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Electrical stimulation as a promising strategy to enhance feeding development in children with severe cerebral palsy
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DOI：10.1002/jpn3.70413.png)
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Abstract
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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 (chi & sup2; = 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.
Keywords:
dysphagia
feeding therapy
International Dysphagia Diet Standardisation Initiative
orofacial function
speech-language therapy
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