運用下巴內縮抗阻力運動改善腦中風吞嚥困難病人之成效

背景：依據衛生福利部於2025年國人死因統計結果，腦血管疾病位居國人十大死因第4位，顯示腦中風仍為國內重要之公共衛生與臨床照護之議題。腦中風經常伴隨半邊肢體無力、言語及口齒不清、面部表情不對稱、吞嚥或語言障礙等併發症，約42%−67%的病人會發生吞嚥困難情形， 17%的病人在二至四個月復健後仍然無法改善吞嚥困難，主要與咽喉肌肉功能障礙和協調失調有關，其次是中樞神經系統失調。為此，針對吞嚥困難問題，Yoon et al.（2014）發展出下巴內縮抗阻力運動（chin tuck against resistance, CTAR），是一種簡單、非侵入性的運動，以改善喉部收縮能力、咀嚼和攪拌食物能力、咽部及上食道括約肌的不協調等問題，但目前仍缺乏針對腦中風急性期住院病人，以下巴內縮抗阻力運動改善吞嚥困難研究。研究目的：本研究旨在探討14天下巴內縮抗阻力運動介入對急性期腦中風吞嚥困難病人之90 ml吞水試驗、體重變化、進食功能及14天內鼻胃管移除率之成效。研究方法：本研究採隨機對照試驗（Randomized Controlled Trial, RCT）設計，於中部某醫學中心腦中風病房之腦中風急性期吞嚥困難病人為研究對象。研究對象以電腦亂數隨機分派至實驗組與對照組，共收案112位，排除轉院及提早出院等流失個案後，最終納入101位進行分析，其中實驗組52位、對照組49位。對照組接受常規復健運動，實驗組除常規復健運動外，另外接受14天CTAR介入。研究工具包含90 ml吞水試驗、進食功能檢測（the 10−item Eating Assessment Tool, EAT−10）、體重測量及14天內鼻胃管移除情形。資料以IBM SPSS Statistics, Version 22.0統計軟體進行分析，並採用描述性統計、Mann–Whitney U test、Friedman test、廣義估計方程式及Fisher’s exact test進行檢定。研究結果：90 ml吞水試驗結果顯示二組未達統計顯著差異；體重及進食功能檢測方面，實驗組於第14天分數均達顯著差異。鼻胃管移除率方面，研究開始時留置鼻胃管者共31位，其中實驗組14天內鼻胃管移除率為81.2%，高於對照組之26.7%，且兩組達顯著差異。結論與建議：本研究結果顯示，14天下巴內縮抗阻力運動介入雖未能使90 ml吞水試驗達顯著差異，但可改善腦中風急性期吞嚥困難病人之自覺吞嚥困難症狀，並對體重維持及鼻胃管移除率具有正向影響。CTAR具備操作簡單、非侵入性、成本低及臨床可行性高等優點，可作為腦中風急性期吞嚥困難病人之輔助吞嚥訓練方式。建議臨床可建立標準化CTAR執行流程與衛教影片，並結合醫師、護理師、語言治療師、營養師及復健團隊進行跨專業照護，以提升臨床照護品質。

Background: According to the 2025 Cause of Death Statistics released by Taiwan’s Ministry of Health and Welfare, cerebrovascular disease ranked as the fourth leading cause of death in Taiwan, highlighting stroke as an important public health and clinical care concern. Stroke is frequently accompanied by complications such as unilateral limb weakness, dysarthria, facial asymmetry, dysphagia, and language impairment. Approximately 42%–67% of patients experience dysphagia after stroke, and 17% continue to have swallowing difficulties despite two to four months of rehabilitation. Post−stroke dysphagia is primarily associated with impaired pharyngeal muscle function and neuromuscular coordination, as well as central nervous system dysfunction. To address these problems, Yoon et al. (2014) developed the chin tuck against resistance (CTAR) exercise. CTAR is a simple and noninvasive exercise designed to improve swallowing−related muscle function, laryngeal elevation, bolus preparation, and coordination of the pharynx and upper esophageal sphincter. However, evidence regarding the effectiveness of CTAR among hospitalized patients with dysphagia during the acute phase of stroke remains limited.Objective: This study investigated the effects of a 14−day CTAR intervention on the 90 ml water swallow test, body weight, swallowing−related eating function, and nasogastric tube removal within 14 days among patients with dysphagia during the acute phase of stroke.Methods: A randomized controlled trial was conducted among patients with dysphagia during the acute phase of stroke who were hospitalized in the stroke ward of a medical center in central Taiwan. Participants were randomly assigned by computer−generated randomization to either the experimental or control group. A total of 112 patients were enrolled. After patients who were transferred to another facility or discharged early were excluded, 101 participants were included in the final analysis, comprising 52 in the experimental group and 49 in the control group. The control group received routine swallowing rehabilitation, whereas the experimental group received a 14−day CTAR intervention in addition to routine rehabilitation. Outcome measures included the 90 ml water swallow test, the 10−item Eating Assessment Tool (EAT−10), body weight, and nasogastric tube removal within 14 days. Data were analyzed using IBM SPSS Statistics, version 22.0. Statistical analyses included descriptive statistics, the Mann–Whitney U test, Friedman test, generalized estimating equations, and Fisher’s exact test.Results: No statistically significant between−group difference was observed in the 90 ml water swallow test. However, significant group−by−time effects were observed for EAT−10 scores and body weight on day 14. At baseline, 31 participants had nasogastric tubes. Within 14 days, the nasogastric tube removal rate was 81.2% in the experimental group, compared with 26.7% in the control group, representing a statistically significant between−group difference.Conclusions: Although the 14−day CTAR intervention did not produce a statistically significant between−group difference in the 90 ml water swallow test, it reduced self−perceived symptoms of dysphagia and had favorable effects on body−weight maintenance and nasogastric tube removal among patients with dysphagia during the acute phase of stroke. CTAR is simple, noninvasive, inexpensive, and highly feasible in clinical settings and may therefore serve as an adjunctive swallowing exercise for patients with acute post−stroke dysphagia. Standardized CTAR protocols and instructional videos should be developed for clinical practice. Interprofessional collaboration involving physicians, nurses, speech−language pathologists, dietitians, and rehabilitation professionals is also recommended to improve the quality of care.