The Center for Non-invasive Mechanical Ventilation Alternatives and Pulmonary Rehabilitation was established in 1992 and cares for patients with neuromuscular weakness and respiratory impairment. It is under the direction of John R. Bach, M.D. who also serves as Co-Director for the Muscular Dystrophy Association Clinic. These neuromuscular weakness intervention programs continue to be successful in prolonging bace-free ambulation and reducing cardiorespiratory morbidity and mortality to prolong quality survival. An inpatient program for the extubation of patients who are "unweanable" from ventilatory support is provided in coordination with the departments of Medicine and Pediatrics. The program focuses on decanulating ventilator users or avoiding tracheostomy by extubating unweanable patients to noninvasive respiratory muscle aids, thereby reducing ICU stays, and facilitating return to the community rather than costly long-term institutionalization. The mechanical ventilation alternatives program has successfully extubated over 203 unweanable intubated patients most of whom were transferred to UH after failing extubation at other facilities. 36 of these patients were referred to UH to be extubated or decanulated since July 2010.