J Korean Dysphagia Soc.  2018 Jul;8(2):121-125. 10.0000/jkdps.2018.8.2.121.

Effect of Hand-free “Chin Tuck against Resistance (CTAR)” Exercise on Hyoid Bone Movement and the Degree of Aspiration in Stroke Patients with Dysphagia: A Report of 2 Cases

  • 1Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea. rehabit@inje.ac.kr
  • 2Department of Occupational Therapy, Kyung-dong University, Wonju, Korea.
  • 3Department of Occupational Therapy, Kyung Buk College of Health, Gimcheon, Korea.
  • 4Department of Occupational Therapy, Seoul North Municipal Hospital, Seoul, Korea.


This study recruited two men with dysphagia after stroke, aged 57 and 62 years. They had difficulty using both hands properly due to paralysis of the left upper extremity and rheumatoid arthritis of the right hand in patient 1 and paralysis of both upper extremities in patient 2. This study examined the effects of 4 weeks of hand-free chin-tuck-resistance exercise on the hyoid movement and aspiration. The exercises involved isotonic and isometric parts. In isometric CTAR, the patients were asked to chin tuck against the device 3 times for 60 s each with no repetition. In isotonic CTAR, the patient performed 30 consecutive repetitions by strongly pressing against the resistance device and then releasing it. Based on a video fluoroscopic swallowing study, the degree of aspiration was measured using the Penetration-Aspiration Scale (PAS) and two-dimensional motion analysis of the hyoid bone. Post-intervention, the hyoid movements in both patients improved by 0.16 and 0.22 cm (anterior movement), and 0.26 and 0.28 cm (superior movement), and the PAS scores decreased by 2 and 2 points, respectively. This study confirms that hands-free chin-tuck resistance exercise is applicable and helpful for improving the hyoid movement and reducing aspiration in patients with dysphagia after stroke. Therefore, this exercise can be introduced as an intervention for improving the swallowing function in patients with dysphagia who have difficulty using both hands.


Dysphagia; Hand-free chin-tuck-resistance exercise; Stroke; Swallowing; Suprahyoid muscle
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