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Electrical stimulation as a promising strategy to enhance feeding development in children with severe cerebral palsy
Aleksandra Kaczyńska1, Piotr Socha1
1Department of Gastrology, Hepatology, Feeding Disorders and Pediatrics, Children's Memorial Health Institute, Warsaw, Poland.
Insights
Adding transcutaneous electrical nerve stimulation/neuromuscular electrical stimulation (TENS/EMS) to speech-language therapy (SLT) significantly improved feeding abilities in children with severe cerebral palsy (CP). This combined approach enhanced orofacial function and acceptance of advanced food textures.
Area of Science:
- Pediatric Rehabilitation
- Neuroscience
- Speech-Language Pathology
Background:
- Children with severe cerebral palsy (CP) often experience dysphagia, impacting oral feeding and increasing malnutrition risk.
- Gross Motor Function Classification System (GMFCS) IV-V indicates severe motor impairment, frequently associated with feeding difficulties.
Purpose of the Study:
- To evaluate the efficacy of augmenting speech-language therapy (SLT) with transcutaneous electrical nerve stimulation/neuromuscular electrical stimulation (TENS/EMS) for children with CP (GMFCS IV-V).
- To assess improvements in orofacial function and the acceptance of advanced food textures.
Main Methods:
- An experimental study involved 50 children (aged 4-8 years) with CP (GMFCS IV-V) and neurogenic dysphagia.
- Participants were randomly assigned to SLT alone (control) or SLT + TENS/EMS (experimental) over three 5-day cycles.
- Intervention included oral-motor exercises, texture advancement (IDDSI), and TENS/EMS applied to suprahyoid and infrahyoid muscles.
Main Results:
- The experimental group showed a significant improvement in International Dysphagia Diet Standardization Initiative (IDDSI) texture acceptance (mean score increase from 2.1 to 4.0).
- Controls showed a lesser improvement (mean score increase from 2.0 to 2.8).
- 72% of the experimental group advanced by two IDDSI levels compared to 28% in the control group (p < 0.01).
Conclusions:
- SLT combined with TENS/EMS significantly enhances orofacial sensory-motor performance and tolerance for complex food textures in children with severe CP.
- TENS/EMS is a promising adjunct therapy for pediatric feeding disorders.
- Further research is needed to confirm long-term efficacy and nutritional outcomes.
Objectives:
Children with cerebral palsy (CP) at Gross Motor Function Classification System (GMFCS) IV-V commonly present with dysphagia that limits oral feeding and increases malnutrition risk. We evaluated whether adding transcutaneous electrical nerve stimulation/neuromuscular electrical stimulation (TENS/EMS) to speech-language therapy (SLT) improves orofacial function and acceptance of more advanced food textures.
Methods:
Experimental study including 50 children aged 4-8 years with CP (GMFCS IV/V) and neurogenic dysphagia. Participants were allocated (concealed envelopes) to SLT alone (control) or SLT + TENS/EMS (experimental) in a random order. The intervention comprised three 5-day treatment cycles spaced 2 months apart. Each 30-min session included oral-motor exercises and texture advancement per the International Dysphagia Diet Standardization Initiative (IDDSI). TENS (50-100 Hz) and EMS (20-50 Hz) were applied to the suprahyoid and infrahyoid muscles. The primary outcome was IDDSI texture acceptance assessed at baseline (I1), mid-cycle (I2), and post-cycle (I3) by blinded evaluators.
Results:
The experimental group improved in mean IDDSI texture acceptance from 2.1 ± 0.8 (I1) to 4.0 ± 0.9 (I3), versus 2.0 ± 0.7 to 2.8 ± 0.8 in controls (p < 0.01). Advancement by two IDDSI levels occurred in 72% (18/25) of the experimental group compared with 28% (7/25) of controls (χ² = 10.36, p < 0.01).
Conclusions:
SLT augmented with TENS/EMS significantly enhances orofacial sensory-motor performance and tolerance of more complex food textures in children with severe CP. TENS/EMS appears to be a promising adjunct in pediatric feeding therapy; longer-term efficacy and nutritional outcomes warrant further study.
