Improving Dysphagia in Stroke Patients With Chin Tuck Against Resistance Exercise

According to a 2014 report from the Ministry of Health and Welfare, cerebrovascular disease is one of the leading causes of death, with a mortality rate of 51.6 per 100,000 population, ranking fourth among the top ten causes of death. Stroke is often associated with symptoms such as unilateral weakness, slurred speech, facial asymmetry, and swallowing or speech difficulties, with approximately 42-67% of patients experiencing dysphagia.

Dysphagia is primarily associated with dysfunction of the pharyngeal muscles and impaired coordination, often accompanied by central nervous system dysfunction. Common symptoms include choking, coughing after eating, drooling, difficulty eating, and swallowing problems, which may lead to complications such as pneumonia and malnutrition.

Chin tuck against resistance (CTAR), developed by Yoon et al. in 2014, is a simple and non-invasive exercise aimed at improving pharyngeal muscle contraction, chewing and bolus formation, and coordination between the pharynx and upper esophagus. Previous studies suggest that CTAR exercises can effectively improve swallowing-related muscle function.

However, there is a lack of research targeting acute stroke patients in hospital settings. Therefore, this study is designed as a randomized controlled trial (RCT) to evaluate the effectiveness of CTAR exercises in improving dysphagia.

Participants will be randomly assigned to an experimental group or a control group. The experimental group will perform CTAR exercises once daily, five days per week, for two weeks, in addition to routine rehabilitation exercises until discharge. The control group will receive routine rehabilitation exercises once daily, five days per week.

Effectiveness will be assessed using a 90 mL water swallowing test and the Eating Assessment Tool-10 (EAT-10). Baseline measurements will be conducted prior to the intervention, and subsequent assessments will be performed every two days during the study period. Additional outcomes include changes in EAT-10 scores and the removal rate of nasogastric tubes before discharge.

Study Overview

• Status: Completed
• Conditions: Stroke; Dysphagia
• Intervention / Treatment: Behavioral: Chin Tuck Against Resistance (CTAR); Other: Routine Rehabilitation

Detailed Description

According to a 2014 report from the Ministry of Health and Welfare, cerebrovascular disease is one of the leading causes of death, with a mortality rate of 51.6 per 100,000 population, ranking fourth among the top ten causes of death. Stroke is commonly associated with neurological deficits such as hemiparesis, dysarthria, facial asymmetry, and dysphagia. Approximately 42-67% of stroke patients experience swallowing difficulties.

Dysphagia in stroke patients is primarily related to dysfunction of pharyngeal muscles and impaired coordination of the swallowing mechanism, often accompanied by central nervous system impairment. Common clinical manifestations include choking, coughing during or after meals, drooling, difficulty chewing and swallowing, which may lead to serious complications such as aspiration pneumonia and malnutrition.

Chin tuck against resistance (CTAR), first introduced by Yoon et al. in 2014, is a simple and non-invasive exercise designed to strengthen suprahyoid muscles, improve pharyngeal contraction, enhance bolus control, and facilitate coordination between the pharynx and upper esophageal sphincter. Previous studies have demonstrated that CTAR exercise can effectively improve swallowing-related muscle function.

However, there remains a lack of evidence focusing on acute stroke patients in hospital settings. Therefore, this study is designed as a randomized controlled trial (RCT) to evaluate the effectiveness of CTAR exercise in improving dysphagia among hospitalized stroke patients.

Participants will be randomly assigned to an experimental group or a control group. The experimental group will perform CTAR exercise once daily, five days per week, for two consecutive weeks, in addition to routine rehabilitation. The control group will receive routine rehabilitation alone at the same frequency.

Swallowing function will be evaluated using a 90 mL water swallowing test and the Eating Assessment Tool-10 (EAT-10). Baseline assessments will be conducted prior to intervention, followed by repeated measurements every two days during the study period. Additional outcomes include changes in EAT-10 scores and the rate of nasogastric tube removal before discharge.

This study aims to determine whether CTAR exercise provides additional benefits over conventional rehabilitation in improving swallowing function in stroke patients, and to provide evidence for clinical rehabilitation practice.

• Study Type: Interventional
• Enrollment (Actual): 112
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Taiwan
  • Taichung, Taiwan, 407
    • Taichung Veterans General Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patients aged ≥ 20 years diagnosed with ischemic stroke
• NIH Stroke Scale (NIHSS) score between 6 and 20
• Conscious and able to communicate in Mandarin or Taiwanese
• Failed the 90 mL water swallow test

Exclusion Criteria:

• Cognitive impairment
• Brainstem stroke or intracerebral hemorrhage
• Diagnosed psychiatric disorder or dementia
• Unstable vital signs
• Presence of endotracheal tube or tracheostomy
• History of cervical spine injury
• Head-of-bed elevation restricted to less than 30 degrees
• Nil per os (NPO) status as ordered by a physician

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Experimental Group; Participants receive routine rehabilitation plus chin tuck against resistance (CTAR) exercise.	Behavioral: Chin Tuck Against Resistance (CTAR); Participants perform chin tuck against resistance (CTAR) exercise once daily, five days per week, for two consecutive weeks. The exercise is conducted in addition to routine rehabilitation therapy to improve swallowing function.; Other: Routine Rehabilitation; Participants receive routine rehabilitation therapy once daily, five days per week, for two consecutive weeks.
Active Comparator: Control Group; Participants receive routine rehabilitation therapy only.	Other: Routine Rehabilitation; Participants receive routine rehabilitation therapy once daily, five days per week, for two consecutive weeks.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Swallowing function assessed by 90 mL water swallowing test	Swallowing function is evaluated using a 90 mL water swallowing test. Participants are assessed at baseline and every 2 days during the intervention period. The outcome is recorded as pass or fail to determine improvement in swallowing ability.	Baseline and every 2 days during the 2-week intervention period

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Swallowing-related quality of life assessed by EAT-10	The total score ranges from 0 to 40, with higher scores indicating more severe dysphagia symptoms. A score of 3 or higher is considered indicative of a risk of dysphagia	Baseline and once weekly during the 2-week intervention period

Collaborators and Investigators

• Sponsor: Taichung Veterans General Hospital
• Investigators: Principal Investigator: Hsiao-Chi Nieh, Nursing Supervisor, Taichung Veterans General Hospital

Study record dates

Study Major Dates

• Study Start (Actual): October 26, 2024
• Primary Completion (Actual): April 20, 2026
• Study Completion (Actual): April 23, 2026

Study Registration Dates

• First Submitted: June 1, 2026
• First Submitted That Met QC Criteria: June 1, 2026
• First Posted (Actual): June 5, 2026

Study Record Updates

• Last Update Posted (Actual): June 5, 2026
• Last Update Submitted That Met QC Criteria: June 1, 2026
• Last Verified: June 1, 2024

More Information

Terms related to this study

• Keywords: Stroke; Dysphagia; Chin Tuck Against Resistance
• Additional Relevant MeSH Terms: Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Digestive System Diseases; Gastrointestinal Diseases; Esophageal Diseases; Otorhinolaryngologic Diseases; Pharyngeal Diseases; Stroke; Deglutition Disorders
• Other Study ID Numbers: CF24234C

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data (IPD) will not be shared due to privacy and confidentiality concerns. The dataset contains sensitive clinical information, and sharing is restricted to protect participant identity in accordance with institutional policies and ethical regulations.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No