Chin Tuck Against Resistance with Feedback: Swallowing Rehabilitation in Frail Older People (CTAR-SwiFt) - A feasibility study

Introduction: It is well-known that frail patients who are admitted to hospital can have particular difficulty in swallowing (pharyngeal dysphagia).

Therapeutic rehabilitation exercises can improve swallowing ability and oral intake by strengthening the suprahyoid muscles involved in laryngeal elevation and anterior movement and upper oesophageal sphincter opening.

The Shaker manouvre was developed to assist in strengthening these muscles, more recently the Chin Tuck Against Resistance – CTAR has been developed.

This technique involves compressing a rubber ball between the chin and suprasternal notch and was shown to be just as effective in exercising the suprahyoid muscles and easier to undertake. However, there have not been studies that have explored the use of the CTAR in clinical populations. Also, there is no ability to monitor the intensity at which CTAR is performed.

Therefore, there is a need for a device and an exercise programme that would allow the CTAR to be performed in a regulated way (eg rubber ball with biofeedback- 'Exerphager') by patients who are frail, such that it improves swallowing, eating and drinking.

Aim: The aim of this project is to develop Biofeedback-regulated Isometric Training Exercises for Swallowing (BITES), which will be based on the CTAR technique, and which can be tested for appropriateness and effectiveness in frail older people. This is a feasibility study.

Method: This study will involve three arms. 60 patients will be randomised between a control arm (usual care) and two low intensity (30%maximum) exercise programmes (Ex1 and Ex2) to explore the most suitable exercise format (once a day vs twice a day).

Videofluoroscopy will be undertaken at Day 0 and Day 84 (week 24) to investigate the physiological effect of the 'Exerphager'.

Clinical assessments will be undertaken at Day 0, Week 12, 16, 18 and 24 to identify the most appropriate outcome measures to evaluate the effects of the BITES programme on swallowing and to assist in determining the number of people required for a full study.

The study will also explore the feasibility of the BITES intervention programme as quantified by willingness of patients to be recruited to and retained in the study (