
Translation:
YouTubeビデオをみるためには
- QRコードをスキャンして
- YouTubeサイトhttps://youtu.be/E0qUYlihHNM にアクセスをして下さい
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 or CTAR is suitable for:
This Korean translated CTAR video and blog post are initiative of the Global Dysphagia Movement (GDM).
উল্লেখিত সি টি এ আর ব্যায়ামের নির্দেশাবলী আপনি ডাউনলোড করতে হলে পৃষ্ঠার নিচে চলে যেতে হবে । থেরাপিস্টরা কিউ আর কোড ডাউনলোড করতে পারেন এবং প্রিন্ট করে নিতে পারেন যদি আপনার রুগীকে এই ইউটিঊব ভিডিওটি দেখাতে চান ।
রাবার বলের মাধ্যমে সি টি এ আর থেরাপি
উদ্দেশ্যঃ
সুপ্রাহাইওয়েড মাংসপেশির শক্তিবৃদ্ধির জন্য এবং সুপ্রাহাইওয়েড মাংসপেশির শক্তিবৃদ্ধির মাধ্যমে খাদ্যনালির উপরিভাগের মধ্যদিয়ে খাবার পাকস্থলীর মধ্যে যেতে সাহায্য করে
যন্ত্রপাতিঃ
সি টি এ আর এর জন্য জিনিসপত্রঃ
রাবারের বল , বল পাম্প দেওয়ার ভাল্ব (ঐচ্ছিক) – হস্তচালিত পাম্প (ঐচ্ছিক); বলের পরিধি কমানো বাড়ানোর জন্য
নির্দেশাবলীঃ
অংশ ১ঃ সাস্টেইন সি টি এ আরঃ
১। সোজা হয়ে বসা বা দাঁড়ানো অবস্থায় কাঁধটাকে শরীরের পিছনের দিকে তুলে ধরতে হবে এভাবে সঠিক দেহভঙ্গি নিয়ন্ত্রণ করতে হবে
২। থুতনির নিচে বলটি হাত দিয়ে ধরে রাখতে হবে
৩। থুতনির নিচে বলটি রাখার পর থেরাপিস্টের পরামর্শ অনুযায়ী থুতনিকে বলের বিপরীতে চাপ দিয়ে ধরে রাখতে হবে ___ সেকেন্ডের জন্য যতটুকু পর্যন্ত শক্তি প্রয়োগ করা যায়
৪। থেরাপিস্টের পরামর্শ অনুযায়ী __ বার করতে হবে
৫। প্রত্যেকবার ব্যায়াম করার মাঝখানে ১ মিনিট করে বিশ্রাম নিতে হবে
অংশ ২ঃ রিপিটিটিভ সি টি এ আরঃ
১। সোজা হয়ে বসা বা দাঁড়ানো অবস্থায় কাঁধটাকে শরীরের পিছনের দিকে তুলে ধরতে হবে এভাবে সঠিক দেহভঙ্গি নিয়ন্ত্রণ করতে হবে
২। থুতনির নিচে বলটি হাত দিয়ে ধরে রাখতে হবে
৩। থুতনির নিচে বলটি রাখার পর থেরাপিস্টের পরামর্শ অনুযায়ী থুতনিকে বলের বিপরীতে চাপ দিয়ে ধরে রাখতে হবে এবং উপরের দিকে থুতনি উঠানো লাগবে
৪। রিপিটিটিভ সি টি এ আর এর ক্ষেত্রে কতবার পুনরাবৃত্তি করতে হবে এবং কতসময় করতে তা একমাত্র একজন গ্রাজুয়েট স্পিচ অ্যান্ড ল্যাঙ্গুয়েজ থেরাপিস্ট নির্ধারণ করবেন
৫। প্রত্যেকবার ব্যায়াম করার মাঝখানে ১ মিনিট করে বিশ্রাম নিতে হবে
ইউটিউব ভিডিওর জন্য-
– আপনার ফোনের ক্যামেরা দিয়ে কিউ আর কোড স্ক্যান করুন
– ইউটিউব লিঙ্ক https://youtu.be/Z-kmMnjsNd4
অনুবাদক
আবুল কাশেম সিহাব
স্পিচ অ্যান্ড ল্যাঙ্গুয়েজ থেরাপিস্ট
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 i.e.
We are happy to announce that the follow up study on CTAR has been published online (online first version) in Dysphagia Journal.
Original Paper
pp 1-11
First online: 02 February 2016
In this study, the efficacy of two dysphagia interventions, the Chin Tuck against Resistance (CTAR) and Shaker exercises, were evaluated based on two principles in exercise science—muscle-specificity and training intensity. Both exercises were developed to strengthen the suprahyoid muscles, whose contractions facilitate the opening of the upper esophageal sphincter, thereby improving bolus transfer. Thirty-nine healthy adults performed two trials of both exercises in counter-balanced order. Surface electromyography (sEMG) recordings were simultaneously collected from suprahyoid muscle group and sternocleidomastoid muscle during the exercises. Converging results using sEMG amplitude analyses suggested that the CTAR was more specific in targeting the suprahyoid muscles than the Shaker exercise. Fatigue analyses on sEMG signals further indicated that the suprahyoid muscle group were equally or significantly fatigued (depending on metric), when participants carried out CTAR compared to the Shaker exercise. Importantly, unlike during Shaker exercise, the sternocleidomastoid muscles were significantly less activated and fatigued during CTAR. Lowering the chin against resistance is therefore sufficiently specific and intense to fatigue the suprahyoid muscles.
Details of the journal can be found at http://link.springer.com/article/10.1007%2Fs00455-015-9678-2
We are happy to announce that we are starting our third CTAR research at the National University of Singapore.
Dear all,
JurongHealth Speech Therapy department will be organising a 2 day workshop next year entitled ‘Best Practices in the Management of Oropharyngeal Dysphagia’. The workshop will be conducted by Dr. Catriona Steele and will be held on 20 – 21 May, 2016 at Ng Teng Fong General Hospital, Singapore.
About the speaker:
Dr. Catriona M. Steele is a clinician scientist working in the area of swallowing and swallowing disorders. She has a background as a medical speech-language pathologist, and is Director of the Swallowing Rehabilitation Research Laboratory at the Toronto Rehabilitation Institute – University Health Network. Dr. Steele is a Professor in the Department of Speech-Language Pathology at the University of Toronto and is in demand as a teacher and workshop instructor around the world. Dr. Steele holds research funding from the National Institutes of Health (USA) and has more than 100 peer-reviewed publications.
Brief outline of workshop
> Best Practices in the Identification and Assessment of Oropharyngeal Dysphagia
– Sensitivity and specificity of different dysphagia screening tools
– Purpose, protocols and important technical considerations of videofluoroscopy
– Using information from research to quantify observations during a clinical bedside swallowing assessment
> Management and Rehabilitation of Oropharyngeal Dysphagia
– Evidence behind texture modification and postural approaches
– Direct and indirect swallowing/exercise approaches including the use of IOPI and sEMG biofeedback
– Other approaches in the literature: respiratory interventions, electrical stimulation, vibratory stimulation
Estimated cost: $400 – $500 per participant for the full workshop.
Registration Correspondent: Ms Wong Wan Xin
Wong Wan Xin| Speech Therapist, Rehabilitation | Ng Teng Fong General Hospital & Jurong Community Hospital | Jurong Health Services
1 Jurong East Street 21, Singapore 609606 | T: (65) 67161674 | E: Wan_Xin_Wong@juronghealth.com.sg
About the Workshop:
Oral motor impairment presents a variety of challenges for both the individual affected, and for the care team providing intervention. Often the individual experiencing oral motor difficulties is not able to follow commands. The person may not be eating or taking fluids orally, which reduces the opportunities for observation of oral movement patterns. The majority of baseline protocols currently available require at least minimal direction-following skills. The protocol developed by Beckman uses mechanical muscle responses, which are not mediated cognitively, to baseline the response to pressure and movement, range of movement, variety of movement, strength of movement and control of movement for the lips, cheeks, jaw, and tongue. In this two day course, participants will actively participate in hands-on practice for compensatory handling techniques for the following concerns: tonic bite, tonic bite on a utensil, slow oral transit, tongue thrust, cough, gag and vomit. The participants will complete an oral motor protocol with each other, analyze the results, and discuss data tracking. The participants will also complete hands-on practice for specific oral motor interventions to address the deficit areas discovered during baseline assessment. Additional topics of discussion may include: goal writing, diet texture progression, tube to oral issues, adaptive mealtime utensils, oral hygiene issues, medication administration issues, oral function for individuals with tracheotomy, facilitating improved articulation through oral motor techniques, research issues, videofluroscopy issues for motorically involved individuals.
Speaker: Mr Stephen Chan (Occupational Therapist)
Target Participants: Licensed Occupational Therapists AND Speech and Language Pathologists/Speech Therapists
Date &Time: 9th & 10th March, 2016 (Wed & Thur) 9:30am – 5:30pm
Venue: Room 706, Peninsula Tower, No. 538, Castle Peak Road, Kowloon, HONG KONG
Seat Availability: 30 seats
Course Fee:
Certification: Upon 100% attendance, participants are awarded the Certificate of Completion by Beckman & Associates, Inc. And after the completion of the course, participants’ name can be listed (optional) on the website http://www.beckmanoralmotor.com.
Enquiry: To learn more about the course, please visit the website: http://www.beckmanoralmotor.com
Registration form can be downloaded from: http://www.crest.hk/wp-content/uploads/2014/07/Beckman-Certificate-Course-Information-by-CREST-2016.03-revised.pdf
For any enquiries, please feel free to contact Mr. Stephen Chan at stephen@crest.hk or (852) 3628 3443
Host: Speech-Language and Hearing Association Singapore (SHAS)
The SHAS will be holding a Special Interest Group : Sharing on Paediatric Feeding Services Available in Singapore
Date: 26 November 2015 (Thursday).
Venue: KK Women’s and Children’s Hospital, Women’s Tower (Level 1), Seminar Room 1, 100 Bukit Timah Rd, Singapore 229899
There will be sharing session by various representatives from different organisations:
If you are interested in attending the session, please email the completed registration form to pd.shas@gmail.com by 20 November 2015 (Friday).
Singapore Swallowing Specialists 