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 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.

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