Patient Information: Male, Age 71
Diagnosis: Guillain-Barré Syndrome / Oropharyngeal Dysphagia
History: This gentleman was referred to a skilled nursing facility for rehabilitation services after a 3-month hospital stay. He was visiting his son in the United States from Venezuela when he began experiencing numbness in his legs. He was hospitalized and diagnosed with Guillain-Barré Syndrome (rare autoimmune disorder that causes rapid and unexpected muscle weakness). While hospitalized he experienced multiple complications including infection, being placed on a ventilator, and placement of a feeding tube. Prior to his hospitalization he lived independently and ate a regular diet.
•Clinical Swallow Evaluation: Exhibited difficulty with tongue movement and function.
•Fiberoptic Endoscopic Evaluation of Swallow (FEES): Unable to initiate a swallow with thin liquid, thickened liquid, or pureed consistencies despite reporting sensation he was swallowing. This resulted in spillage of drink and food over the back of the tongue with aspiration (food and drink entering the airway) and inability to clear the airway with all consistencies.
•Functional Oral Intake Scale (FOIS): Level 1; nothing by mouth.
•Diet Modification: NPO (nothing by mouth) with all nutrition and hydration delivered through the feeding tube.
•Modality: Omnistim® FX2 Portable Muscle Stimulator.
•Frequency: 3x per week.
•Protocol Specifics: Patterned Electrical Neuromuscular Stimulation (PENS) head and neck protocol (electrodes on masseter and posterior neck) to improve swallow initiation and function, following one and a half weeks of traditional swallow exercise.
•Duration: Four weeks.
• Other Therapy Services Provided: Oropharyngeal muscle strengthening and neuromuscular re-education exercises including effortful swallows, Mendelsohn maneuvers, and base of tongue exercises performed in conjunction with PENS. Food trials with compensatory strategies were also utilized.
•Clinical Swallow Evaluation: Consumes liquids and regular foods without difficulty.
•FEES: Initiates a swallow consistently and timely showing no penetration or aspiration.
•FOIS: Level 7; total oral intake with no restrictions.
•Diet Modification: Regular diet with thin liquids; feeding tube was removed.
This gentleman was able to return home with his son, with plans to soon return home to Venezuela. He expressed much gratitude for regaining the ability to eat a regular diet. After one treatment session with PENS, he noted increased ease with swallowing. He commented, he felt “like he got his life back!”