Cardiovascular Effects of the Supraglottic and Super-supraglottic Swallowing Maneuvers in Stroke Patients with Dysphagia

Abstract

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.

Tactile, gustatory, and visual biofeedback stimuli modulate neural substrates of deglutition

“…stroke, Alzheimer’s and Parkinson’s diseases). Dysphagia treatments often involve both exogenous and endogenous techniques (Chaudhuri et al, 2002; Logemann and Kahrilas, 1990; Pelletier and Lawless, 2003). Despite evidence that swallowing kinematics can be modified with different forms of input, the underlying neural substrates associated with these effects are still largely unknown.…”

Coordination of respiration and swallowing: functional pattern and relevance of vocal folds closure

“…Under conscious decision humans are able to swallow and stop a breathing cycle whenever required. In this way, to swallow with a large lung air volume, high lung elastic resistance, in association with vocal folds closure could reinforce the airway protective mechanism as proposed by supraglottic and super-supraglottic maneuvers (2,3,7) . Nevertheless, under subconscious control, humans do not swallow in association with deep inspiration.…”

Dysphagia Management in Acute and Sub-acute Stroke

“…A study by Chaudhuri et al (2002) demonstrated that using these maneuvers in stroke patients resulted in arrhythmias that occurred within a treatment session, subsided within minutes of session end, and that did not occur during other activities. (51) Thus clinicians should be mindful of using these maneuvers in stroke patients especially in those with coexisting heart disease.…”