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Aim-To determine whether NTrainer patterned orocutaneous therapy affects preterm infants' non-nutritive suck and/or oral feeding success.Subjects-Thirty-one preterm infants (mean gestational age 29.3 weeks) who demonstrated minimal non-nutritive suck output and delayed transition to oral feeds at 34 weeks post-menstrual age.Intervention-NTrainer treatment was provided to 21 infants. The NTrainer promotes nonnutritive suck output by providing patterned orocutaneous stimulation through a silicone pacifier that mimics the temporal organization of suck.Method-Infants' non-nutritive suck pressure signals were digitized in the NICU before and after NTrainer therapy and compared to matched controls. Non-nutritive suck motor pattern stability was calculated based on infants' time-and amplitude-normalized digital suck pressure signals, producing a single value termed the Non-Nutritive Suck Spatiotemporal Index. Percent oral feeding was the other outcome of interest, and revealed the NTrainer's ability to advance the infant from gavage to oral feeding.Results-Multilevel regression analyses revealed that treated infants manifest a disproportionate increase in suck pattern stability and percent oral feeding, beyond that attributed to maturational effects alone. Conclusion-TheNTrainer patterned orocutaneous therapy effectively accelerates non-nutritive suck development and oral feeding success in preterm infants who are at risk for oromotor dysfunction.

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Joint dysfunctions and associated musculoskeletal pain are among the most common medical complaints presented to clinicians. Ligaments are collagenous fibrous structures that are primarily responsible for maintaining smooth joint motion, restraining excessive joint displacement, and providing stability across the joint. Ligaments also act as sensory organs for the joints and have significant input to pain sensation. When ligaments are subjected to forces beyond their normal range of motion, injury and failure occur, resulting in joint laxity (looseness or instability), and subsequent disruptions in the balance between joint mobility and joint stability. These dysfunctions can result in joint pain and the development of osteoarthritis. Several strategies have been employed over the years in attempts to improve joint instability from ligament injury; however, some of the standard therapeutic approaches (drugs, corticosteroid injections, and surgery) employed to address these problems have not been very effective because they often do not address the underlying cause of the problems, and in fact can inhibit ligament healing and restoration. For these reasons, there is current and growing interest among patients and clinicians in prolotherapy, an alternative therapeutic modality that can reduce or eliminate pain by stimulating the natural regenerative processes in and around the joint to facilitate the restoration of degenerated ligaments and tendons to a healthy state, improving joint support, function and reducing pain. This review presents current evidence from clinical studies demonstrating that prolotherapy is a significant and effective alternative treatment modality for people with ligament-related injuries and resultant joint instability.