Electrophysiological and Functional Effects of Neuromuscular Electrical Stimulation Compared with Sham Stimulation in Children with Cerebral Palsy and Dysphagia: A Randomized Controlled Trial

Objective: To examine the functional and electrophysiological effects of NMES in children with cerebral palsy presenting with dysphagia.
Materials and Methods: This prospective, randomized, sham-controlled clinical trial was conducted in children with cerebral palsy presenting with oropharyngeal
dysphagia. A total of 26 children (mean age: 7.02 ± 2.40 years) were randomly allocated to either the NMES group (n = 16) or the sham-NMES group (n = 10). Both
groups received conventional swallowing rehabilitation. Outcome measures included the Pediatric Eating Assessment Tool (PEDI-EAT-10), Penetration-Aspiration Scale
(PAS), Karaduman Chewing Performance Scale (KCPS), Swallowing Ability and Function Evaluation (SAFE), and electrophysiological assessment of suprahyoid activity
during four consistencies. The trial was registered at ClinicalTrials.gov (Identifier: NCT07329387; registered September 30, 2025).
Results: PEDI-EAT-10 scores improved in both groups (NMES: p = 0.001, d = 0.92; sham-NMES: p = 0.012, d = 0.71) without a significant between-group difference
(p=0.318). PAS decreased in both groups (NMES: p = 0.002, d = 0.88; sham-NMES: p = 0.021, d = 0.69; between-group p = 0.274). The SAFE oral phase improved in
both groups, whereas the pharyngeal phase improved only in the NMES group (p < 0.001, d = 1.12). KCPS improved only with NMES (p=0.043, d = 0.64). Suprahyoid
activation increased significantly with NMES during spontaneous, liquid, and solid swallowing, with the greatest improvement observed for solid swallowing.
Swallowing duration favored NMES (p = 0.013–0.027).
Conclusion: Functional gains were similar between groups; however, NMES provided additional benefits in pharyngeal function and suprahyoid activation, particularly
during solid swallowing.