Objective Inpatient rehabilitation study comparing swallowing outcomes and discharge destinations in acute stroke tube-feeding dependent dysphagia patients treated with neuromuscular electrical stimulation and traditional dysphagia therapy versus those treated with only traditional dysphagia therapy. Design Retrospective case-control study including 359 patients with acute stroke having initial Functional Oral Intake Scale scores of 3 or lower (profound to severe tube-feeding dependent dysphagia). One hundred ninety participants received neuromuscular electrical stimulation with traditional dysphagia therapy, and 169 controls received only traditional dysphagia therapy. Treatment occurred in hourly sessions 5 d/wk. Main outcome measures were comparison of Functional Oral Intake Scale scores after treatment (N = 359) and comparison of discharge destinations (n = 267). Results The neuromuscular electrical stimulation posttreatment mean ± SD Functional Oral Intake Scale score was 4.21 ± 2.1 versus 2.94 ± 1.96 for controls (t = 5.85, P < 0.001). The neuromuscular electrical stimulation group posttreatment mean ± SD Functional Oral Intake Scale gain was 3.24 ± 2.26 points versus 1.87 ± 2.01 for controls (t = 6.05, P < 0.001). After treatment, 51.6% (98/190) neuromuscular electrical stimulation patients had minimal or no swallowing restrictions (Functional Oral Intake Scale scores = 5–7), whereas only 26.6% (45/169) controls improved with Functional Oral Intake Scale scores of 5–7 (χ2 = 23.3, P < 0.0001). Groups differed by discharge destinations: neuromuscular electrical stimulation having more discharges to community than controls, 60% versus 44% (χ2 = 9.16, P = 0.003), and neuromuscular electrical stimulation having fewer acute care transfers compared with controls, 8% versus 25% (χ2 = 32.7, P < 0.0001). Conclusions Neuromuscular electrical stimulation with traditional dysphagia therapy was associated with better discharge swallowing outcomes and Functional Oral Intake Scale scores than traditional dysphagia therapy alone during inpatient rehabilitation in treating acute stroke feeding tube–dependent dysphagia and was associated with more discharges to community and less transfers back to acute care.

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Background Guillain-Barre-Syndrome (GBS), an autoimmune polyneuropathy causing acute flaccid paralysis, is a rare condition with1-2 cases per 100,000 annually (approximately 5000 cases/year) in the United States (US). There is a paucity of published data regarding patient outcomes in association with discharge destinations following inpatient-rehabilitation (IR) in this patient population, thus this study. Objectives To analyze IR efficacy, and possible predictors of discharge to home/community in a US-national-sample of GBS patients. Methods Retrospective-observational-cohort study of 1304 GBS patients admitted to IR comparing discharge disposition destinations (community/home, skilled-nursing-facility [SNF], or return to acute-care) by demographic (age, gender) and clinical variables (length-of-stay [LOS], case-mix-index [CMI], and Functional-Independence-Measure [FIM] score changes). Multinomial-logistic-regression and discriminant-function-analysis were performed to determine model fit in predicting discharge destination. Results 81.8% were discharged to home/community- average LOS 19-days, total-FIM-gain 43.2; 9.8% discharged to SNFs- average LOS 27.5-days, total-FIM-gain 27.2; and 8.4% discharged to acute-care- average LOS 15.4-days and total-FIM-gain 16.5, (F = 176, p < .001). Stepwise-linear-regression for prediction of community discharge showed change in FIM-Bed/chair/wheelchair-Transfers was the most significant predictor (Wald = 42.2; p < .001), followed by CMI (Wald = 26.9; p < .001), change in FIM-walking/wheelchair (Wald = 14.9; p < .001), and age (Wald = 9.5; p < .002). Using discriminant-function-analysis to test model validity for predicting discharge disposition, FIM-change for Bed/chair/wheelchair Transfers, Walking, and Self-Care as predictors resulted in a classification rate of 78.1%, 92% of variance explained, and Eigenvalue of .53 (p < .001). Conclusions Total-FIM scores improved in all groups, and most patients were discharged to home/community suggesting IR efficacy. The ability to transfer bed/chair/wheelchair was the most important predictive factor associated with discharge destination.