Neuromuscular electrical stimulation for treatment of dysphagia in infants and young children with neurological impairment: a prospective pilot study

OBJECTIVES: To describe the acceptability, safety and effectiveness of neuromuscular electrical stimulation (NMES) in infants and young children with neurological impairment (NI) who have severe dysphagia. DESIGN: A prospective pilot study using a before and after study design. SETTING: The Hospital for Sick Children, Toronto, Canada. PATIENTS: Ten infants and young children (0–24 months) with NI and severe dysphagia on videofluoroscopic swallow study (VFSS) who were referred to an occupational therapist (OT). Those with neurodegenerative conditions were excluded. INTERVENTION: NMES treatments lasting 20–45 min twice weekly for the duration of 2–4 months. The NMES was administered during feeding therapy sessions by a trained OT. MAIN OUTCOME MEASURES: Improvement in swallowing function as measured by VFSS and the need for tube feeding, adverse events and parental acceptability. RESULTS: Seven of 10 enrolled subjects (median age, 8.9 months) completed biweekly NMES treatments (median number of treatments per subject, 18). All of the seven (100%) subjects who completed treatment showed an improvement in swallow function on VFSS. Of the five patients who were not safe to orally feed on any consistency of liquid or puree at baseline, three established full oral feeding and two established partial oral feeding. At baseline, 5/7 children were completely fed by tube versus 0/7 at the end of treatment. No adverse events occurred other than mild skin irritation at the site of electrode placement. Five of seven caregivers felt that feeding was improved and were satisfied with the intervention. CONCLUSIONS: Our prospective pilot study of NMES in seven neurologically impaired infants and young children with severe dysphagia suggests that NMES is safe, acceptable to parents and has potential efficacy. Trials are needed to determine if any treatment benefit exists. TRIAL REGISTRATION: ClinicalTrials.gov NCT01723358.