Effect of Multidirectional Chin Tuck Against Resistance Exercise on Oropharyngeal Muscles and Swallowing Function in Subacute Stroke Patients With Dysphagia: A Randomised Controlled Trial

ABSTRACT Background The chin tuck against resistance (CTAR) exercise is a rehabilitative technique for stroke patients with dysphagia. However, related clinical evidence remains unclear, and methodological improvements in this therapy are required. Objective This study aimed to investigate the effects of the modified CTAR exercise on swallowing‐related muscles and swallowing function in stroke patients with dysphagia. Methods Stroke patients with dysphagia ( n = 30) were randomly assigned to a multidirectional CTAR exercise group (md‐CTAR exercise group) and a vertical‐directional (vd‐CTAR exercise group) ( n = 15 per group). The md‐CTAR exercise group performed exercises in the left and right diagonal and vertical directions using a prototype device. The vd‐CTAR group performed only vertical exercises. Both groups performed the exercises for 5 days each week over a period of 6 weeks. Primary outcome measures included tongue strength, thickness and suprahyoid muscle activation. Secondary outcome measures included the Videofluoroscopic Dysphagia Scale (VDS) and Penetration–Aspiration Scale (PAS) based on videofluoroscopic study. Results The md‐CTAR group exhibited significantly higher maximal tongue strength, thickness and suprahyoid muscle activity than the vd‐CTAR group ( p < 0.05, all), as well as a significant decrease in the oral and pharyngeal phase of the VDS score ( p = 0.048 and 0.041) and PAS compared to the vd‐CTAR group ( p = 0.047). Conclusion md‐CTAR exercise is more effective than vd‐CTAR exercise in improving the oropharyngeal muscles and swallowing function in stroke patients with dysphagia. Therefore, the md‐CTAR exercise is recommended as a modified therapeutic exercise for dysphagia rehabilitation.