Effect of Chin Tuck Against Resistance (CTAR) Exercise in Improving Swallowing ability among Stroke patients with Dysphagia: A pilot study

Abstract

Background: Stroke remains the second leading cause of mortality and the third most significant contributor to disability globally, accounting for approximately 6.5 million deaths and 113 million disability cases. In India, the burden of ischemic heart disease and stroke has surged by 2.3 times over the past 30 years—from 25.7 million cases in 1990 to 64 million by 2023. Dysphagia affects up to 65% of stroke survivors, posing serious risks such as aspiration and nutritional deficiency. Chin Tuck Against Resistance (CTAR) exercises have emerged as a promising therapeutic approach to address post-stroke dysphagia, aiming to enhance swallowing function and minimize aspiration risks. Aim: This study aimed to evaluate the effectiveness of CTAR exercises in improving swallowing ability among stroke patients experiencing dysphagia.

Materials and Methods: A pilot study was conducted at the All India Institute of Medical Sciences (AIIMS), Jodhpur, over a two-month period (February–March 2024), using a non- equivalent control group design. A total of 10 stroke patients with dysphagia (5 in each group) were recruited from the Neurology ward and ICU using purposive sampling. The Gugging Swallowing Screen (GUSS) was used to assess swallowing function, complemented by a direct swallowing test. The intervention group received CTAR exercises as per a standardized protocol—three sessions daily for seven consecutive days. Ethical approval (AIIMS/IEC/2023/5765) was obtained. Data were analyzed using IBM SPSS v20, employing descriptive and inferential statistics, including Repeated Measures ANOVA.

Results: At baseline, all participants exhibited severe dysphagia (GUSS score 0–9). By Day 7, 60% of the intervention group improved to mild dysphagia and 40% to moderate, with none remaining in the severe category. In contrast, 60% of the control group continued to exhibit severe dysphagia. Mean swallowing scores in the intervention group rose from 4.80 ± 0.44 on Day 1 to 14.40 ± 1.14 by Day 7, while the control group improved from 4.60 ± 0.89 to 9.00 ±1.00. Statistical analysis revealed significant effects of time (p < 0.001, ηp² = 0.985), group (p< 0.001, ηp² = 0.717), and time-group interaction (p < 0.001, ηp² = 0.914), indicating a more substantial and rapid improvement in the intervention group.

Conclusion: The findings underscore the effectiveness of CTAR exercises in significantly enhancing swallowing function in stroke patients. These results support incorporating CTAR into standard post-stroke rehabilitation practices to improve outcomes for patients with dysphagia.