The prolonged voluntary closure of the glottis during the supraglottic and super-supraglottic swallowing techniques may create the Valsalva maneuver. The Valsalva maneuver has been associated with sudden cardiac death and cardiac arrhythmias. This study describes the effects of the supraglottic and super-supraglottic swallowing techniques on the cardiovascular system. Subjects included 23 patients from an acute inpatient rehabilitation hospital. Subject groups included recent stroke, dysphagia. and a history of coronary artery disease (Group 1, N = 11). recent stroke and dysphagia with no known coronary artery disease (Group 2, N = 4), and orthopedic diagnosis with no known dysphagia or coronary artery disease (Group 3, N = 8). Cardiac status was monitored for 4 hours during swallowing training, regular therapy sessions, and a meal. For Groups I and 2, 86.6% (13 out of 15) of the subjects demonstrated abnormal cardiac findings during the swallowing session including supraventricular tachycardia, premature atrial contractions, and premature ventricular contractions. Arrhythmia subsided within a few minutes after the session and did not occur during other activities. In Group 3 (control group), none of the subjects demonstrated abnormal cardiac findings except for bradycardia in one subject. It is suggested that the supraglottic and super-supraglottic swallow maneuvers may be contraindicated for patients with a history of stroke or coronary artery disease.

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Objective: To compare rehabilitation outcomes based on anterior hip arthroplasty for patients with and without post-operative surgical precautions.Methods: Sixty-eight consecutive patients' medical records were retrospectively reviewed. Main outcome measures included total admission and total discharge functional independence measure (FIM) scores, FIM gain, FIM gain per day, and length of stay (LOS).Results: Group 1, n=31, included patients admitted to inpatient rehabilitation without post-operative surgical precautions. Group 2=37, included patients admitted to inpatient rehabilitation with post-operative surgical precautions. No statistically significant differences were observed between the groups at admission for age (Group 1 mean age=66.74 years; Group 2=67.30 years; F=0.014, p=811) and admission FIM scores (p=.866), suggesting groups were similar at admission. At discharge, both groups made similar progress related to overall FIM gain (p=. 679) and discharge FIM scores (p=.864). There was a statistically significant difference between the groups for LOS with the no-precaution group demonstrating approximately a 3-day shorter stay (Group 1=8.97 days; Group 2=11.73 days; F=0.195, p=0.012). This finding translated into improve FIM efficiency for Group 1 with statistically significant differences observed for Motor FIM gain per day for Group 1=2.83 and for Group 2=2.0 (F=17.275, p=0.007) and Total FIM gain per day with Group 1=2.90 and Group 2=2.07 (F=15.318, p=.006). Conclusion:Both groups made similar progress during inpatient rehabilitation with respect to overall FIM gain and discharge FIM scores. The no-precaution group made gains within a shorter timeframe reflecting improve efficiency with rehabilitation outcomes for the no-precaution group.

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