Effect of Transcutaneous Electrical Stimulation on Constipation

Cerebral palsy (CP) is a group of non-progressive neurological disorders that affect body movement, muscle coordination, and posture .It is caused by damage in developing brain, usually before or during birth, but can also occur during early childhood. They may include muscle stiffness or floppiness, abnormal reflexes, impaired coordination, difficulty with fine motor skills, speech and swallowing difficulties, involuntary movements, problems with balance and posture, and intellectual or developmental disabilities. Constipation is a common gastrointestinal issue in children with cerebral palsy (CP) due to reduced muscle tone, impaired coordination, limited mobility, and side effects of certain drugs like antispasmodics or anti-epileptics. Transcutaneous electrical nerve stimulation (TENS) is a non-invasive therapy. Usually, TENS is commonly used as pain management modality, its role in treating constipation in children with cerebral palsy is still being explored. Research on the use of TENS for constipation in children with cerebral palsy is limited, and most studies have focused on constipation in adults or individuals without CP. However, some studies have investigated the effects of TENS on gastrointestinal function in children with CP, including constipation.

This study was Randomized Controlled Trial with random sampling technique. Study was conducted in DHQ Hospital, Hafizabad from July 2023 to December 2023 on 34 children with cerebral palsy with constipation having age from 1 to 6 years according to inclusion and exclusion criteria. After recruitment, it was divided into two Groups. Baseline treatment was provided to control group while TENS will be used in other experimental group. TENS was applied on abdominal area for 20 minutes along with baseline treatment. Record pre and post session history of patient defecation frequency per week, abdominal pain or discomfort, and type of stool via using Rome-IV criteria, Bristol Stool Scale, Constipation Assessment scale and Gross Motor Function Classification System before and after treatment. Data Analyses was based on statistical parameters and comparison performed before and after application of treatment.

This was Randomized controlled trial. Study has been conducted in DHQ Hospital, Hafizabad from July 2023 to December 2023 on children with cerebral palsy with constipation. By using convenient sampling technique, participants were recruited according to the inclusion criteria i.e. constipated children with Cerebral Palsy of age from 1-6,having Constipation from at least a month Labelled as constipation according to the Rome IV criteria; having History of severe stool retention, History of difficult and painful bowel movements. History of large diameter stool, Presence large fecal masses in rectum and in toilet trained children history of obstructing the toilet at least once a week after use of toilet. After recruitment, they were divided into two Groups. In interventional group baseline measurements regarding defecation frequency per week, abdominal pain or discomfort, type of stool, quality of life and functional status was recorded before the start of treatment. After taking the readings, apply TENS on abdomen via skin electrodes for a month (20 minutes per session and 3 times a week) along with baseline treatment .In interventional group TENS is applied on the lower gastrointestinal tract, placed these electrodes on the abdomen lateral to the umbilicus and other two skin electrodes applied at back side at T9-L2 level. First place electrodes at front side then at back side. Assess the patient severity of the constipation, frequency and consistency of stool, and abdominal pain before the commencement of treatment by using Bristol Stool Scale (BSS), Romes-IV criteria, Visual Analogue Scale (VAS), and Gross Motor Functional Classification System (GMFS) at baseline and end of last session of the treatment(Pre and post-treatment). In control group, after the recruitment of population according to the inclusion criteria. The baseline measurement were recorded. The baseline treatment was given in which general movements were performed i.e. Double knee-to-chest movement, sitting, standing, rolling included. Each movement is performed by 10 repetition in one set. Again assess the patient severity of constipation, frequency and consistency of stool, abdominal pain and functional status and quality of life at the end of last session of the treatment.

Strict confidentiality of participants' information will be maintained, and data collection will be conducted with the approval of the Institutional Review Board (IRB).

Eligibility Criteria:
Inclusion Criteria:

* age 1-6years
* Constipation from at least a month
* Labelled constipation according to the Rome IV criteria
* History of severe stool retention
* History of difficult and painful bowel movements
* History of large diameter stool
* Presence large fecal masses in rectum
* In toilet trained children history of obstructing the toilet at least once a week after use of toilet

Exclusion Criteria:

* History of indigestion
* History of metabolic disorders
* Hirschsprung's disease
* hypothyroidism
* cystic fibrosis
* previous abdominal or anal sphincter surgery history