Improvement of swallowing function due to neuromuscular electrical stimulation in children with primary dysphagia

Introduction
Children suffering from primary dysphagia require enteral nutrition due to a lack of sufficient skills in oral feeding and swallowing. There are no data on neuromuscular electrical stimulation (NMES) in primary dysphagia treatment. Our aim was to identify possible changes in the swallowing function in children with limited cooperation and compare functional oral intake before and after NMES therapy.

Material and methods
A prospective study was performed to assess the effects of therapy among children with primary dysphagia and lack of progress in the development of swallowing function. The therapy was introduced for 30 minutes twice a day for 5 consecutive days. Such an intense cycle of therapy was repeated every one/two months. Each participant was scheduled for 10 therapeutic cycles. Evaluation was based on parents’ and therapists’ clinical observations, analysis of changes in several aspects of swallowing function, videofluoroscopic examination and the functional oral intake scale (FOIS).

Results
The studied group consisted of 34 children (mean age 33 months). Only 10 patients completed the full 10 cycles of therapy. The average number of cycles was 3.5 ±2.3. 23/34 patients improved their feeding abilities. There was a significant improvement on the FOIS scale [1 (1; 2) vs. 2.5 (2; 6); baseline vs. final; median (lower; upper quartile); p < 0.0001]. Additionally, we observed a positive change in the following aspects of swallowing function: effectiveness of defensive laryngeal reactions (15/34); control of saliva (9/34); reduction of gurgling breath (9/34); enhancement of facial and tongue muscle tonus (12/34); coordination between swallowing and breathing (6/34); initiation or increasing frequency of oral feeding (14/34).

Conclusions
Electrical stimulation improves functional oral intake. It may increase the frequency of oral feeding and reduce enteral nutrition regardless of the children’s age at the beginning of the therapy.