Modified Shaker’s Hyolaryngeal Excursion Exercise (SHEE) / CTAR


Part One – Positioning:


Part Two – Repeated Variation:


Part Two – Sustained Variation:


Purpose of Exercise:
– Increased hyolaryngeal excursion and opening of the Upper Esophageal Sphincter (UES)

Medical Contraindications (populations to avoid this exercise):
– Neck or cervical spine injury/surgery

Precautions / Tips:
– This is a variation of the more well-researched Shaker’s Hyolaryngeal Excursion Exercise (SHEE). You may wish to try it if you feel your client is having excessive difficulty or discomfort when performing the standard variation.
– Do not do this exercise if you have eaten in the previous hour, in order to reduce the risk of vomiting.
– Some discomfort may be normal in the first few days, and should resolve over time.
– If you have high blood pressure, check with your doctor before performing the sustained exercise, and if you choose to do this exercise, do not squeeze hard.

Research Articles:*
– Kraaijenga, S. A. C., van der Molen, L., Stuiver, M. M., Teertstra, H. J., Hilgers, F. J. M., & van den Brekel, M. W. M. (2015). Effects of Strengthening Exercises on Swallowing Musculature and Function in Senior Healthy Subjects: a Prospective Effectiveness and Feasibility Study. Dysphagia, 30(4), 392-403.
– Yoon, W. L., Khoo, J. K. P., Rickard Liow, S. J. (2014). Chin Tuck Against Resistance (CTAR): New method for enhancing suprahyoid muscle activity using a Shaker-type Exercise. Dysphagia, 29(2), 243-248.

*Articles cited are a limited sample only, and there may be other & more recent evidence which supports / contraindicates use of this exercise.


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