神经肌肉电刺激治疗神经功能障碍婴幼儿吞咽困难：一项前瞻性初步研究。
Neuromuscular electrical stimulation for treatment of dysphagia in infants and young children with neurological impairment: a prospective pilot study.
作者信息
Marcus Sherna, Friedman Jeremy N, Lacombe-Duncan Ashley, Mahant Sanjay
机构信息
Department of Rehabilitation, Hospital for Sick Children, Toronto, Ontario, Canada.
Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada.
出版信息
BMJ Paediatr Open. 2019 Jan 23;3(1):e000382. doi: 10.1136/bmjpo-2018-000382. eCollection 2019.
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.
目的
描述神经肌肉电刺激（NMES）在患有严重吞咽困难的神经功能障碍（NI）婴幼儿中的可接受性、安全性和有效性。
设计
采用前后对照研究设计的前瞻性试点研究。
地点
加拿大多伦多病童医院。
患者
10名0至24个月的NI患儿，经电视透视吞咽研究（VFSS）确诊为严重吞咽困难，被转介给职业治疗师（OT）。排除患有神经退行性疾病的患儿。
干预措施
NMES治疗，每周两次，每次持续20 - 45分钟，为期2 - 4个月。由经过培训的OT在喂养治疗期间进行NMES治疗。
主要观察指标
通过VFSS评估吞咽功能的改善情况、管饲需求、不良事件以及家长的可接受性。
结果
10名登记受试者中的7名（中位年龄8.9个月）完成了每两周一次的NMES治疗（每位受试者的治疗次数中位数为18次）。完成治疗的7名受试者（100%）在VFSS上显示吞咽功能有所改善。基线时5名对任何液体或泥糊状食物都无法安全经口喂养的患者中，3名建立了完全经口喂养，2名建立了部分经口喂养。基线时，7名儿童中有5名完全依靠管饲，而治疗结束时为0/7。除电极放置部位出现轻度皮肤刺激外，未发生其他不良事件。7名护理人员中有5名认为喂养情况得到改善，并对干预措施感到满意。
结论
我们对7名患有严重吞咽困难的神经功能障碍婴幼儿进行的NMES前瞻性试点研究表明，NMES是安全的，家长可接受，并且具有潜在疗效。需要进行试验以确定是否存在任何治疗益处。
试验注册
ClinicalTrials.gov NCT01723358。
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