Effects of CTAR and PNF Exercises on Swallowing in Multiple Sclerosis

NCT07726667 | Completed

• 1 other identifier: hakanpolat20
• Study Type: interventional
• Target: 39
• Locations: 1 country
• Sites: 1

Brief Summary

This study compares two exercise programs for people with multiple sclerosis (MS) who have trouble swallowing. One group did chin exercises against resistance (CTAR), and the other group did neck exercises based on a technique called proprioceptive neuromuscular facilitation (PNF). Both groups also received a sensory technique to help trigger swallowing. The study tested whether these exercises could improve swallowing ability, swallowing speed, and quality of life related to eating and drinking. Participants were randomly assigned to one of the two exercise groups and were treated for 8 weeks, three times per week. Swallowing was assessed before and after treatment using validated questionnaires and a water-swallow test.

Conditions

Multiple Sclerosis; Dysphagia; Deglutition Disorders

Keywords

Multiple Sclerosis; Dysphagia; Deglutition Disorders

Outcome Measures

Primary Outcomes (1)

• Change in DYMUS (Dysphagia in Multiple Sclerosis Questionnaire) Total Score

  The DYMUS is a 10-item self-report questionnaire assessing oropharyngeal dysphagia in multiple sclerosis patients, scored 0 (no) to 1 (yes) per item, yielding a total score range of 0-10. Higher scores indicate greater dysphagia severity. A score ≥3 indicates severe swallowing difficulty.

  Baseline and week 8 (post-treatment)

Secondary Outcomes (4)

• Change in EAT-10 (Eating Assessment Tool-10) Score

  Baseline and week 8

• Change in FOIS (Functional Oral Intake Scale) Level

  Baseline and week 8

• Change in SWAL-QOL (Swallowing Quality of Life) Score

  Baseline and week 8

• Change in 100 mL Water Swallow Test Parameters (Swallowing Speed, Volume per Swallow, Duration)

  Baseline and week 8

Study Arms (2)

CTAR Group

EXPERIMENTAL

Participants received Chin Tuck Against Resistance (CTAR) exercises combined with thermal-tactile stimulation, 3 sessions/week for 8 weeks.

Behavioral: CTAR exercise

PNF Group

EXPERIMENTAL

Participants received cervical Proprioceptive Neuromuscular Facilitation (PNF) exercises combined with thermal-tactile stimulation, 3 sessions/week for 8 weeks.

Behavioral: PNF exercises

Interventions

CTAR exercise BEHAVIORAL

Participants performed isometric chin-tuck exercises against resistance using a ball positioned under the chin. Each session consisted of 2-3 sets of 8-12 repetitions, with each isometric contraction sustained for 5-10 seconds and 30-60 seconds of rest between sets. Sessions were conducted 3 times per week for 8 weeks (24 sessions total), supervised by a physiotherapist certified in swallowing rehabilitation.

CTAR Group

PNF exercises BEHAVIORAL

Participants received cervical proprioceptive neuromuscular facilitation using a combined isotonic contraction technique with diagonal movement patterns. Each repetition involved movement from an extension-left rotation position to a flexion-right rotation position against manual resistance, followed by a 6-second isometric hold and controlled eccentric return; the pattern was also performed in reverse diagonal direction. A total of 30 repetitions were completed per session without rest between repetitions. Sessions were conducted 3 times per week for 8 weeks (24 sessions total), supervised by a physiotherapist certified in swallowing

PNF Group

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• \- Confirmed diagnosis of multiple sclerosis according to the 2017 McDonald criteria
• DYMUS (Dysphagia in Multiple Sclerosis) questionnaire score ≥1
• Age between 18 and 65 years
• No relapse within the preceding 6 months

You may not qualify if:

• \- Pregnancy or breastfeeding
• Presence of another neurological disease that could cause dysphagia
• Presence of pneumonia
• History of head-neck surgery or head-neck cancer
• Persistent neck pain and/or radiculopathy
• Inadequate head control
• Inability to understand or follow verbal commands

Sponsors & Collaborators

• Sanko University: lead

Study Sites (1)

Sanko Unıversıty

Gaziantep, Gaz, 27090, Turkey (Türkiye)

Location

MeSH Terms

Conditions

Multiple Sclerosis; Deglutition Disorders

Interventions

Muscle Stretching Exercises

Condition Hierarchy (Ancestors)

Demyelinating Autoimmune Diseases, CNS; Autoimmune Diseases of the Nervous System; Nervous System Diseases; Demyelinating Diseases; Autoimmune Diseases; Immune System Diseases; Esophageal Diseases; Gastrointestinal Diseases; Digestive System Diseases; Pharyngeal Diseases; Otorhinolaryngologic Diseases

Intervention Hierarchy (Ancestors)

Exercise Therapy; Rehabilitation; Aftercare; Continuity of Patient Care; Patient Care; Therapeutics; Physical Therapy Modalities; Exercise; Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: The outcome assessor was a physiotherapist not involved in intervention delivery and unaware of group allocation. Participants were asked not to disclose their group assignment during assessment sessions
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: dırector

Model Details: Participants were randomly assigned in a 1:1 ratio to one of two parallel exercise arms (CTAR or PNF), both receiving a shared baseline sensory intervention (thermal-tactile stimulation).

Study Record Dates

• First Submitted: July 16, 2026
• First Posted: July 24, 2026
• Study Start: November 1, 2025
• Primary Completion: April 1, 2026
• Study Completion: May 1, 2026
• Last Updated: July 24, 2026

Record last verified: 2026-07

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)