Dysphagia (difficulty in swallowing) can hinder many functions that people once took for granted. Things like eating can become difficult or nearly impossible. Patients report a feeling of food stuck in the throat. Several conditions can lead to dysphagia, and stroke is one of them.
Techniques to improve swallowing
Usually, stroke-related dysphagia management uses a set of standard exercises. These involve mouth exercises (opening and closing), tongue extensions, teeth clicking, and swallowing. However, researchers from China have been working to find better ways to improve the swallowing ability of patients following stroke. The two methods they thought would work the best are the chin tuck against resistance (CTAR) and Shaker exercises (a popular rehabilitation training for dysphagia). To test these techniques, the researchers divided the patients in this study, who were 60 years and older, into three different groups: CTAR, Shaker, and standard exercises (also known as the control group).
CTAR and Shaker exercises put to the test
Patients in the CTAR group compressed an inflatable rubber ball with their chin as far as they could. In the Shaker group, patients lay in a supine position (face and body facing up) and lifted their head and neck to look at their feet. Both CTAR and Shaker exercises were done 30 times per session, 3 times a day. Patients did this 7 days a week for 42 days.
The researchers then measured the improvement both in swallowing ability and depression. They used a Self-Rating Depression Scale (SDS) and a videofluoroscopic swallowing study (VFSS) within 48 hours after hospital admission. Patients again received VFSS 2, 4, and 6 weeks after rehabilitation training, respectively, for evaluation of swallowing function.
CTAR and Shaker exercises are the 2 most effective training methods
At the end of the study, researchers used an X-ray technique to evaluate the patients’ swallowing ability. After the intervention, all patients had various degrees of improvement for dysphagia in the three groups. Both the CTAR and Shaker groups showed greater improvement compared to the control group, especially between weeks 2 and 4. The CTAR group measurements went from 5.30 to 2.77 (the lower the score is, the better the swallowing ability is) while the Shaker group measurements went from 5.30 to 2.87.
Researchers evaluated the patients for depression in addition to swallowing ability. Again, both the CTAR and Shaker groups showed significant improvement. Patients went from 49 to 42 on the SDS (the lower the score, the less patients feel depressed). The control group, which did the standard exercises, didn’t show any improvement in either the swallowing or depression assessment.
This study demonstrated that both CTAR and Shaker exercises help patients with dysphagia during the early phases of stroke. The choice depends on the patient’s preference and ability. Those who prefer a sitting position can go with CTAR exercises. Those who prefer the lying position can go with the Shaker exercises.
Patients can perform these exercises at home as they’re easy to do and don’t require expensive equipment or tools. If you are interested in therapy aids, you can get special tools for CTAR exercises from PhagiaFlex for as low as $150.
The lead author of the publication is Dr. Gao from the Department of Neurology, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China; Nursing School, Liaoning Medical University, Jinzhou, China.