Neuromuscular electrical stimulation (NMES) and oral sensorimotor stimulation in a young child with cerebral palsy and severe dysphagia

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.