Neuromuscular electrical stimulation for treatment of dysphagia in infants and young children with neurological impairment: a prospective pilot study

Abstract

ObjectivesTo describe the acceptability, safety and effectiveness of neuromuscular electrical stimulation (NMES) in infants and young children with neurological impairment (NI) who have severe dysphagia.DesignA prospective pilot study using a before and after study design.SettingThe Hospital for Sick Children, Toronto, Canada.PatientsTen infants and young children (0–24 months) with NI and severe dysphagia on videofluoroscopic swallow study (VFSS) who were referred to an occupational therapist (OT). Those with neurodegenerative conditions were excluded.InterventionNMES treatments lasting 20–45 min twice weekly for the duration of 2–4 months. The NMES was administered during feeding therapy sessions by a trained OT.Main outcome measuresImprovement in swallowing function as measured by VFSS and the need for tube feeding, adverse events and parental acceptability.ResultsSeven of 10 enrolled subjects (median age, 8.9 months) completed biweekly NMES treatments (median number of treatments per subject, 18). All of the seven (100%) subjects who completed treatment showed an improvement in swallow function on VFSS. Of the five patients who were not safe to orally feed on any consistency of liquid or puree at baseline, three established full oral feeding and two established partial oral feeding. At baseline, 5/7 children were completely fed by tube versus 0/7 at the end of treatment. No adverse events occurred other than mild skin irritation at the site of electrode placement. Five of seven caregivers felt that feeding was improved and were satisfied with the intervention.ConclusionsOur prospective pilot study of NMES in seven neurologically impaired infants and young children with severe dysphagia suggests that NMES is safe, acceptable to parents and has potential efficacy. Trials are needed to determine if any treatment benefit exists.Trial registrationClinicalTrials.gov NCT01723358.

Neuromuscular electrical stimulation for children with dysphagia: a systematic review

“…The studies were from six countries: Egypt, 32 China, 29 30 Canada, 34 Turkey, 9 South Korea 31 33 and USA. 35–37 The mean age of the included participants was less than 4 years in eight studies 9 29 30 32 34–37 and the mean age was 6 years in one study.…”

“…Most studies placed the electrodes around the hyoid bone and thyroid notch, 29 30 32 34–37 and in one study, electrode placement was further adjusted on an individual basis. 34 One study placed electrodes on the sublingual muscles, 30 and one study placed electrodes on the submental region. 33 The frequency of sessions ranged from 5 days per week 9 29 30 33 to 1–2 times per week.…”

Manejo multidisciplinario con terapia de electroestimulación en un paciente con síndrome de Goldenhar, trastorno de la deglución y falla para crecer

“…Sin embargo, existe poca evidencia que la respalde, y aún es más escasa en población pediátrica. Por otro lado, resulta más contundente en pacientes con disfagia adquirida que en aquellos con disfagia de origen primario 8,12 .…”

“…En lo que respecta a la población pediátrica, se ha utilizado en pacientes con daño neurológico con resultados positivos 5 . La técnica consiste en colocar electrodos en la piel (parte anterior del cuello), los cuales liberarán pequeñas cantidades de energía para estimular los músculos encargados de la deglución 12 . Lamentablemente, existen pocos artículos de investigación que reporten la eficacia de la NMES en pediatría y la evidencia es insuficiente.…”

“…Por un lado, Frost, et al 7 reportaron más beneficios con la terapia de electroestimulación en los pacientes con disfagia adquirida en comparación con aquellos con disfagia primaria. Por otro lado, Marcus, et al 12 reportaron que dicha terapia sí resultó benéfica en el tratamiento de la disfagia en pacientes pediátricos. Otro estudio de casos y controles en población pediátrica reportó una mejoría con el uso de ambas terapias, aunque únicamente cuando se utilizó NMES se observó una diferencia significativa 5 .…”