[Dysphagia] Ethical Dilemma

[wendycccslp at yahoo.com (wendy jackson)]

I had an interesting ethical situation arise this week
and would appreciate some input from the list.
I had a patient arrive for an outpatient video swallow
exam.  He was a walkie/talkie but very unintelligible
and resided at a group home. A caregiver was present
but only able to provide me limited information.  I
was able to look up an old video from 4 years ago and
learned he had a hx of TBI and alcoholism.  The video
at that time indicated severe pharyngeal dysphagia and
a trial of therapy was recommended (super supraglottic
swallow, tongue base exercises, etc)
.  
Now the patient was back and apparently receiving
"swallowing therapy" from a Physical Therapy office in
town that I was not familiar with.  The caregiver
described that the patient was to stretch his neck
from side to side and then up and down before every
swallow.  Hmmmm.  I completed the exam, recommended a
diet, and recommended the patient discontinue therapy
as his dysphagia was chronic and essentially unchanged
in 4 years.  I gave the Physical Therapy office a call
and spoke with an occupational therapist.  She told me
they were doing "stretching exercises" to trigger the
swallow reflex.  I told her I had never heard of this
before.  She apparently had learned it from and SLP
she worked with 40 years ago!!!  I politely told her
we didn't do anything like that anymore but she felt
like it was helping.
NOW........What is my professional ethical
obligation?? I have some ideas but wanted to pick your
brains first.  Any help would be appreciated.  
Thanks,
Wendy Jackson
Kalamazoo, MI