Abstract:
Background: A number of research studies implementing VitalStim® Therapy or
neuromuscular electrical stimulation (NMES) found positive results in the swallowing
abilities of adults with severe dysphagia. Percutaneous endoscopic gastrostomy (PEG) tube
feeding is often recommended for children with severe dysphagia when oral feeding is
deemed unsafe. Although PEG tube feeding has many benefits, there are associated
disadvantages. NMES research, suggests it may limit the need for PEG tube feeding.
Objective: The aim of the study was to determine whether change took place in a young
child’s oral preparatory, oral and pharyngeal phase of swallowing after 20 sessions of NMES
and oral sensorimotor stimulation. This participant has been long-term PEG tube fed.
Method: A pre-test-post-test single case design with a control was implemented. The
participants were recruited at the same time and randomly assigned to act as the main and
control participants. The participants were 62 and 40 months, with spastic cerebral palsy and
were fed via PEG tubes. The main participant received NMES while both received oral
sensorimotor stimulation. Data was collected by means of a case history, clinical evaluations
and Modified Barium Swallow (MBS) examinations before and immediately after treatment.
Both participants received 20 sessions of treatment over six weeks. Post-treatment follow-up
MBS examinations were conducted at seven and 15 months on the main participant only.
Results: Both participants showed improvement of oral dysphagia after six weeks of
treatment. Although both showed improvement in their oral preparatory and oral phase
difficulties, the main participant showed better improvement of pharyngeal phase difficulties
than the control. The main participant’s improvement was not sustained at the seven and 15
month follow-up MBS examinations. Poor positioning could have attributed to this.
Conclusion: Similar oral preparatory and oral phase difficulties were identified before
treatment in both participants. Initial positive post-treatment results in the oral preparatory
and oral phase of both participants may have been associated with frequent oral sensorimotor
stimulation only. Although only short-term differences were observed, it appeared that
improvement in the pharyngeal phase of swallowing in the main participant could be
associated with NMES. It appeared that oral sensorimotor stimulation only for the treatment
of pharyngeal difficulties in the control participant did not yield positive results. Based on the study results NMES may be used in conjunction with oral motor exercises to address oral and
pharyngeal difficulties associated with feeding and swallowing difficulties in young children
with severe dysphagia, especially after conventional dysphagia treatment has failed. Factors
that could have contributed to the results are discussed.
