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[Dysphagia] Shaker exercise - contraindicated?
Maybe on a tilt table?
On Wed, 18 Apr 2007 16:12:35 -0700 (PDT), "wendy avery"
<ww_avery at yahoo.com> said:
> Lisa,
>
> The purpose of supine for Shaker exs is to increase the resistance and
> hasten muscle strengthening. The patient could do Shaker exs in
> seated with neck in neutral starting position to get some
> strengthening effect but it wouldn't be as efficient or fast as in
> supine. I'd avoid hyperextending the neck in any position. The motion
> you want to isolate for Shaker is capital flexion. Good luck,
>
> Wendy
>
>
> Dave & Lisa Tews <pleasantville at netexpress.net> wrote:
> 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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