Special thanks to Mr. Ahmet Erkut, the President of the Speech Therapy Association of Turkey, for inviting Mr. Yoon Wai Lam from Singapore Swallowing Specialists to present at the second Zoom workshop (23 & 30 June 2024) on âVFS & FEES Interpretation and Treatment Planningâ to the Speech Therapy Association of Turkey. The workshop was attended by more than 140 enthusiastic speech therapists, resulting in lots of great questions and discussions.
We look forward to more future collaboration.
The following are some of the slides from the FEES Workshop:
FEES view at the Oropharynx and Laryngopharyx FEES: Anatomy of the pharynx and larynx (Superior View)FEES: Interesting case study on the “Rising Tide” presentation
The following are some of the slides from the VFS workshop:
VFS: AnatomyVFS: The normal swallowing sequenceVFS: Case Study on the “Tennis Player” A chronic severe dysphagia client was successfully treated with therapy using sEMG biofeedback. This client managed to resume a regular diet and thin fluids and had his PEG tube removed.
The year 2023 marks a monumental achievement for the Singapore Speech Therapy/Dysphagia community as CTAR (Chin Tuck Against Resistance), the inaugural swallowing therapy exercise, gains recognition for its pivotal role in advancing swallowing rehabilitation (Huckabee et al., 2023). Invented by Mr. Yoon Wai Lam, a distinguished Speech Therapist from Singapore, CTAR aims to provide a simple, economical, and highly effective exercise for strengthening the suprahyoid muscles involved in swallowing. Mr. Yoon first developed CTAR using a S$2.00 ‘pasar malam’ (a Malay word meaning night market in Singapore) inflatable rubber ball.
Figure taken from: Huckabee, ML., Mills, M., Flynn, R. et al. The Evolution of Swallowing Rehabilitation and Emergence of Biofeedback Modalities. Curr Otorhinolaryngol Rep 11, 144â153 (2023). https://doi.org/10.1007/s40136-023-00451-8
CTAR made its global debut at the Dysphagia Research Society conference in 2013 in Seattle, Washington, USA. The unexpected surge of interest and the honor of receiving first place for the Scientific Abstract Poster underscored CTAR’s immediate impact. The initial CTAR journal article, published in Dysphagia Journal in 2014, quickly became one of the top 10 most downloaded articles of that year. A subsequent 2016 article further solidified its influence, collectively amassing 157 citations in various textbooks and journal articles to date.
Beyond its original conception, CTAR inspired the development of numerous devices globally. However, Mr. Yoon distinguished himself by advancing the CTAR procedure without additional costs or commercial devices, relying solely on hand movements.
In a commendable move towards accessibility, Mr. Yoon launched the Singapore Swallowing Specialists YouTube Channel (http://www.youtube.com/@singaporeswallowingspecial735). This platform provides free CTAR videos in multiple languages, reaching over 60 thousand individuals worldwide.
The details of the CTAR exercise can be found at the following links:
Huckabee, ML., Mills, M., Flynn, R. et al. The Evolution of Swallowing Rehabilitation and Emergence of Biofeedback Modalities. Curr Otorhinolaryngol Rep 11, 144â153 (2023). https://doi.org/10.1007/s40136-023-00451-8
Sze, W. P., Yoon, W. L., Escoffier, N., & Rickard Liow, S. J. (2016). Evaluating the Training Effects of Two Swallowing Rehabilitation Therapies Using Surface Electromyography-Chin Tuck Against Resistance (CTAR) Exercise and the Shaker Exercise. Dysphagia, 31(2), 195â205. http://doi.org/10.1007/s00455-015-9678-2
Yoon, W.L., Khoo, J., & Liow, S. (2014). Chin tuck against resistance (CTAR): a new method for enhancing suprahyoid muscle activity using a Shaker-type exercise. Dysphagia. Retrieved from http://link.springer.com/article/10.1007/s00455-013-9502-9
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 âDysphagia Management in Adultâ 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.
Youtube Video on CTAR in MandarinGDM would like to thank Mr Eng Tze Hao (Speech Therapist from Singapore) for his help in translation and presentation of the Mandarin Version of the CTAR video.
The following Mandarin CTAR video and blog post are initiative of the Global Dysphagia Movement (GDM). įŧŠä¸åˇ´æéģčŋå¨čŊčŽįģäŊ įä¸čéĒ¨čįž¤īŧäģĨæåŧčŋéŖééīŧä¸éŖéæŦįēĻčīŧīŧ莊éŖįŠéĄēåŠįčŋå Ĩčã
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. čŋä¸Ēčŋå¨äģčĸäŧįŗå įäē2013åš´åå§åīŧå°ąå¨åŊé é´åšŋä¸ēäŊŋį¨īŧæäģŦå¸æčŋæ¯åŊąįå¯äģĨæäžæ´å¤æ§čĄčŋå¨įįģčãæäģŦ莥åå°čŋåĒåŊąįäģĨåæĒæĨæ´å¤įåŊąįįŋģæä¸åč¯č¨īŧæäžä¸įåå°äŊŋį¨ã
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. åĻæäŊ åæŦĸčŋä¸ĒåŊąįīŧč¯ˇä¸åæčĩīŧåæļ莰åžåäēĢåčŽĸé æäģŦįéĸéīŧäģĨæļįæ´å¤å ŗäēCTARåååŊįåŊąįã æŗįĨéæ´å¤ååŊå°éžå¤įŊŽįæį¨čĩčŽ¯åæšæŗīŧč¯ˇčŋŊč¸ĒæäģŦįé¨čŊæ ŧhttps://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. ä¸čŊŊCTARčŋå¨æå¯ŧįPDFīŧč¯ˇįšåģä¸æšįčŋįģ: (To download a PDF copy of the CTAR exercise instructions):
GDM would like to thank Ms Sandy Lim (SLP from USA) for her help in translation and presentation of the Korean Version of the CTAR video.
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.
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.
GDM would like to express our heartfelt thanks to the Taiwanese SLP team for their help in translation and presentation of the Taiwanese Minnan Version of the CTAR video.
This Taiwanese Minnan 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.
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.
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.
ä¸čŧCTARéåæå°įPDFīŧčĢéģæä¸æšįéŖįĩ: (To download a PDF copy of the CTAR exercise instructions):
YouTube Video on Japanese CTAR with Rubber BallGDM would like to express our heartfelt thanks to Dr Kotomi Sakai for her help in translation and presentation of the Japanese Version of the CTAR video.
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.
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.
Evaluating the Training Effects of Two Swallowing Rehabilitation Therapies Using Surface ElectromyographyâChin Tuck Against Resistance (CTAR) Exercise and the Shaker Exercise
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 scienceâmuscle-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.
JurongHealth Speech Therapy department will be organising a 2 day workshop next year entitled âBest Practices in the Management of Oropharyngeal Dysphagiaâ. The workshop will be conducted by Dr. Catriona Steele and will be held on 20 â 21 May, 2016 at Ng Teng Fong General Hospital, Singapore.
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 â 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
>Â Best Practices in the Identification and Assessment of Oropharyngeal Dysphagia
– Â Sensitivity and specificity of different dysphagia screening tools
– Â 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
– Â Evidence behind texture modification and postural approaches
– Â Direct and indirect swallowing/exercise approaches including the use of IOPI and sEMG biofeedback
– Â Other approaches in the literature: respiratory interventions, electrical stimulation, vibratory stimulation
Estimated cost: Â $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
Singapore Swallowing Specialists 