Serebral palsili çocuklarda salya probleminin tedavisinde nöromusküler elektrik stimülasyonunun etkinliğinin araştırılması

Amaç: Salya problemi serebral palsili (SP) çocuklarda fonksiyon bozukluğuna yol açan, çocukların bakımını zorlaştıran önemli bir problemdir. Çalışmamızda salya problemi olan SP’li çocuklarda Nöromusküler Elektrik Stimülasyonu (NMES) uygulamasının salya kontrolü, dilin itme refleksi ve yutma üzerindeki etkilerinin araştırılması hedeflenmektedir.Yöntem: Çalışmaya SP’li 40 çocuk dahil edildi ve rastgele yöntemle randomize olarak iki gruba ayrıldı (20 kontrol, 20 NMES). Tüm olgular; Kaba Motor Fonksiyon Sınıflandırma Sistemi (KMFSS), Dil İtme Refleksi Değerlendirme Skalası (DİRS), Salya Kontrol Problemi Sıklık ve Şiddeti Skalası (SKŞS), Salya Akış Oranının değerlendirilmesi için sünger testi ve yutma yeteneği için Su Yutma Testi (SYT) ile değerlendirildi. Kontrol grubuna intraoral uyarı, orafasyal masaj, pasif dil hareketleri içeren oral motor egzersiz tedavi (OMET) programı, ev programı olarak verildi. NMES grubuna, ev programına ilave olarak haftada 2 seans, 4 hafta boyunca bilateral masseter, orbicularis oris ve suprahiyoidal kaslara 20 dakika düşük frekanslı NMES uygulandı.Bulgular: Tedavi sonrası grup içi karşılaştırmada salya akış oranlarının değerleri her iki grupta anlamlı (kontrol grubunda p=0,030; NMES grubunda p<0,001) bulunurken, gruplar arası karşılaştırmada istatistiksel olarak anlamlı bir fark bulunmadı (p=0,617). Tedavi sonrası DİRS, SKŞS düzeyleri ve SYT değerleri her iki grupta grup içi ve gruplar arası değerlendirmeler arasında anlamlı bir fark bulunmadı.Sonuç: Salya problemi olan SP’li çocuklarda ev programına ek olarak yapılan NMES uygulamasının 4 haftalık uygulama süreci sonunda salya kontrolü, dilin itme refleksi ve yutma üzerindeki etkilerinin olmadığı görülmüştür.

Anahtar Kelimeler:

Serebral palsi, Salya kontrol problemi, Elektrik stimülasyonu

Investigation of the effects of neuromuscular electrical stimulation in the treatment of drooling in children with cerebral palsy

Purpose: Drooling is an important problem that causes dysfunction in children with cerebral palsy and makes it difficult for children’s care. In our study, we aimed to investigate the effects of Neuromuscular Electrical Stimulation (NMES) on saliva control, tongue thrust and swallowing in children with Cerebral Palsy (CP) with drooling problems. Methods: Fourty children with CP were included in the study and randomly divided into two groups (20 control, 20 NMES). All cases were assessed by using Gross Motor Function Classification System (GMFCS), Tongue Thrust Rating Scale (TTRS), Drooling Severity and Frequency Scale (DSFS), Swab test for salivation flow rate evaluation, and Water Swallowing Test (WST) for swallowing. Oral Motor Exercise Therapy (OMET) program including intraoral stimulation, orofacial massage, and passive tongue movements as a home program was given to the control group. The NMES group received a low frequency NMES for 20 minutes to be applied bilaterally to the masseter, orbicularis oris, and suprahyoidal muscles for two sessions per week for 4 weeks, in addition to the home program.Results: A significant difference was found in both groups in the evaluation of salivary flow rate (control group p=0.030; NMES group p<0.001) after the treatment. Comparing the groups, there was no significant difference in the analysis of saliva flow rates after the treatment (p=0.617). There were also no significant differences regarding to TTRS, DSFS and WST levels in both groups after the treatment.Conclusion: Among children with CP having drooling problems, NMES application with home exercise program did not have an effect on saliva control, tongue thrust, and swallowing after four weeks period.

Keywords:

Cerebral palsy, Drooling, Electrical stimulation,

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