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.
Design: 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. χ2 Analyses/t tests revealed no significant statistical differences between the groups for age (t = −0.85; P = 0.40), sex (χ2 = 0.05; P = 0.94), and stroke location (χ2 = 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 (χ2 = 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.
From the Department of Rehabilitation Medicine, University of Miami Miller School of Medicine, Miami, Florida (DSK, DJ-G); Department of Speech-Language Pathology, HealthSouth Rehabilitation Hospital, Miami, Florida (KP); and Department of Speech-Language Pathology, HealthSouth Rehabilitation Hospital, Sunrise, Florida (STE, MP-C).
All correspondence and requests for reprints should be addressed to: David S. Kushner, MD, Department of Rehabilitation Medicine, University of Miami Miller School of Medicine, 20601 Old Cutler Rd, Miami FL 3318.
Supported, in part, by the United States Department of Education, National Institute of Disability Research and Rehabilitation grant H133A120099 (to D.J-G.)
Presented at the American Congress of Rehabilitation Medicine annual conference in Atlanta in October 2011, and the abstract was published in Archives of Physical Medicine and Rehabilitation October 2011;92(10):1691–2.
Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.