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

neslihan altuntaş yılmaz , Aynur Ayşe Karaduman , Kayhan Öztürk , ÖMER ERDUR

  • neslihan altuntaş yılmaz: Necmettin Erbakan UNİVERSİTESİ
  • Aynur Ayşe Karaduman: Lokman Hekim University
  • Kayhan Öztürk: KARATAY ÜNİVERSİTESİ MEDİCANA TIP FAKÜLTESİ
  • ÖMER ERDUR: SELÇUK ÜNİVERSİTESİ
  • Year : 2026
  • Vol : 42
  • Issue : 3
  •  Page : 285-294
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.
Cite this Article As : Altuntas Yilmaz N, Karaduman AA, Ozturk K, Erdur O. Electrophysiological and Functional Effects of Neuromuscular Electrical Stimulation Compared with Sham Stimulation in Children with Cerebral Palsy and Dysphagia: A Randomized Controlled Trial. Selcuk Med J 2026;42(3): 285-294

Download Citation: Endnote/Zotero/Mendeley (RIS) RIS File

Download Citation: BibTeX BibTeX File

Conflict of interest : The authors declare that they have no conflict of interest.
This article is published under the CC BY-NC 4.0 license.
Selcuk Medical Journal
2026, Vol. 42 (3)
ISSN: 1017-6616
E-ISSN: 2149-8059
Received : , Accepted : , Published Online :

References

  1. 1. Wardhani RK, Wahyuni LK, Laksmitasari B, et al. Effectivity of neuromuscular electrical stimulation and oral sensorimotor stimulation as therapeutic interventions for pediatric dysphagia: A comparative study of swallowing outcomes. NeuroRehabilitation 2025;57(2):181–89. doi: 10.1177/10538135251336048.
  2. 2. Mokhlesin M, Yadegari F, Noroozi M, et al. Effect of action observation training on the oral phase of swallowing in children with cerebral palsy: a pilot randomized controlled trial. Logoped Phoniatr Vocol 2024;49(4):188-96. doi: 10.1080/14015439.2023.2300081.
  3. 3. Calderone A, Militi D, Cardile D, et al. Swallowing disorders in cerebral palsy: a systematic review of oropharyngeal Dysphagia, nutritional impact, and health risks. Ital J Pediatr 2025;51(1):57. doi: 10.1186/s13052-025-01903-1.
  4. 4. Palisano RJ, Hanna SE, Rosenbaum PL, et al. Validation of a model of gross motor function for children with cerebral palsy. Phys Ther. 2000;80(10):974-85.
  5. 5. Furkim AM, Duarte ST, Sacco FB, et al. O uso da ausculta cervical na inferência de aspiração traqueal em crianças com paralisia cerebral. Rev CEFAC. 2009;11(4):624-29. doi:10.1590/S1516-18462009000800011.
  6. 6. Umay E, Gurcay E, Ozturk EA, et al. Is sensory-level electrical stimulation effective in cerebral palsy children with dysphagia? A randomized controlled clinical trial. Acta Neurol Belg. 2020;120(2):1097-05. doi: 10.1007/s13760-018-01071-6.
  7. 7. Freed ML, Freed L, Chatburn RL, et al. Electrical stimulation for swallowing disorders caused by stroke. Respir Care. 2001;46(5):466-74.
  8. 8. Bengisu S, Demir N, Krespi Y. Effectiveness of Conventional Dysphagia Therapy (CDT), Neuromuscular Electrical Stimulation (NMES), and Transcranial Direct Current Stimulation (tDCS) in Acute Post-Stroke Dysphagia: A Comparative Evaluation. Dysphagia 2024;39(1):77-91. doi: 10.1007/s00455-023-10595-w.
  9. 9. Bykova KM. Measurement of surface electromyography activity during swallowing in paediatrics: a scoping literature review. Eur J Pediatr 2024;183:4145–57. doi: 10.1007/s00431-024-05685-2.
  10. 10. Serel Arslan S, Demir N, Karaduman AA. Effect of a new treatment protocol called Functional Chewing Training on chewing function in children with cerebral palsy: a double-blind randomised controlled trial. J Oral Rehabil. 2017;44(1):43-50. doi: 10.1111/joor.12459.
  11. 11. Sugaya N, Goto F, Seino Y, et al. The effect of laryngeal elevation training on swallowing function in patients with dysphagia. J Laryngol Otol 2021;135(7):574–78. doi: 10.1017/S0022215121001481.
  12. 12. Ibrahim MF. Effect of thermal stimulation on temporal measures in patients with oropharyngeal dysphagia post cerebrovascular stroke. Saudi J Otorhinolaryngol Head Neck Surg 2015;17(2):70-73. doi: 10.4103/1319-8491.274661.
  13. 13. Ma SR, Choi JB. Effect of electrical stimulation on aspiration in children with cerebral palsy and dysphagia. J Phys Ther Sci 2019;31(1):93–94. doi: 10.1589/jpts.31.93.
  14. 14. Borders JC, Brates D. Use of the Penetration-Aspiration Scale in Dysphagia Research: A Systematic Review. Dysphagia 2020;35(4):583–97. doi: 10.1007/s00455-019-10064-3.
  15. 15. Serel AS, Demir N, Barak Dolgun A, et al. Development of a new instrument for determining the level of chewing function in children. J Oral Rehabil. 2016;43(7):488-95. doi:10.1111/joor.12399.
  16. 16. Barton C, Bickell M, Fucile S. Pediatric Oral Motor Feeding Assessments: A Systematic Review. Phys Occup Ther Pediatr 2018;38(2):190–09. doi: 10.1080/01942638.2017.1290734.
  17. 17. Borders JC, Grande AA, Troche MS. Statistical Power and Swallowing Rehabilitation Research: Current Landscape and Next Steps. Dysphagia 2022;37(6):1673–88. doi: 10.1007/s00455-022-10428-2.
  18. 18. Propp R, Gill PJ, Marcus S, et al. Neuromuscular electrical stimulation for children with dysphagia: a systematic review. BMJ Open 2022;12(3):e055124. doi: 10.1136/bmjopen-2021-055124.
  19. 19. Tarihci Cakmak E, Sen EI, Doruk C, et al. The Effects of Neuromuscular Electrical Stimulation on Swallowing Functions in Post-stroke Dysphagia: A Randomized Controlled Trial. Dysphagia 2023;38(3):874–85. doi: 10.1007/s00455-022-10512-7.
  20. 20. Oh DH, Park JS, Kim HJ, et al. The effect of neuromuscular electrical stimulation with different electrode positions on swallowing in stroke patients with oropharyngeal dysphagia: A randomized trial. J Back Musculoskelet Rehabil 2020;33(4):637–44. doi: 10.3233/BMR-181133.
  21. 21. Tan Z, Wei X, Tan C, et al. Effect of neuromuscular electrical stimulation combined with swallowing rehabilitation training on the treatment efficacy and life quality of stroke patients with dysphagia. Am J Transl Res 2022;14(2):1258–67.
  22. 22. Wang S, Shi Z, Wu T, et al. Comparative efficacy of combined and single neuromuscular electrical stimulation and traditional swallowing training for neurogenic dysphagia: a network meta-analysis. Front Neurol 2025;16:1700317. doi: 10.3389/fneur.2025.1700317.
  23. 23. Benfer KA, Weir KA, Bell KL, et al. Oropharyngeal dysphagia and gross motor skills in children with cerebral palsy. Pediatrics 2013;131(5):e1553–62. doi: 10.1542/peds.2012-3093.
  24. 24. Giannasi LC, Matsui MY, Freitas SRB, et al. Effects of neuromuscular electrical stimulation on the masticatory muscles and physiologic sleep variables in adults with cerebral palsy: a novel therapeutic approach. PLoS One. 2015;10(8):e0128959. doi:10.1371/journal.pone.0128959.
  25. 25. Mishra A, Malandraki GA, Sheppard JJ, et al. Voluntary cough and clinical swallow function in children with spastic cerebral palsy and healthy controls. Dysphagia. 2019;34(2):145-54. doi:10.1007/s00455-018-9933-4.
  26. 26. Xia W, Zheng C, Lei Q, et al. Treatment of post-stroke dysphagia by vitalstim therapy coupled with conventional swallowing training. J Huazhong Univ Sci Technolog Med Sci 2011;31(1):73–76. doi: 10.1007/s11596-011-0153-5.
  27. 27. Vaiman M, Segal S, Eviatar E. Surface electromyographic studies of swallowing in normal children, age 4–12 years. Int J Pediatr Otorhinolaryngol 2004;68(1):65–73. doi: 10.1016/j.ijporl.2003.09.014.
  28. 28. Christiaanse ME, Mabe B, Russell G, et al. Neuromuscular electrical stimulation is no more effective than usual care for the treatment of primary dysphagia in children. Pediatr Pulmonol 2011;46(6):559–65. doi: 10.1002/ppul.21400.