Is sensory-level electrical stimulation effective in cerebral palsy children with dysphagia? A randomized controlled clinical trial

Abstract

Dysphagia is one of the common findings in children with cerebral palsy (CP). Electrical stimulation (ES) has been demonstrated to positively contribute to swallowing functions, particularly in adult patients with various neurological disorders. Therefore, the objective of this study was to assess the effects of sensory-level ES treatment combined with conventional dysphagia rehabilitation in pediatric age group CP patients who had any oropharyngeal dysphagia symptoms and/or findings. Participants were randomly assigned to either the experimental group (Group 1, n = 52) who underwent intermittent galvanic stimulation to bilateral masseter muscles for 5 days/week, for 4 weeks combined with conventional dysphagia rehabilitation or the control group (Group 2, n = 50) who received sham stimulation with conventional dysphagia rehabilitation. The experimental group achieved significantly more improvement in swallowing functions including drooling, tongue movements, chewing, eating large food ability, feeding duration, as well as dysphagia screen test and dysphagia level, compared to control group. This study suggested that sensory-level ES might be a useful and safe therapeutic modality to improve oropharyngeal symptoms, symptom severity and dysphagia level in children with CP and dysphagia. Further research is needed to determine the long-term effects of ES on dysphagia, especially in different neurological disorders such as CP.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Hutton JL (2006) Cerebral palsy life expectancy. Clin Perinatol 33(2):545–555

    Article  Google Scholar 

  2. 2.

    Strauss D, Shavelle R (1998) Life expectancy of adults with cerebral palsy. Dev Med Child Neurol 40(6):369–375

    CAS  PubMed  Google Scholar 

  3. 3.

    Fung EB, Samson-Fang L, Stallings VA, Conaway M, Liptak G, Henderson RC (2002) Feeding dysfunction is associated with poor growth health status in children with cerebral palsy. J Am Diet Assoc 102:361–368

    Article  Google Scholar 

  4. 4.

    Himuro N, Mishima R, Seshimo T, Morishima T, Kosaki K, Ibe S et al (2018) Change in mobility function and its causes in adults with cerebral palsy by Gross Motor Function Classification System level: a cross-sectional questionnaire study. NeuroRehabilitation. https://doi.org/10.3233/NRE-172340(Epub ahead of print)

    Article  PubMed  Google Scholar 

  5. 5.

    Van den Engel-Hoek L, Harding C, van Gerven M, Cockerill H (2017) Pediatric feeding and swallowing rehabilitation: An overview. J Pediatr Rehabil Med 10(2):95–105

    Article  Google Scholar 

  6. 6.

    Benfer KA, Weir KA, Bell KL, Ware RS, Davies PSW, Boyd RN (2017) Oropharyngeal dysphagia and cerebral palsy. Pediatrics. 140(6)

  7. 7.

    Morgan AT, Dodrill P, Ward EC (2012) Interventions for oropharyngeal dysphagia in children with neurological impairment. Cochrane Database Syst Rev 10:CD009456. https://doi.org/10.1002/14651858.CD009456.pub2

    Article  PubMed  Google Scholar 

  8. 8.

    Arvedson JC (2013) Feeding children with cerebral palsy and swallowing difficulties. Eur J Clin Nutr 67(Suppl 2):S9–S12

    Article  Google Scholar 

  9. 9.

    Christiaanse ME, Mabe B, Russell G, Simeone TL, Fortunato J, Rubin B (2011) Neuromuscular electrical stimulation is no more effective than usual care for the treatment of primary dysphagia in children. Pediatr Pulmonol 46(6):559–565

    Article  Google Scholar 

  10. 10.

    Rice KL (2012) Neuromuscular electrical stimulation in the early intervention population: a series of five case studies. Internet J Allied Health Sci Pract 10(3):1e7

    Google Scholar 

  11. 11.

    Song WJ, Park JH, Lee JH, Kim MY (2015) Effects of neuromuscular electrical stimulation on swallowing functions in children with cerebral palsy: a pilot randomised controlled trial. HKJOT 25:1e6

    Google Scholar 

  12. 12.

    Umay E, Unlu E, Cakci A (2014) Psychological status and quality of life of caregivers of children with dysphagic cerebral palsy. Res J 1:768–776

    Google Scholar 

  13. 13.

    Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B (1997) Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 39(4):214–223

    CAS  Article  Google Scholar 

  14. 14.

    Serel Arslan S, Demir N, Karaduman AA, Belafsky PC (2017) The pediatric version of the eating assessment tool: a caregiver administered dyphagia-specific outcome instrument for children. Disabil Rehabil 5:1–5

    Google Scholar 

  15. 15.

    Dziewas R, Warnecke T, Olenberg S, Teismann I, Zimmermann J, Kramer C et al (2008) Towards a basic endoscopic assessment of swallowing in acute stroke development and evaluation of a simple dysphagia score. Cerebrovasc Dis 26:41–47

    Article  Google Scholar 

  16. 16.

    Karaca Umay E, Yaylaci A, Saylam G, Gundogdu I, Gurcay E, Akcapinar D et al (2017) The effect of sensory-level electrical stimulation of the masseter muscle in early stroke patients with dysphagia: a randomized controlled study. Neurol India 64(4):734–742

    Article  Google Scholar 

  17. 17.

    Sheppard JJ (2008) Using motor learning approaches for treating swallowing and feeding disorders: a review. Lang Speech Hear Ser 39(2):227–236

    Article  Google Scholar 

  18. 18.

    Gow D, Hobson AR, Furlong P, Hamdy S (2004) Characterising the central mechanisms of sensory modulation in human swallowing motor cortex. Clin Neurophysiol 115(10):2382–2390

    Article  Google Scholar 

  19. 19.

    Steele CM, Miller AJ (2010) Sensory input pathways and mechanisms in swallowing: a review. Dysphagia 25(4):323–333

    Article  Google Scholar 

  20. 20.

    Arvedson J, Clark H, Lazarus C, Schooling T, Frymark T (2010) The effects of oral-motor exercises on swallowing in children: an evidence-based systematic review. Dev Med Child Neurol 52(11):1000–1013

    Article  Google Scholar 

  21. 21.

    Scott S (2014) Classifying eating and drinking ability in people with cerebral palsy. Dev Med Child Neurol 56(3):201

    Article  Google Scholar 

  22. 22.

    Dodrill P, Gosa MM (2015) Pediatric dysphagia: physiology, assessment, and management. Ann Nutr Metab 66(suppl 5):24–31

    CAS  Article  Google Scholar 

  23. 23.

    Harding C, Cockerill H (2015) Managing eating and drinking difficulties (dysphagia) with children who have learning disabilities: What is effective? Clin Child Psychol Psychiatry 20(3):395–405

    Article  Google Scholar 

  24. 24.

    Jayasekeran V, Singh S, Tyrrell P, Michou E, Jefferson S, Mistry S et al (2010) Adjunctive functional pharyngeal electrical stimulation reverses swallowing disability after brain lesions. Gastroenterology 138(5):1737–1746

    Article  Google Scholar 

  25. 25.

    Permsirivanich W, Tipchatyotin S, Wongchai M, Leelamanit V, Setthawatcharawanich S, Sathirapanya P et al (2009) Comparing the effects of rehabilitation swallowing therapy vs. neuromuscular electrical stimulation therapy among stroke patients with persistent pharyngeal dysphagia: a randomized controlled study. J Med Assoc Thai 92(2):259–265

    PubMed  Google Scholar 

  26. 26.

    Xia W, Zheng C, Lei Q, Tang Z, Hua Q, Zhang Y et al (2011) Treatment of post-stroke dysphagia by vitalstim therapy coupled with conventional swallowing training. J Huazhong Univ Sci Technolog Med Sci 31(1):73–76

    CAS  Article  Google Scholar 

  27. 27.

    Li L, Li Y, Huang R, Yin J, Shen Y, Shi J (2015) The value of adding transcutaneous neuromuscular electrical stimulation (VitalStim) to traditional therapy for post-stroke dysphagia: a randomized controlled trial. Eur J Phys Rehabil Med 51(1):71–78

    PubMed  Google Scholar 

  28. 28.

    Sproson L, Pownall S, Enderby P, Freeman J (2018) Combined electrical stimulation and exercise for swallow rehabilitation post-stroke: a pilot randomized control trial. Int J Lang Commun Disord 53(2):405–417

    Article  Google Scholar 

  29. 29.

    Merrill DR (2009) Review of electrical stimulation in cerebral palsy and recommendations for future directions. Dev Med Child Neurol 51(Suppl 4):154–165

    Article  Google Scholar 

  30. 30.

    Pernambuco Lde A, Silva HJ, Lima LM, Cunha RA, Santos Vda S, Cunha DA et al (2011) Electrical activity of masseter muscle in young adults during swallowing of liquid. J Soc Bras Fonoaudiol 23(3):214–219

    Article  Google Scholar 

  31. 31.

    Ludlow CL, Humbert I, Saxon K, Poletto C, Sonies B, Crujido L (2007) Effects of surface electrical stimulation both at rest and during swallowing in chronic pharyngeal. Dysphagia Dysphagia 22(1):1–10

    Article  Google Scholar 

Download references

Funding

There is no funding source in this study.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Ebru Umay.

Ethics declarations

Conflict of interest

There is no conflict interest among the authors. Author EU declares that she has no conflict of interest. Author EG declares that she has no conflict of interest. Author EO declares that he has no conflict of interest. Author EUA declares that she has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from the caregivers of all participants included in the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Umay, E., Gurcay, E., Ozturk, E.A. et al. Is sensory-level electrical stimulation effective in cerebral palsy children with dysphagia? A randomized controlled clinical trial. Acta Neurol Belg 120, 1097–1105 (2020). https://doi.org/10.1007/s13760-018-01071-6

Download citation

Keywords

  • Cerebral palsy
  • Deglutition
  • Deglutition disorder
  • Sensory-level electrical stimulation