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J.-S.Park et al.
self-report scale. The experimental group achieved
significantly higher scores in the motivation and enjoy-
ment/interest items than the control group. Conversely,
the control group had significantly higher scores in
the physical effort needed and pain/fatigue items than
the control group, indicating that gbCTAR exercise is
less physically rigorous than HLE. In fact, none of the
patients in the experimental group in the current study
dropped out because of physical difficulty. On the other
hand, 4 patients in the control group dropped out due to
temporary pain and discomfort in the neck.
Previous studies have also reported that HLE not only
requires more effort from the neck muscles, but also
induces sustained activation of the sternocleidomastoid
muscle via surface electromyography, which is known to
cause temporary pain or discomfort in the neck, thereby
reducing compliance with exercise (7, 8). This finding is
consistent with our results. In contrast, gbCTAR exercise
can stimulate motivation, enjoyment, and interest from
patients, thereby contributing to more active participa-
tion, which, in turn, increases patient compliance. The
game programs induce enjoyment and interest in reha-
bilitation therapy, thereby acting positively to promote
motor learning (19). The games also inspire, motivate,
and trigger enjoyment and interest in rehabilitation by
utilizing the player’s intrinsic sense of competition and
desire for interaction, thereby promoting learning move-
ments (20). Therefore, the such games can contribute to
successful rehabilitation as a positive factor for patients
in rehabilitation.
Study limitations
The limitations of this study are as follows. First, the
sample size was small, and therefore the findings are
difficult to generalize. Secondly, the absence of follow-up
after the intervention did not permit the determination of
long-term effects. Thirdly, the findings do not reflect a
pure effect of gbCTAR exercise because the exercise was
prescribed together with conventional dysphagia therapy.
Conclusion
This study demonstrates that gbCTAR exercise is a
therapeutic approach, which not only has a similar effect
to HLE in patients with dysphagia, but is also less rigorous
and more enjoyable and exciting for patients than HLE.
ACKNOWLEDGEMENTS
This work was supported by the BB21+ project in 2019 and
in part by the Basic Science Research Program through the
National Research Foundation of Korea (NRF) funded by the
Ministry of Education (No.2016R1A6A3A11933819) & (NRF-
2019R1I1A1A01052893)
The authors have no conflicts of interest to declare.
www.medicaljournals.se/jrm
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