Effects of Neuromuscular Electrical Stimulation on the Masticatory Muscles and Physiologic Sleep Variables in Adults with Cerebral Palsy: A Novel Therapeutic Approach

Abstract

Cerebral palsy (CP) is a term employed to define a group of non-progressive neuromotor disorders caused by damage to the immature or developing brain, with consequent limitations regarding movement and posture. CP may impair orapharygeal muscle tone, leading to a compromised chewing function and to sleep disorders (such as obstructive sleep apnea). Thirteen adults with CP underwent bilateral masseter and temporalis neuromuscular electrical stimulation (NMES) therapy. The effects on the masticatory muscles and sleep variables were evaluated using electromyography (EMG) and polysomnography (PSG), respectively, prior and after 2 months of NMES. EMG consisted of 3 tests in different positions: rest, mouth opening and maximum clenching effort (MCE). EMG values in the rest position were 100% higher than values recorded prior to therapy for all muscles analyzed (p < 0.05); mean mouth opening increased from 38.0 ± 8.0 to 44.0 ± 10.0 cm (p = 0.03). A significant difference in MCE was found only for the right masseter. PSG revealed an improved in the AHI from 7.2±7.0/h to 2.3±1.5/h (p < 0.05); total sleep time improved from 185 min to 250 min (p = 0.04) and minimun SaO2 improved from 83.6 ± 3.0 to 86.4 ± 4.0 (p = 0.04). NMES performed over a two-month period led to improvements in the electrical activity of the masticatory muscles at rest, mouth opening, isometric contraction and sleep variables, including the elimination of obstructive sleep apnea events in patients with CP.Trial RegistrationReBEC RBR994XFS http://www.ensaiosclinicos.gov.br

Periodontal Diseases in Patients with Special Health Care Needs

“…The intrinsic factors include immune response deficiency, a high amount of periopathogens, sleep disorders such as obstructive sleep apnea, dysfunction of the oropharyngeal muscles resulting in severe dysphagia, and the risk of occurrence for aspiration pneumonia. Previous studies confirm the presence of respiratory pathogens in the oral cavity which may be aspirated into the lung alveoli due to severe dysphagia, developing aspiration pneumonia [12,13]. This comorbidity may negatively influence the oral health homeostasis, aggravating the preexistent inflammatory processes, in particular, the PD.…”

“…This biostimulating effect also reflected in the electrical activity of the oropharyngeal muscles, favoring their functional performance; then, a positive effect on the apnea and hypopnea index was found. These episode cascades reduced the number of pathological respiratory events, promoting improvements in the quality of life for these patients [12][13][14].…”

Evaluation of the masticatory muscle function, physiological sleep variables, and salivary parameters after electromechanical therapeutic approaches in adult patients with Down syndrome: a randomized controlled clinical trial

“…Power analysis or Power test is the process used for determining the sample size for this study, using SPSS (version 22.0.0.0). This is based on a work entitled “Effects of Neuromuscular Electrical Stimulation on the Masticatory Muscles and Physiologic Sleep Variables in Adults with Cerebral Palsy: A Novel Therapeutic Approach” [15]. The intervention was considered to result in a minimum effect similar to the EMG activity of the masseter and temporalis muscles in disabled adults.…”

“…Thus, previous studies have suggested that new therapeutic approaches are promising options to improve masticatory muscle function and to treat sleep disorders, including sleep bruxism and OSA. These investigations have demonstrated satisfactory results in patients with disabilities who presented concomitant unbalanced masseter and temporalis muscle patterns, sleep bruxism, and OSA [13–15].…”

Masticatory force and electromyographic activity of the mandibular elevators muscles in different rehabilitation treatments.

“…The maximum bite force may be measured through electromyography, considering this technique is an important tool in the assessment of mandibular movements and neuromuscular performance during chewing. [15]…”