Is sensory-level electrical stimulation effective in cerebral palsy children with dysphagia? A randomized controlled cli
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ORIGINAL ARTICLE
Is sensory-level electrical stimulation effective in cerebral palsy children with dysphagia? A randomized controlled clinical trial Ebru Umay1 · Eda Gurcay2 · Erhan Arif Ozturk1 · Ece Unlu Akyuz1 Received: 6 September 2018 / Accepted: 18 December 2018 © Belgian Neurological Society 2019
Abstract Dysphagia is one of the common findings in children with cerebral palsy (CP). Electrical stimulation (ES) has been demonstrated to positively contribute to swallowing functions, particularly in adult patients with various neurological disorders. Therefore, the objective of this study was to assess the effects of sensory-level ES treatment combined with conventional dysphagia rehabilitation in pediatric age group CP patients who had any oropharyngeal dysphagia symptoms and/or findings. Participants were randomly assigned to either the experimental group (Group 1, n = 52) who underwent intermittent galvanic stimulation to bilateral masseter muscles for 5 days/week, for 4 weeks combined with conventional dysphagia rehabilitation or the control group (Group 2, n = 50) who received sham stimulation with conventional dysphagia rehabilitation. The experimental group achieved significantly more improvement in swallowing functions including drooling, tongue movements, chewing, eating large food ability, feeding duration, as well as dysphagia screen test and dysphagia level, compared to control group. This study suggested that sensory-level ES might be a useful and safe therapeutic modality to improve oropharyngeal symptoms, symptom severity and dysphagia level in children with CP and dysphagia. Further research is needed to determine the long-term effects of ES on dysphagia, especially in different neurological disorders such as CP. Keywords Cerebral palsy · Deglutition · Deglutition disorder · Sensory-level electrical stimulation
Introduction Cerebral palsy (CP) is a permanent, non-progressive disorder, caused by brain damage occurred during fetal brain development or within the first 2 years of life. Recently, many premature infants are kept alive due to advancement in neonatal care, leading to increased in CP incidence [1]. Since 30-years life expectancy is 80–85%, socio-economic perspective has become important [2]. Deterioration of CP may cause spasticity, muscle contractures, weakness and difficulty in coordination which affects the control ability of walking, swallowing, and speech articulation and causes secondary outcome such as growth retardation [3, 4].
* Ebru Umay [email protected] 1
Ankara Diskapi Training and Research Hospital, Physical Medicine and Rehabilitation Clinic, University of Health Sciences, Altindag, Ankara, Turkey
Gaziler Physical and Rehabilitation Medicine Training and Research Hospital, Ankara, Turkey
2
Dysphagia in children with CP usually emerges in parallel with other disruptions of development such as cognitive, fine and gross motor skills. Although the overall reported incidence of dysphagia in children with CP is 40–86% [5], a recent study has shown that the rate
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