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?

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.

Dysphagia Training

NFOSD Dysphagia Webinar Series: Transitional Foods – Updates on Their Behavior, Use and Benefits in Adult & Pediatric Populations

Date and time: Thu, Jul 23, 2020 8:00 AM – 9:30 AM SGT

Webinar Description:  

This webinar is for healthcare providers, patients and caregivers impacted by dysphagia, and students learning about swallowing disorders.

This presentation will define and categorize types of transitional foods.  We will discuss the potential benefits of improved choices, increased textures and ultimately improved dining enjoyment. Use of transitional foods in the pediatric population will be discussed with examples of use presented in specific special needs populations. The IDDSI testing method for transitional foods will be reviewed and the variation in results obtained with this test will be demonstrated between known transitional foods. We will share two research methods of evaluating the dissolution patterns of transitional foods in the oral environment will be described with relevant clinical implications.  The external environment (air, humidity, length of exposure) play a significant role in the transitional behavior of these foods and ultimately their safety. The oral environment (amount of saliva, degree of tongue pressure, anterior-posterior transit time) also has a significant impact as well.  Both groups of factors will be discussed in detail providing a broader scope of understanding of patient selection, and proper use.  Ultimately expanding our knowledge of transitional foods will improve our understanding of use with the goal of improving patient engagement and outcomes.

Learner Outcomes: 

  • Understand the difference between transitional food behaviors in the mouth in comparison to  IDDSI benchtop methods.
  • Classification of transitional foods and the importance of the oral environment
  • Learn the role transitional foods can play in dysphagia management

Click here to register of the Free Webinar: https://swallowingdisorderfoundation.com/webinar-transitional-foods/

swallowing therapy

Latihan Menelan (Dysphagia Therapy) Chin Tuck Against Resistance / CTAR dengan Bola Getah

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:

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:

  • 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.
Dysphagia Training

Free Webinar by NFOSD: Managing Dysphagia in Adults with Intellectual Disability

Date and Time: Wednesday, June 17, 5:00 pm Pacific (June 18, 8.00am Singapore / Malaysia / Philippine )

Webinar Description:  

Adults with intellectual disability are at risk for dysphagia.  The unique swallowing, feeding, and behavioral challenges experienced in this population are vital considerations in the assessment and treatment of these patients.  This webinar will discuss the nature of dysphagia management in adults with intellectual disability by exploring the current evidence in this area and discuss the clinical experiences of speech pathologists who assess and treat adults with intellectual disability in the Intermediate Care Setting.

At the completion of this webinar, participants will:

  • Understand the impacts of dysphagia in people with intellectual disability
  • Identify the systems that must be considered in the assessment and treatment of dysphagia in those with intellectual disability
  • Anticipate the physical-nutritional needs of those with intellectual disability as they age
  • Describe the interdisciplinary team collaborations required to manage dysphagia in this population

Click here to register for the FREE webinar:

https://register.gotowebinar.com/register/76969519229535757

NFOSD website:

Dysphagia & Special Populations: Managing Dysphagia in Adults with Intellectual Disability

swallowing therapy

(Recommended article) Moving Forward with Dysphagia Care: Implementing Strategies during the COVID-19 Pandemic and Beyond

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.

Click here to access full article (Open access):

Dysphagia
https://doi.org/10.1007/s00455-020-10144-9

swallowing therapy

Dysphagia Swallowing Therapy – Chin Tuck Against Resistance (CTAR) with Rubber Ball

Video on CTAR by using the rubber ball

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)

  1. Sit / stand upright and pull your shoulders back. Maintain this posture during the exercise.
  2. Hold the ball under your chin with your hand and keep it in position during the exercise.
  3. Sustain chin tuck against the ball for as hard as possible; for the duration of _______ sec.
  4. Repeat _______ sets as recommended by your speech therapist / pathologist.
  5. Rest for 1 minute in between each set of the exercise.

Part 2: Repetitive CTAR (Isokinetic)

  1. Sit / stand upright and pull your shoulders back. Maintain this posture during the exercise.
  2. Hold the ball under your chin with your hand and keep it in position during the exercise.
  3. Tuck your chin in, as hard as possible against the ball; then lift your chin.
  4. Repeat the above steps for ________ times and ________ sets as recommended by your speech therapist / pathologist.
  5. 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:

YouTube video URL: https://youtu.be/zBoZSr19zWo

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:

  • 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.
speech therapy singapore

Our Online Speech Therapy or Telepractice Experience in Singapore during Covid-19

According to ASHA definition: https://www.asha.org/Evidence-Maps/
‘Telepractice is the application of telecommunications technology to the delivery of speech language pathology and audiology professional services at a distance by linking clinician to client or clinician to clinician for assessment, intervention, and/or consultation.’

Telepractice for Speech Therapy has been proven to be effective and has been practiced in countries like the United States, Canada and Australia.

Our experience:
Since Covid-19 outbreak started, the acceptance of telepractice for speech therapy in Singapore has increased significantly especially during the circuit breaker period.

Our experience shows that it benefits most of our clients who require speech and language therapy, and to some of our clients who require swallowing therapy. We prefer to use Zoom Meetings for our telepractice. We find it easy to be used for 1-to-1 session as well as for group therapy sessions. Therapy tasks can to be shared and be viewed easily by our client(s). Clients are able to respond easily by indicating their answers on the screen by using the writing/drawing function. The Zoom file sharing function has allowed us to still customize and personalize each therapy sessions for our clients.

However, we need to take into consideration client’s proficiency level in technology. For clients who are less tech proficient, our experience shows that simple apps such as Facetime and Whatapp video call can work as well.

LATEST: On 24/4/2020, Facebook has just announced their videoconferencing function that allows video meeting up to 50 people without downloading any apps. That will open up another platform for telepractice.

For Speech-Language Therapists who would like to adopt Telepractice, you may refer to the following links for resources:

dysphagia research

Swallow with CTAR (S-CTAR) Poster presented at DRS 2017 @ Portland, Oregon

S-CTAR Poster

Life has been so busy since I came back from DRS 2017. Finally, I have some time to put up this blog.

I was honored to be invited to present a research poster at DRS this year.

This is probably one of the best year for dysphagia research representation from Singapore as we have 2 oral presentations from Singapore General Hospital and 1 poster presentation (presented by me) from National University of Singapore.

My poster presentation was on Swallow with Chin Tuck Against Resistance (S-CTAR). 

Some of the happy moments at DRS:

  • Portland, Oregon is really beautiful and … cold. 
  • Finally get a chance to meet my Facebook pal, Nabil from Canada in person. We share a common interest in dysphagia. Lots of interesting discussion on dysphagia via WhatsApp and Facebook messenger. 
  • Get to meet some old friends and made more new friends from all around the world. 
  • managed to take a selfie with Dr Reza Shaker!
  • Happy to know that CTAR or Chin Tuck Against Resistance is a well known and well like exercise in USA and Brazil. Brazil Speech Pathologists informed me that they have started research on CTAR! I really hope that clinical study on CTAR will be out soon. 
  • Most Speech-Language Pathologists were excited to know that S-CTAR can be used as a task specific exercise and foresee that they will use it in their dysphagia therapy or management. 
Portland Oregon
Portland, Oregon
Portland
Portland, Oregon
  • With Dr Shaker
    with Dr Reza Shaker
    Nabil = my FB Pal
    My FB Pal, SLP from Canada – Nabil
    Kotomi - SLP from Japan
    Kotomi Sakai – SLP from Japan
    Brazil SLP
    SLP from Brazil
    Poster presentation
    Demonstrating CTAR to a dentist from Japan
    Demonstrating CTAR & S-CTAR
    Demonstrating CTAR and S-CTAR
    I am a new DRS Member
    I am a new DRS member.
    Ironing sandwich
    This is new to me… Ironing sandwiches?!!!

    I was asked a few interesting questions on CTAR. One of the few interesting question is: are there any devices in the market that you think is good to be used to perform CTAR? I think this is an interesting question as we have seen quite a number of devices (different type of balls, hand held devices etc) being introduced to the market since the first paper on CTAR was published in 2014.

    Click  S-CTAR Poster to download the poster that I presented at DRS 2017.

    I will list out all those questions and answers in separate post soon. 

    To end this post, I would like to congratulate and express my appreciation to all the DRS committees for this successful and enlightening meeting. 

    Swallowing Problem

    How does dysphagia from mechanical obstruction sounds like?

    The following patient presents with dysphagia (swallowing difficulties) secondary to the presence of prominent anterior cervical osteophytes at the level of C3-C6, most prominent at C4.

    Dysphagia symptoms include:

    • Occasional coughing noted when eating solids as well as drinking fluids.
    • Multiple swallows per bolus

    I managed to record the patient’s usual swallowing sound using my IPhone 6s. Could this be the sound of mechanical obstruction?

    osteophytes
    MRI Cervical Spine shows cervical myelopathy. Prominent anterior cervical osteophytes from C3-C6.
    osteophytes label

    The sound of patient swallowing 10ml water recorded using an IPhone 6s. Note multiple swallows & loud squish sound.

    Cost effective treatment, dysphagia research, Dysphagia Therapy, Singapore, speech therapy singapore, speech-language therapy, Swallowing Problem, Teaching, Uncategorized

    Second Publication on Chin Tuck Against Resistance (CTAR)

    We are happy to announce that the follow up study on CTAR has been published online (online first version) in Dysphagia Journal.

    Original Paper

    Dysphagia

    pp 1-11

    First online: 02 February 2016

    Evaluating the Training Effects of Two Swallowing Rehabilitation Therapies Using Surface Electromyography—Chin Tuck Against Resistance (CTAR) Exercise and the Shaker Exercise

    • Wei Ping Sze 
    • , Wai Lam Yoon
    • , Nicolas Escoffier
    • , Susan J. Rickard Liow

    Abstract

    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.

    CTAR research 3
    CTAR research 3 in progress

    materials for CTAR 3
    Materials used in CTAR 3