[Dysphagia] Shaker exercise - contraindicated?

[EDolinger at Christianacare.org (Dolinger, Eric)]

You could probably do it semi-reclined or how bout with neck
hyperextended over the back of a chair,
Maybe you can fashion some kind of head weight to counteract the loss of
gravity.
another consideration....is exercise, even low effort, going to increase
abdominal pressure and possibly exacerbate the GER

Eric Dolinger, MA CCC-SLP
Senior Speech Pathologist
Christiana Care Health System 
Phone 302-733-1015
Fax 302-733-1061
edolinger at christianacare.org


-----Original Message-----
From: dysphagia-bounces at dysphagia.com
[mailto:dysphagia-bounces at dysphagia.com] On Behalf Of Dave & Lisa Tews
Sent: Tuesday, April 17, 2007 10:17 PM
To: dysphagia at dysphagia.com
Subject: [Dysphagia] Shaker exercise - contraindicated?


Does anyone have information on whether the Shaker exercise is
contraindicated for patients with severe GERD?  

There is a patient on our Rehab unit that has an extensive medical
history which began last October -  perforation of esophagus during
laparascopic chole., subsequent esophagectomy as the perforation was
unsuccessfully repaired, resp distress with trach, was on the vent, had
MI x2, aspiration pneumonia, and has J-tube for nutrition.  He is very
debilitated but is off the vent, has been decannulated and is doing well
other than his swallowing musculature is very weak.  He had silent
aspiration on previous MBS's; pharyngeal stage was severe with poor
hyolaryngeal excursion and moderate residue.  He has recently had issues
re. reflux of bile which is a concern since the Shaker requires the
patient to lie flat. He is so motivated to do any and all exercises.
Just wondering if it's appropriate to slowly start him with a few reps
of Shaker exs as he tolerates, scheduling them between his bolus
feedings.  If he shouldn't lie flat, is there any safe degree of
elevation that would r!
 educe the reflux but still provide the benefits of the exercise?

Any input would be greatly appreciated!

Lisa Tews, M.A., CCC/SLP
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