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Evaluating the Training Effects of Two Swallowing Rehabilitation Therapies Using Surface Electromyography—Chin Tuck Against Resistance (CTAR) Exercise and the Shaker Exercise

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Abstract

In this study, the efficacy of two dysphagia interventions, the Chin Tuck against Resistance (CTAR) and Shaker exercises, were evaluated based on two principles in exercise science—muscle-specificity and training intensity. Both exercises were developed to strengthen the suprahyoid muscles, whose contractions facilitate the opening of the upper esophageal sphincter, thereby improving bolus transfer. Thirty-nine healthy adults performed two trials of both exercises in counter-balanced order. Surface electromyography (sEMG) recordings were simultaneously collected from suprahyoid muscle group and sternocleidomastoid muscle during the exercises. Converging results using sEMG amplitude analyses suggested that the CTAR was more specific in targeting the suprahyoid muscles than the Shaker exercise. Fatigue analyses on sEMG signals further indicated that the suprahyoid muscle group were equally or significantly fatigued (depending on metric), when participants carried out CTAR compared to the Shaker exercise. Importantly, unlike during Shaker exercise, the sternocleidomastoid muscles were significantly less activated and fatigued during CTAR. Lowering the chin against resistance is therefore sufficiently specific and intense to fatigue the suprahyoid muscles.

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Notes

  1. The term ‘suprahyoid muscles’ used in this paper refers to suprahyoid muscle group. For textual fluidity, ‘suprahyoid muscles’ is also used.

  2. The electrode position for the sternocleidomastoid muscle is also generally consistent with Falla et al.’s (2002) recommendations [42]. The placement is perpendicular to the one-third distance from the sternal notch.

  3. The use of a 50 Hz notch filter may shift the median frequency measures to slightly higher frequencies. However the filter was applied to all conditions and participants, making a potential frequency shift identical across conditions, and therefore would not affect differences between the conditions [43]. Previously published studies on muscle fatigue have also employed the 50 Hz notch filter [44, 45].

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Authors and Affiliations

  1. Speech and Language Therapy Department, St Andrew’s Community Hospital, 8 Simei Street 3, Singapore, 529895, Singapore

    Wei Ping Sze

  2. Speech and Language Pathology, Division of Graduate Medical Studies, National University of Singapore, Singapore, Singapore

    Wai Lam Yoon & Susan J. Rickard Liow

  3. Asia Research Institute, National University of Singapore, Singapore, Singapore

    Nicolas Escoffier

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Correspondence to Wei Ping Sze.

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Appendix: Health Screening Questionnaire

Appendix: Health Screening Questionnaire

Respondent ID: __________________

Please circle Yes or No:

1. Have you ever had any swallowing problem(s)?

Yes/No

2. Have you ever had a major surgery on or above the neck or on the spine?

Yes/No

3. Have you ever had any muscle disease(s)?

Yes/No

4. Have you ever had any heart or lung disease(s)?

Yes/No

5. Have you ever had a thyroid disease?

Yes/No

6. Have you ever had a neurological disease?

Yes/No

7. Have you ever had head injury with loss of consciousness?

Yes/No

8. Are you on any medication now? If yes, please state:

Yes/No

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Sze, W.P., Yoon, W.L., Escoffier, N. et al. Evaluating the Training Effects of Two Swallowing Rehabilitation Therapies Using Surface Electromyography—Chin Tuck Against Resistance (CTAR) Exercise and the Shaker Exercise. Dysphagia 31, 195–205 (2016). https://doi.org/10.1007/s00455-015-9678-2

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