[Dysphagia] Shaker exercise - contraindicated?

[pleasantville at netexpress.net (Dave & Lisa Tews)]

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 reduce the reflux but still provide the benefits of the exercise?

Any input would be greatly appreciated!

Lisa Tews, M.A., CCC/SLP