Public awareness – Singapore Swallowing Specialists

Cost effective treatment, Dysphagia Therapy, Public, Public awareness, Singapore, Singapore swallowing therapy, speech therapy singapore, Swallowing Problem, swallowing therapy

1st Singapore Swallowing Therapy CTAR Contributes to Swallowing Rehabilitation Evolution

31/12/202301/01/2024 Yoon Wai Lam

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, 144–153 (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:

References:

Huckabee, ML., Mills, M., Flynn, R. et al. The Evolution of Swallowing Rehabilitation and Emergence of Biofeedback Modalities. Curr Otorhinolaryngol Rep 11, 144–153 (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), 195–205. 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

Public awareness

FB Live SSLT Talk Show: Provision of Dysphagia Services Between Developed and Developing Country

17/09/202018/10/2020 Yoon Wai Lam

Speech Therapy Works | Singapore Swallowing Specialists have been invited to participate in this upcoming Facebook Live Talk Show organized by the Society of Speech & Language Therapists, Bangladesh.

This is also a Global Dysphagia Movement initiative to create better dysphagia awareness to international community.

#SSLT

All are welcome to watch the 9th episode of our SSLT TALK SHOW ‘Provision of Dysphagia Services Between Developed and Developing Country’ program.

Program Time (Event Time):

Bangladesh Time:

September 18, 2020 (Friday 8 pm).

Singapore Time:

18th September, 2020 (Friday, 10:00pm)

You can watch the FB Live talk show via this link:

https://www.facebook.com/SocietyofSLTs/

Public awareness

FB Presentation Video and Handouts: Speech, swallowing and hearing difficulties in nasopharyngeal cancer (NPC) before, during and after radiotherapy. Why and how to manage ok?

17/07/202018/10/2020 Yoon Wai Lam

Speech Therapy Works and Singapore Swallowing Specialists collaborated with 20dB Hearing Sdn Bhd, Malaysia to present this interesting topic Live on Facebook on 22 July 2020 at 8.00pm (SGT).

We had audiences from all around the world. Great questions were asked during the presentation. Feedback on the live presentation has been good.

Speech Therapy Works and Singapore Swallowing Specialists will organize more Live Facebook presentation in future. Topic would include speech, language and swallowing difficulties for stroke / dementia / neurodegenerative diseases including Parkinson’s disease and etc. Do follow our blog or Facebook to receive notification on the future Facebook Live presentation.

We are happy to announce that the president from the OneHeart Support Group (A Nasopharyngeal Cancer support group in Singapore) has opened their support to individuals or cancer survivors especially the NPC survivors. OneHeart Support Group will provide emotional and psychological support. For those interested to seek support from OneHeart, please contact Dave at +65 9101 8223. We will include a copy of OneHeart Support group brochure in this post once we receive it.

Please see attached for the handouts for this presentation.

handouts-for-speech-swallowing-hearing-difficulties-in-npc-post-rtx-Download

Public awareness

Covid 19: Tip to reduce or prevent ear pain from prolonged masks wearing

04/05/202031/05/2020 Yoon Wai Lam

Pain or itching on ear caused by mask straps

Pain or itching on the ear caused by mask straps from prolonged mask wearing has been a common complaint.
There are many custom made “ear saver” ideas that you can find from Google. Some people are selling these ideas, you may be familiar with the term “mask strap extender”.

Personally, I have tried using a paper clip and it was not very comfortable.
After some experimenting, I have found a design that I would like to share with you to help you make a comfortable “ear saver”.

Here in Singapore, I have taught some of the healthcare professionals and food sellers to make this “ear saver” and the feedback has been good.

The materials required are simple. Just use an elastic band or string!

Tie both mask straps together with the elastic band/string and customise it to a length you are comfortable with.

Just found out another great ‘ear saver’ idea by my Japanese friend Ms Kotomi Sakai.

DIY Ear Saver by Ms Kotomi Sakai using spiral hair tie

Dysphagia Therapy, Public awareness, Singapore, Swallowing Problem

Nasopharyngeal Cancer Support Group Talk: How does NPC affect speech and swallowing?

20/05/201520/05/2015 Yoon Wai Lam

The Singapore Nasopharyngeal Cancer (NPC) Support Group will be organizing the above mentioned talk.

Date: 21/5/2015 (Thursday)

Venue: CareConnect, Tan Tock Seng Hospital, Singapore

This talk is open to all NPC survivors / caregivers.

Speaker: Mr Yoon Wai Lam (Director of Speech Therapy Works, Part-time lecturer in the Master in Speech Pathology Programme, National University of Singapore)

Topic: How does NPC affect speech and swallowing? Can speech and swallowing function be maintained after radiotherapy?

Speech and swallowing difficulties can occur at the time when the diagnosis of NPC is made or it can also occur during and/or after treatment. In this talk, how speech and swallowing problem happen and its management will be discussed. Simple speech and swallowing exercises that may be useful to maintain speech and swallowing function would be demonstrated during the talk.

Cost effective treatment, Dysphagia Therapy, Public awareness

Chin Tuck Against Resistance (CTAR) is the top 10 most downloaded article from the Dysphagia Journal

24/03/201524/03/2015 Yoon Wai Lam

CTAR is top 10 most downloaded article in Dysphagia 2014

Chin Tuck Against Resistance (CTAR) is the top 10 most downloaded article from the Dysphagia Journal in 2014

I would like to take this opportunity to thank Speech-Language Pathologists / Therapists around the world for all the interest, support and word of encouragement for the Chin Tuck Against Resistance (CTAR) exercise and researches.

The National University of Singapore MSc SLP team will continue to try our best to come out with more quality researches.

The surprise news came from Mr Sze Wei Ping (A MSc graduate from National University of Singapore) 2 weeks ago when he went to present the follow up study on CTAR at the 23^rd Dysphagia Research Meeting at Chicago, 2015. The first CTAR publication is actually the top 10 most downloaded article for the Dysphagia journal for year 2014.

Chin tuck against resistance (CTAR): new method for enhancing suprahyoid muscle activity using a Shaker-type exercise. Dysphagia. 2014 Apr;29(2):243-8. doi: 10.1007/s00455-013-9502-9. Epub 2013 Dec 15.

CTAR was awarded first place in Scientific Abstract Poster at DRS 2013

The interest on CTAR has started in Singapore long before it was announced to the world in 2013. In March 2013, Mr Jason Khoo (A MSc SLP graduate from NUS) presented the first scientific poster on CTAR at the Dysphagia Research Society Meeting at Seattle, Washington, USA in 2013. Little did we expect that CTAR actually drew so much interest at the DRS meeting and was also awarded first place for the Scientific Abstract Poster.

Some wrote in to enquire on how CTAR started?

Here is how it all begins….

The hunt for stretch ball was started in the year 2002 when I was still a junior SLP at Singapore General Hospital. I drew the inspiration from my geriatric patients who kept complaining that the Shaker’s exercise are too strenuous and they declined to perform it. After some thought, I came out with the idea of performing the chin tuck in a sitting position and conveniently use one of the stretch ball belongs to one of the patient and placed it under the patient’s chin as resistance. The geriatric patient was more willing to perform it and complaint of soreness felt at the chin area (Suprahyoid area) – that’s the sign of muscle fatigue! So I started to hunt for stretch balls on the very same night, bought at least 10 pieces. But I did not take into consideration the variation in neck length. The stretch ball was too small and hard for those with longer neck to hold it in between their chin and chest. A bigger ball was used (~10cm) and it seems to fit in nicely for most patients.

I actually prefer to use my palm to provide resistance. Why?

What about for patients who were just too weak to even initiate chin tuck with effort against the ball resistance? I noticed these patients were just resting their chin on the ball. I decided to use my palm to support the chin and found out that the effort for some of this patients were just so minimal as a result of their weakness. I did some search and found out from some dental journals indicated that the Suprahyoid muscles will only be activated when the chin is tucked down for at least 20 degrees, and the greater the degree, more suprahyoid muscle activities were noted. Also taking into consideration the principle of muscle strengthening, that for muscle to be strengthen, it has to be resisting about 60-80% of one repetition maximum. At least by using my palm I can estimate patient’s maximum effort and attempt to adjust my resistance accordingly to their effort (~60-80% of their max effort).

Outcome?

I have been performing CTAR for my patients for more than 10 years and I have seen good clinical outcomes in even severe dysphagia cases (i.e. lateral medullary syndrome).

Why I use a 12cm diameter ball in my study?

Making exercise easy and cost effective has always been my aim. The ball was chosen because it suits most neck length. Also, in research all subjects should be given the same type of resistance.

In the next coming blogs, I will be posting all the CTAR posters. Stay tuned!

Cost effective treatment, Dysphagia Therapy, Public awareness, Teaching

Must active swallowing therapy or speech therapy be initiated all the time?

26/02/201527/02/2015 Yoon Wai Lam

The answer is NO.

Most patients have the perception that when they see or being referred to a speech therapist, they must receive some form of active treatment that involves active exercises. This may not be true all the time.

Why?

From speech therapy perspective, a medical diagnosis that explains the presentation of speech/ language/ voice / swallowing difficulties is required before any active therapy can be initiated.

That is because these difficulties are usually symptoms presented as a result of certain medical condition(s). For example, a new onset of swallowing difficulty is actually a symptom of neurological disorder(s) or brain related problem(s) that require further diagnosis by a neurologist. The causes may include stroke, neurodegenerative diseases, myasthenia gravis and etc.

Some active treatment may contraindicate the presenting medical diagnosis. For example, for myasthenia gravis (MG), the muscles will weaken further as one gets more tired/fatigue. As such strengthening exercises would not be appropriate for this condition. In fact, compensatory methods such as eating small amount but frequent meals if patient gets fatigue easily and unable to finish up full meal safely may be a better choice of management. In fact treatment for MG that has been shown to be more effective in improving functions include medical intervention and/or surgical intervention. Speech therapist plays the role in assessing suitability for oral feeding, teaching compensatory strategies and providing information counseling.

So for any presenting symptoms that do not associate with any preexisting medical diagnoses, perhaps the next best management is to refer the patient to see a medical specialist who can assess and potentially provide a diagnosis that may explain the presenting symptoms.

In summary, active speech therapy that involves exercises need not be the choice of management all the time especially if there is no confirmed medical diagnoses. Finding out the cause(s) of the symptom(s) / presentation(s) will allow us to make better clinical diagnosis which will lead to better management / treatment that is usually more cost effective. This is especially so with the rising cost of healthcare in Singapore and Worldwide.

sEMG biofeedback as an adjuct to swallowing therapy