Journal of Rehabilitation Medicine 51-10 | Page 29

J Rehabil Med 2019; 51: 749–754 ORIGINAL REPORT EFFECTS OF GAME-BASED CHIN TUCK AGAINST RESISTANCE EXERCISE VS HEAD-LIFT EXERCISE IN PATIENTS WITH DYSPHAGIA AFTER STROKE: AN ASSESSOR-BLIND, RANDOMIZED CONTROLLED TRIAL Ji-Su PARK, OT, PhD 1 , Gihyoun LEE, PhD 2 and Young-Jin JUNG, PhD 3 From the 1 Advanced Human Resource Development Project Group for Health Care in Aging Friendly, Industry, DongSeo University, Busan, 2 Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, and 3 Department of Radiological Science at Health Sciences Division in DongSeo University, Busan, South Korea Objective: To compare the effects of game-based Chin Tuck against resistance exercise and head-lift exercise on swallowing function and compliance of patients with dysphagia after stroke. Patients and methods: A total of 37 patients with stroke were randomly assigned to 2 groups. The experimental group performed game-based chin tuck against resistance exercise, whereas the con- trol group performed traditional head-lift exercise. The videofluoroscopic dysphagia scale (VDS) and penetration-aspiration scale (PAS) were used to evaluate swallowing function. In addition, the func­ tional oral intake scale (FOIS) was used for dietary assessment. Finally, the numerical rating self-report scale was used to assess compliance (motivation, interest/enjoyment, physical effort needed, muscle fatigue) with the 2 exercises. Results: After intervention, there was no significant difference in VDS, PAS, and FOIS between the 2 groups. Comparing the compliance with the 2 exer- cises, the scores for motivation and interest/enjoy- ment items were significantly higher, and the scores for physical effort needed and muscle fatigue were significantly lower, in the experimental group than in the control group. Conclusion: Game-based Chin Tuck against Resis- tance exercise not only has a similar effect to head- lift exercise on swallowing function of patients with dysphagia, but is also a less strict and more enjoy­ able and interesting method. Key words: stroke; dysphagia; videofluoroscopic swallowing study; head-lift exercise; Chin Tuck against resistance; game. Accepted Sep 2, 2019; Epub ahead of print Sep 13, 2019 J Rehabil Med 2019; 51: 749–754 Correspondence address: Young-Jin Jung, Department of Radiological Science at Health Sciences Division in Dongseo University, V318, 47 Jurye-Ro, Sasang-Gu, Busan, 47011, Republic of Korea. E-mail: mi- [email protected] T he submental muscles are a group of muscles located between the hyoid bones just under the jaw, which include the geniohyoid, mylohyoid, and digastric muscles (1). During swallowing, contrac- tion of these muscles pulls the hyoid and larynx upwards, resulting in normal swallowing (2). Train- ing to strengthen the submental muscles is therefore LAY ABSTRACT This study compared the effects of game-based Chin Tuck against resistance exercise and traditional head- lift exercise on swallowing function and compliance of patients with dysphagia after stroke. There was no sig- nificant difference between the 2 exercises in terms of videofluoroscopic dysphagia scale, penetration-aspira- tion scale and functional oral intake scale, suggesting that both therapeutic methods have similar effects in patients with dysphagia after stroke. However, on com- paring the compliance of the 2 exercises, it was found that game-based Chin Tuck against resistance exercise is not only more interesting and exciting than head-lift exercise, but also less physically demanding. Therefo- re, these results suggest that game-based Chin Tuck against resistance exercise is less restrictive for patients with post-stroke dysphagia and is a therapeutic exercise that provides enjoyment and excitement. important for safe swallowing in elderly individuals or patients with stroke who are susceptible to swallowing problems, such as airway aspiration (3). Head-lift exercise (HLE), also called Shaker exer- cise, is a representative dysphagia treatment aimed at strengthening the submental muscles. While the patient is in the supine position they are asked to repeatedly lift their head and maintain a head-lift position for a specific time (4). Previous studies have shown that HLE is effective in activating the submental muscles, which reduces airway aspiration and helps open the upper oesophageal sphincter in patients with dysphagia after stroke (4–6). Thus, in clinical practice, HLE is used to improve swallowing function in patients with dysphagia. Nonetheless, HLE is a very challenging exercise and is therefore difficult to perform. Given that HLE affects not only the submental muscles of the target muscle, but also the sternocleidomastoid muscle, it causes a high level of fatigue of the neck and results in discom- fort, muscle aches, and temporary pain (7, 8). This, in turn, negatively affects performance compliance, and participants may fail to complete the exercise protocol, resulting in drop-out. Several studies have reported on Chin Tuck against resistance exercise (CTAR) as an alternative to over- come the limitations of HLE (8–10). Unlike in HLE, This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2603