About CTAR

Chin Tuck Against Resistance (CTAR) is a swallowing exercise created by Mr Yoon Wai Lam in Singapore.

CTAR became one of the most popular swallowing exercise that is widely practiced worldwide since its introduction in 2013. In March 2013, our first scientific poster on CTAR was presented at the Dysphagia Research Society Meeting at Seattle, Washington, USA. 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. Chin Tuck Against Resistance (CTAR) is the top 10 most downloaded article from the Dysphagia Journal in 2014. To date (April 2020), our CTAR research publications have more than 80 citations in international journal papers and text books.

CTAR is a swallowing muscles strengthening exercise specifically targeting the suprahyoid muscles. CTAR is usually used in cases with decreased upper esophageal opening and incomplete epiglottic retroflexion secondary to reduced hyolaryngeal excursion. The effectiveness of CTAR in rehabilitating dysphagia has been reported in many researches (Kim et al., 2019; Park et al., 2019; Park et al., 2018; Gao et al., 2017 and etc.).

Swallow with Chin Tuck Against Resistance (S-CTAR)

Wai Lam created S-CTAR in 2015, a more task-specific swallowing strengthening exercise. In 2017, He presented S-CTAR research at the 25th Annual Meeting of the Dysphagia Research Society, Portland, Oregon, USA in 2017.

How to perform CTAR?

  • Sit up straight and pull your shoulders back. Maintain in this posture during the exercise.
  • Chin tuck down (more than 20 degrees) against resistance
  • Resistance to be provided by using:
    • Rubber ball
    • Palm (pushing upwards) – self or assisted by others.
    • Neckline slimmer
  • Ensure that the chin tuck is maintained at least 20 degrees or more during isometric
  • Suggested therapy regime is the same as Shaker’s exercise (Shaker, 1997)
  • Isometric:
    • Sustain chin tuck down against resistance for 60 seconds. Rest for 1-2 minutes.
    • Perform 3 cycles
  • Isokinetic:
    • Repeat chin tuck down against resistance and chin up x 30 times. Rest for 1-2 minutes.
    • Perform 2 cycles
  • Perform 2-3 sets daily
  • Clinician to adjust frequency and intensity accordingly to patient’s ability.

CTAR is suitable for:

  • 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.