title: Neuromuscular electrical stimulation efficacy in acute stroke feeding tube-dependent dysphagia during inpatient rehabilitation.
abstract: OBJECTIVE
  The aim of this study was to compare the efficacy of neuromuscular electrical stimulation (NMES) in addition to traditional dysphagia therapy (TDT) including progressive resistance training (PRT) with that of TDT/PRT alone during inpatient rehabilitation for treatment of feeding tube-dependent dysphagia in patients who have had an acute stroke.
  
  
  METHODS
  This study is an inpatient rehabilitation case-control study involving 92 patients who have had an acute stroke with initial Functional Oral Intake Scale (FOIS) scores of 3 or lower and profound to severe feeding tube-dependent dysphagia. Sixty-five patients, the NMES group, received NMES with TDT/PRT, and 27 patients, the case-control group, received only TDT/PRT. Treatment occurred in hourly sessions daily for a mean ± SD of 18 ± 3 days. χ(2) Analyses/t tests revealed no significant statistical differences between the groups for age (t = -0.85; P = 0.40), sex (χ(2) = 0.05; P = 0.94), and stroke location (χ(2) = 4.2; P = 0.24). A Mann-Whitney U test revealed a statistically significant difference between the groups for the initial FOIS score (z = -2.4; P = 0.015), with the NMES group having worse initial scores with a mean rank of 42.64 and the case-control TDT/PRT group having a mean rank of 55.8. The main outcome measure was the comparison of the FOIS scores after treatment.
  
  
  RESULTS
  The mean ± SD FOIS score after NMES with TDT/PRT treatment was 5.1 ± 1.8 compared with 3.3 ± 2.2 in the case-control TDT/PRT group. The mean gain for the NMES group was 4.4 points; and for the case-control group, 2.4 points. Significant improvement in swallowing performance was found for the NMES group compared with the TDT/PRT group (z = 3.64; P < 0.001). Within the NMES group, 46% (30 of 65) of the patients had minimal or no swallowing restrictions (FOIS score of 5-7) after treatment, whereas 26% (7 of 27) of those in the case-control group improved to FOIS scores of 5-7, a statistically significant difference (χ(2) = 6.0; P = 0.01).
  
  
  CONCLUSIONS
  This study suggests that NMES with TDT/PRT is significantly more effective than TDT/PRT alone during inpatient rehabilitation in reducing feeding tube-dependent dysphagia in patients who have had an acute stroke.
authors.affiliation: Department of Rehabilitation Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Kushner
authors.forename: Kenneth
authors.initials: K
authors.lastname: Peters
authors.forename: Stacy Thomashaw
authors.initials: ST
authors.lastname: Eroglu
authors.forename: Melissa
authors.initials: M
authors.lastname: Perless-Carroll
authors.forename: Douglas
authors.initials: D
authors.lastname: Johnson-Greene
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003680:Deglutition Disorders / Q000209:etiology / Q000534:rehabilitation*; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007297:Inpatients; D007441:Intubation, Gastrointestinal / Q000009:adverse effects* / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D026741:Physical Therapy Modalities; D020127:Recovery of Function / Q000502:physiology; D012016:Reference Values; D012047:Rehabilitation Centers; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D020521:Stroke / Q000150:complications* / Q000175:diagnosis; D000071939:Stroke Rehabilitation; D013997:Time Factors; D016896:Treatment Outcome