Chin Tuck Against Resistance (CTAR) and JOAR: EBP Dysphagia Exercises

There is research to support using these exercises in dysphagia treatment. They are widely accepted as Evidence Based Practice. Many well respected hospitals, rehabilitation centers, and universities have reviewed the available research and approved the purchase of the ISO-CTAR Device for use by their Speech Language Pathologists.

Presentation Packet

ISO-CTAR Device Instructions

Chin Tuck Against Resistance Exercise (CTAR) for Dysphagia

Hold the ISO-CTAR Device with the red handle pointing away from your chest,

with the red chest pad pressed against your chest,

and the black chin pad pressed firmly into the soft area directly behind the chin bone.

Begin with your chin slightly elevated, back straight, ears directly over your shoulders.

Slowly nod your head up and down like you are nodding “YES”, with good range of motion, up and down.

Do not let your head lean forward. Keep your ears directly over your shoulders throughout the exercise.

A variation of this exercise is to tuck the chin down and hold for 30-60 seconds.

Jaw Opening Against Resistance Exercise (JOAR) for Dysphagia

Begin the same as the CTAR exercise. When in the chin tucked position, hold and slowly open mouth widely and slowly close mouth.

A variation of this dysphagia exercise is to hold the mouth open position for 30-60 seconds.

How to use disposable chin pad covers with the ISO-CTAR Device:

1. Separate the adhesive chin pad cover from the protective paper
2. Place on chin pad with adhesive side down, 
lining up corners of the cover with the corners
of the chin pad, and wrapping it around to the underneath
3. After use with one patient, peel the chin pad cover off and dispose
4. Clean the entire device (including the chin pad) with a disinfectant wipe

 

Other Dysphagia Exercises with the ISO-CTAR Device 

Exercise 1

With the ISO-CTAR Device pressed under your chin, tuck chin down and open your mouth widely. Then, stick out your tongue as far as you can and hold for 30-60 seconds.  

Exercise 2

With the ISO-CTAR Device pressed under your chin, tuck chin down and open your mouth widely. Then, stick out your tongue and try to reach your chin with the tongue tip. Hold for 30-60 seconds.

Exercise 3

With the ISO-CTAR Device pressed under your chin, tuck chin down and open your mouth widely. Then, stick out your tongue and try to reach your nose with the tongue tip. Hold for 30-60 seconds.

Exercise 4

With the ISO-CTAR Device pressed under your chin tuck chin down and open your mouth widely. Then, repeatedly stick your tongue in and out as fast and far as you can.

Exercise 5

With the ISO-CTAR Device pressed under your chin, tuck chin down and open your mouth widely, Then move the tip of your tongue from corner to corner of your lips (side to side) as quickly as you can.

Exercise 6

With the ISO-CTAR Device pressed under your chin, tuck chin down. Then, move your tongue around your lips in a circle as quickly as you can until it is fatigued, and then reverse the direction of the circle and repeat.

Exercise 7

With the ISO-CTAR Device pressed under your chin, tuck your chin towards your chest and while holding that position, say "Ma-Ma-Ma-Ma" as quickly as possible.

Exercise 8

With the ISO-CTAR Device pressed under your chin, tuck your chin towards your chest and while holding that position, say "La-La-La-La" as quickly as possible.

Exercise 9

With the ISO-CTAR Device pressed under your chin, tuck your chin towards your chest and while holding that position, say "Ka-Ka-Ka-Ka" as quickly as possible. 

Exercise 10

With the ISO-CTAR Device pressed under your chin, tuck your chin towards your chest and while holding that position, say "Kalagaga-Kalagaga-Kalagaga-Kalagaga"  as quickly as possible. 

Exercise 11

With the ISO-CTAR Device pressed under your chin, tuck your chin towards your chest and while holding that position, sing musical scales, the vowel sounds (A-E-I-O-U), and simple songs like "Happy Birthday to You" and "Old McDonald Had a Farm".

Exercise 12

With the ISO-CTAR Device pressed under your chin, open your mouth widely and press the tip of your tongue against the roof of your mouth. Then move your tongue to the front of the roof your mouth and then pull your tongue back to the back of the roof of your mouth. Go back and forth until fatigued.

More Dysphagia Exercises

If it is determined that you have dysphagia, your speech-language pathologist may recommend that you practice the following exercises during therapy and at home, as well as compensatory strategies, to improve your swallow function and safety.

1. The Shaker Exercise

Lie on your back on a bed or sofa without a pillow. Slowly raise your head up so that you can look at your feet, then slowly lower it back down. Repeat until the muscles in your neck feel fatigued.

2. The Shaker Exercise - Extended Hold

Lie on your back on a bed or sofa without a pillow. Slowly raise your head up so that you can look at your feet and hold it there for 30 seconds. Slowly lower it back down. Repeat until the muscles in your neck feel fatigued.

3. Showa's Maneuver

Press your tongue flat against the roof of your mouth and hold it there while you swallow hard, squeezing the muscles in your face and neck tightly. Repeat this exercise after each of the other exercises.

4. Masako's Technique

Protrude the tongue out of the mouth and hold in that position, between the teeth, as you swallow . Repeat this exercise after each of the other exercises.

5. Supraglottic Swallow

Take a deep breath and hold while you swallow. Exhale and clear your throat and then swallow again. Repeat after each of the other exercises.

6. Lateralizing Tongue Press Against Resistance

Press your tongue into your right cheek. Gently press against it with your hand to provide resistance and hold for 30 seconds. Then do the same thing on the left side. Alternate back and forth until your tongue muscles become fatigued.