Chin Tuck Against Resistance (CTAR)
CTAR is a strength-based exercise intended to strengthen the perihyoid muscles. This tutorial will take you through the steps for prescribing and instructing the CTAR exercise.
First, before recommending CTAR for a patient, it is important to determine if a person's perihyoid strength is weak. If a patient's perihyoid strength is within normal limits, then you may consider recommending exerices other than CTAR. If perihyoid strength is reduced (weak), then targeting increased perihyoid strength via CTAR may be a helpful treatment target (although there may be other more effective exercises). How do you measure perihyoid strength clinically? Use the Open Mouth-Maximal Isometric Press (OMMIP)!
The OM-MIP is a simple, objective way to quantify perihyoid strength. OM-MIP involves having a person tuck their chin with maximal force against a handheld dynamometer while maintaining a neutral open mouth posture. The OMMIP has age- and sex-based norms to objectively determine if a person's perihyoid strength is within or outside of normal limits.
By assessing your patient’s OMMIP, you can: (1) objectively determine if perihyoid strength is reduced; (2) systematically decide whether CTAR is appropriate; and (3) individualize the intensity of the CTAR exercise to fit your patient’s strength training needs.
Second, determine which device will be used to facilitate CTAR. Cushion balls were used in the original CTAR publication (see below image) and are therefore frequently used for CTAR. However, the resistance exerted by a cushion ball can vary greatly based on the location and depth of each CTAR compression (see below video). This can drastically affect treatment delivery and rehabilitation outcomes!
Therefore, consider using the Neckline Slimmer (Note: I have no financial conflict of interest). The Neckslimmer allows the clinician and patient to clearly determine when a CTAR repetition was completed accurately or not. This allows for easier and more accurate delivery of the CTAR exercise for your patient. The NecklineSlimmer comes with 3 different resistance springs which can be used in isolation or combination, for a total of 7 resistance levels. This allows for the possibility of much more targeted, patient-specific, strength training regimen.
Yoon, W. L., Khoo, J. K. P., & Rickard Liow, S. J. (2014). Chin tuck against resistance (CTAR): new method for enhancing suprahyoid muscle activity using a Shaker-type exercise. Dysphagia, 29(2), 243-248.
Park, J. S., & Hwang, N. K. (2021). Chin tuck against resistance exercise for dysphagia rehabilitation: a systematic review. Journal of oral rehabilitation, 48(8), 968-977.
Curtis, J. A., Langenstein, J., Troche, M. S., Laus, J., & Schneider, S. L. (2019). Open mouth-maximal isometric press: Development and norms for clinical swallowing evaluations and treatment. American journal of speech-language pathology, 28(1), 148-154.