Serebral Palsi'li Çocuklarda Nmes'in Yutma Güçlüğü Rehabilitasyonunda Etkinliğinin Elektrofizyolojik Olarak İncelenmesi

Abstract

This study aims to examine the functional and electrophysiological effectiveness of NMES the rehabilitation of swallowing difficulties in children with dysphagic Cerebral Palsy (SP). The study included 26 children with SP an average age of 7.03±2.40. Children were randomized into two treatment groups where NMEs (N=16) and ShamNMES (n=10) were administered in addition to conventional swallowing rehabilitation. All children were given oral motor exercises, laryngeal mobilization, thermal stimulation and gum massage as conventional swallowing rehabilitation. For all children, Gross Motor Function Classification System (GMFCS), Clinical Rating Scale For Head Control, Pediatric Eating Assessment Scale (Pedi EAT-10), Penetration-Aspiration Assessment (PAS), Karaduman Chewing Performance Scale (KCPS), Swallowing Ability and Function Evaluation (SAFE), electrophysiological assessment of the suprahyoid muscles, was performed. All patients received a swallowing rehabilitation program for a total of 12 sessions for 4 weeks, 3 sessions per week, by the therapist in the clinic. As the level of GMFCS increased, the swallowing problem increased, while the level of benefit from both treatments decreased. NMES statistically increased swallowing ability and ability at all stages. Sham-NMES was found to be significantly beneficial only in oral phase evaluation (p<0.05). Both treatments had significant curative effects on the Dysphagia limit, aspiration and penetration risk. But both applications; It was found that there was no statistically significant advantage over each other on functionality of swallowing (p>0.05). As food density increased, the contraction performance of the suprahyoid muscle increased. NMES significantly improved muscle contraction performance in solid foods (p<0.05). It was noted that the resting potential of suprahyoid muscle in both treatment groups decreased after treatment in all food density (p>0.05). In all patients, swallowing time decreased in all consistencies. Between the groups, contraction time was significantly decreased in spontaneous and solid swallowing in the NMES group and liquid swallowing in the Sham-NMES group (p<0.05). As a result of the study, we found that NMES does not have superiority over Sham-NMEs in terms of the functionality of swallowing. But we think that NMES treatment in spontaneous and solid foods is superior to improving the performance of the suprahyoid muscle.