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 “VFS & FEES Interpretation and Treatment Planning” 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, 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:
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
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.
Video latihan menelan Chin Tuck Against Resistance / CTAR GDM would like to express our heartfelt thanks to Ms Siti Amirah for her help in translation of the Malay Version of the CTAR video.
Video latihan menelan Chin Tuck Against Resistance / CTAR ini merupakan video Bahasa Melayu pertama yang dihasilkan oleh Singapore Swallowing Specialists.
Chin Tuck Against Resistance (CTAR) dengan Bola Getah
Tujuan: Untuk menguatkan otot suprahyoid yang digunakan semasa menelan. Otot-otot suprahyoid penting untuk membuka sfinkter paip makanan atas anda (sfinkter esofagus atas) untuk membolehkan makanan memasuki perut anda.
Peralatan: 1) Bola getah, 2) jarum pam udara dan pam udara (pilihan) – untuk meningkatkan diameter dan tekanan bola
Arahan:
Bahagian 1: CTAR berkekalan (Isometrik)
Duduk / berdiri tegak dan tarik bahu ke belakang. Kekalkan postur ini semasa latihan.
Pegang bola di bawah dagu dengan tangan anda dan kekalkan posisi bola sepanjang latihan.
Tundukkan dagu anda pada bola sekeras mungkin; dan kekalkan selama _______ saat.
Ulangi _______ set seperti yang disyorkan oleh terapis / patologis pertuturan anda.
Rehat selama 1 minit di antara setiap set latihan.
Bahagian 2: CTAR berulang (Isokinetik)
Duduk / berdiri tegak dan tarik bahu ke belakang. Kekalkan postur ini semasa latihan.
Pegang bola di bawah dagu dengan tangan anda dan kekalkan posisi bola sepanjang latihan.
Tundukkan dagu anda, sekeras mungkin pada bola; kemudian angkat dagu.
Ulangi langkah di atas untuk ________ kali dan set ________ seperti yang disyorkan oleh terapis / patologis pertuturan anda.
Rehat selama 1 minit di antara setiap set latihan.
Klik pada yang berikut untuk memuat turun (download) arahan latihan:
Mark A. Fritz · Rebecca J. Howell · Martin B. Brodsky · Debra M. Suiter · Shumon I. Dhar · Anais Rameau · Theresa Richard · Michelle Skelley · John R. Ashford · Ashli K. O’Rourke · Maggie A. Kuhn
Abstract Growing numbers of SARS-CoV-2 cases coupled with limited understanding of transmissibility and virulence, have challenged the current workfow and clinical care pathways for the dysphagia provider. At the same time, the need for non-COVID-19-related dysphagia care persists. Increased awareness of asymptomatic virus carriers and variable expression of the disease have also focused attention to appropriate patient care in the context of protection for the healthcare workforce. The objective of this review was to create a clinical algorithm and reference for dysphagia clinicians across clinical settings to minimize spread of COVID-19 cases while providing optimal care to patients sufering from swallowing disorders. Every practitioner and healthcare system will likely have different constraints or preferences leading to the utilization of one technique over another. Knowledge about this pandemic increases every day, but the algorithms provided here will help in considering the best options for proceeding with safe and effective dysphagia care in this new era.
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)
Sit / stand upright and pull your shoulders back. Maintain this posture during the exercise.
Hold the ball under your chin with your hand and keep it in position during the exercise.
Sustain chin tuck against the ball for as hard as possible; for the duration of _______ sec.
Repeat _______ sets as recommended by your speech therapist / pathologist.
Rest for 1 minute in between each set of the exercise.
Part 2: Repetitive CTAR (Isokinetic)
Sit / stand upright and pull your shoulders back. Maintain this posture during the exercise.
Hold the ball under your chin with your hand and keep it in position during the exercise.
Tuck your chin in, as hard as possible against the ball; then lift your chin.
Repeat the above steps for ________ times and ________ sets as recommended by your speech therapist / pathologist.
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:
Singapore Swallowing Specialists 
