Shaker exercise to manage swallowing disorder in patient with stroke experiencing dysphagia

Abstract

This case study evaluates the clinical application of Shaker exercises to treat dysphagia and impaired swallowing function in a post-stroke patient. Baseline assessment using the 13-domain NANDA-I framework identified a nursing diagnosis of impaired swallowing secondary to cerebrovascular dysfunction, clinically manifested by difficulty swallowing, weak deglutition musculature, and secondary refusal to eat. To evaluate baseline function and progress, a standard Water Swallow Test (WST) using boiled water was conducted. As a non-pharmacological nursing intervention, the patient performed Shaker exercises twice daily over a five-day therapeutic period. Longitudinal evaluation via the WST demonstrated progressive clinical improvement: initial testing on days one and two remained abnormal; by day three, functional gains were evident despite transient post-swallow coughing; and by days four and five, the patient achieved normal swallowing function with a completely normal WST result. Ultimately, five consecutive days of targeted head-lift exercises resulted in the complete resolution of the swallowing disorder, evidenced by enhanced suprahyoid muscle strength, improved nutritional intake, and normal deglutition mechanics. At post-therapy evaluation, the patient demonstrated seamless swallowing without difficulty, absence of coughing during or after fluid ingestion, stable vocal quality, and no clinical signs of airway compromise or aspiration. These findings highlight Shaker exercises as an effective, autonomous nursing intervention that improves swallowing recovery and reduces aspiration risks in stroke patients presenting with neuropathic dysphagia.

Keywords: Dysphagia, exercise, nursing care, stroke, swallowing disorder