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Hi Rita >From my observations, PEG feeding is required when patients become unable to get enough nutrition from the conventional route and/ or they are aspirating food and/or fluids. Once the PEG tube is in place, the respiratory problem usually improves dramatically. If the chest remains productive, postural drainage is only possible when the patient is not being fed, and for some hours after this if they have any tendency to gastric reflux. Often, if the patient's swallowing is so badly affected that a PEG is required, they may well have other movement disorders - so the usual approaches of maximising independent mobility may at this stage be more of a postural management issue. The patient will probably have had a video-fluoroscopy assessment prior to the PEG tube which will give you information about the extent of aspiration pre-op. The re-establishing of adequate nutrition usually improves the patient's general health and energy levels quite rapidly, ie within a few weeks, so they become more able to participate in chest clearance activities that were previously too exhausting. My experience is mostly with young adults who have degenerative neurological disorders who are being managed in the community - a somewhat different client group from yours but probably similar problems. As a final comment, the real experts on PEGs are Speech & Language Therapists, who I sometimes think should rename themselves to include "Swallowing Therapists." and Dieticians. Have a chat with yours ! Nikki Adams [log in to unmask] -----Original Message----- From: rita kenny <[log in to unmask]> To: [log in to unmask] <[log in to unmask]> Date: Sunday, October 10, 1999 7:04 PM Subject: PEG feeding physiotherapy input in elderly care wards with a view to chest care >I am a physio working on elderly care wards. I currently have two patients >with PEG feeds in place both have ongoing chest problems of course. One has >had a tracheostomy which was closed the other has not had a tracheostomy. >There seems to be no written physiotherapy advice specifically on this >subject so i would be interested in reading the views of others dealing with >this type of patient. Any comments? > >______________________________________________________ >Get Your Private, Free Email at http://www.hotmail.com %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%