It is the most advanced tool for helping your patients perform chin tuck against resistance (CTAR) and jaw opening against resistance (JOAR). It was invented by Jolie Parker, M.S., CCC-SLP, and her husband Page. CTAR exercise was developed by Mr. Yoon Wai Lam in Singapore in 2013. Multiple studies have been conducted on the phagiaflex (Kim et al., 2019; Park et al., 2019; Park et al., 2018; Gao et al., 2017). I have used it myself on patients who were diagnosed with COVID-19 and had extended times on the ventilator longer times on paralytic medication, resulting in tracheostomies and/or peg tubes. The primary challenge seen under videofluoroscopy was no inversion of the epiglottis due to reduced hyolaryngeal excursion, thus weakened suprahyoid muscles and decreased laryngeal lift. These deficiencies allow aspiration during the swallow as the airway is not protected or reduced flow in the UES that refluxes into the airway. The CTAR exercises also help with esophageal UES opening. I had several NPO patients return to eating using the CTAR device. It is hands-free and provides the best resistance I have seen, far superior to the rolled-up towel and dollar-store balls I have used for decades. It is easier to use. Patients do this until they fatigue several times a week. The website tells you exactly how to use the device safely. This makes it easy for therapists to write short and long-term goals that are measurable. ASHA has pushed for years to use efficacious methodologies. This CTAR is one of the tools we can add to our repertoire to achieve success and keep our patients eating and enjoying their lives. Patients I saw seemed more motivated to use the device than the ball or towel. The JOAR exercises can be done easily with the tool and support the suprahyoid muscles.
Go to their website listed below and study the device. It is under $300.00 and comes in pediatric and adult sizes. Due to the studies showing its effectiveness, you should have no trouble convincing your boss to get it for you.
Therapy does work!
Best,
Your mobile MBSS dysphagia consultants
Missy Bingham, M.A., CCC-SLP
Lead therapist for DDS
The picture was taken from the phagia-flex.com website for illustration purposes only, and DDS makes no commission.