How to use the PhagiaFlex CTAR (chin tuck against resistance) device

This information is for adults who have had a PhagiaFlex CTAR device recommended to them by a speech and language therapist (SLT) to help to improve dysphagia (swallowing impairment).

What is a PhagiaFlex CTAR device?

A PhagiaFlex CTAR is a device which targets the suprahyoid muscles under the chin. These are important muscles used for swallowing, eating and drinking. These muscles assist in elevating the larynx (voice box) and opening the oesophagus (food pipe) when swallowing.

Why have I been given a PhagiaFlex CTAR device?

A speech and language therapist (SLT) has assessed your swallowing and decided that part of your swallowing difficulty is secondary to you having reduced movement of your larynx (voice box). Upwards movement of the larynx is essential to ensure that your airway closes off when swallowing, to reduce the risk of food or drink entering your airway. If your airway is not fully protected when you swallow, it could put you at risk of of food or drink entering your airway and possibly entering your lungs (the technical term for which is 'aspiration').

The movement of the larynx is also important in helping to open the entrance to your oesophagus (food pipe), to allow food and drink to enter your stomach and reduce the risk of food and drink sticking in your pharynx/ throat.

Benefits

• To improve your swallowing by improving the movement and strength of your suprahyoid muscles through exercise.
• This device is often easier to use and more effective than the alternative ‘Shaker exercise’ which can also be recommended by the SLT.

Are there any risks with using the PhagiaFlex CTAR device?

If you have any pre-existing jaw, neck, shoulder or chest injuries or have had any surgeries to your head and neck, please alert the SLT as the device may not be suitable for you to use. The SLT will be able to check with your doctor or surgeon that it is safe for you to use it or to ask if they can suggest an alternative exercise.

How do I use the PhagiaFlex CTAR device?

Positioning

• Begin with your chin in a slightly upward position. Keep your ears directly over your shoulders.
• Place the blue chest pad against your chest and hold the blue handle with your palm facing up. Cover the chin pad with the plastic covers provided and place the black chin pad under the edge of your chin/into the soft area directly behind the chin bone.

Exercises

Exercise One: Chin tuck against resistance

• Slowly tuck your chin down towards your chest (as if you were nodding ‘yes’).
• Hold this position for one to two seconds.
• Slowly raise your chin back up.
• It is a small, gentle, easy movement.
• Do not let your head lean forwards - be sure to keep your ears over your shoulders.
• Repeat until your muscles fatigue (until you don’t feel you can hold this position any longer).

Exercise Two: Chin tuck against resistance and hold

• Slowly tuck your chin down towards your chest.
• Hold this position (with your chin tucked downwards) until the muscles under your chin fatigue (between approximately 30 and 90 seconds).
• Rest and then repeat these steps three to five times.

If you feel the muscles in the back of your neck getting tired, try keeping your head further back (ears over shoulders) with very good posture, or even partially recline in a chair to help isolate and target the correct muscles.

You may need to have a break between exercise one and exercise two to give your muscles time to recover.

You should attempt to complete both exercises a total of ______ times a day.

What should I feel when using it?

It is normal for the muscles of your throat to ache or develop a mild burning sensation with this device as you are repeatedly exercising the same muscle group (similar to what you would feel in your arm if you were lifting weights). However, if you are experiencing pain or other discomfort, please stop using the device and contact your SLT as soon as possible.

How long do I use the device for?

The SLT will provide guidance on how long you should continue with these exercises. Usually they will recommend you use the device for a six to eight week period in order to see if there is any improvement to your swallowing. At this stage, the SLT team may reassess your swallowing to see if the device has helped. Some people may need to use the device for longer periods but you will be guided on this depending on how effective it has been for you.

How do I look after my PhagiaFlex CTAR device?

• Please use the plastic covers enclosed over the chin pad to help to keep the pads clean. The SLT will show you how to place these.
• You can use a disinfectant wipe on the device if it becomes dirty.
• If the pads become unstuck, please let the SLT know and they can provide you with replacement pads.

Contacts/ Further information

If you have any questions about how to use the device or you are experiencing any difficulties, please contact your SLT on 01223 216200.

References/ Sources of evidence

PhagiaFlex website (opens in a new tab)

Evidence

Yoon WL, Khoo JKP, Rickard Liow SJ (2014) Chin Tuck Against Resistance (CTAR): New method for enhancing suprahyoid muscle activity using a Shaker-type Exercise. Dysphagia, 29(2), 243-248.

Park Ji-Sua, An Duk-Hyunb, Oh Dong-Hwanc, Chang Moon-Youngd (2018) Effect of chin tuck against resistance exercise on patients with dysphagia following stroke: A randomized pilot study. NeuroRehabilitation, 42(2), 191-197.

Sze WP, Yoon WL, Escoffier N, Rickard Liow SJ Evaluating the Training Effects of Two Swallowing Rehabilitation Therapies Using Surface Electromyography-Chin Tuck Against Resistance (CTAR) Exercise and the Shaker Exercise. Dysphagia. 2016 April;31(2):195-205. Epub 2016 Feb 2.