# Electrical Stimulation May Improve the Feeding and Nutritional Status of Children with Dysphagia
## 7 NMES in Children with Dysphagia  
Findings from studies in adults should not be extrapolated to children, given that the etiology of dysphagia in adults is very different (e.g., pharyngeal tumors, stroke, dementia), as well as the fact that the goal of rehabilitation in adults is different. Adult patients undergo rehabilitation due to swallowing loss, whereas children typically undergo rehabilitation to develop and enhance their swallowing ability [20]. Moreover, neuroplasticity changes with age. There are limited data on the effectiveness of NMES in children with dysphagia. These studies indicated that using NMES to strengthen the muscles of the orofacial complex may help treat dysphagia in children that is caused by dysfunctions of these muscle [6; 65; 79]. Other studies showed the advantages of NMES in enhancing speech function and reducing food aspiration into the respiratory tract, as observed in more than half of patients treated with the conventional method [25]. NMES combined with conventional therapy provided better results than conventional therapy alone. NMES has the potential to enhance swallowing biomechanics, including laryngeal and hyoid movements, thereby reducing the risk of aspiration and facilitating the passage of food through the pharyngeal passage [19; 20]. In a few studies, it was suggested that NMES combined with nutritional therapy could improve nutritional status and reduce the risk of aspiration in children with neurological problems [19; 80; 81]. In almost all studies available in the literature, the swallowing function and feeding ability of children improved during NMES treatment. The children increased the ability to swallow different consistencies [19; 80; 82; 83; 84]. Improvement was also noted in patients who were dependent on gastrostomy [19]. Only one study by [PERSON] et al. found that the NMES intervention was not associated with an improvement in feeding ability compared with the control group [21]. These are only a few of the available studies that assessed the nutritional status of children during NMES treatment [19; 80; 81]. Studies on NMES therapy in children with dysphagia are presented in Table 2. \begin{table}
\begin{tabular}{c c c} \hline
**NMES** & **Traditional Therapy** & **Criterion** \\ \hline Electrical stimulation of the muscles & Muscle activation through manual massage or the & Mechanism of Action \\ responsible for swallowing & patient’s intentional exercises & \\ \hline Passive (electrodes are attached, allowing the & Passive-active (eexcrises controlled by the patient or & \\ patient to focus on other activities) & passive manual therapy without the possibility to & Type of Activity \\  & & engage in other tasks) & \\ \hline Requires specialized equipment & It can be performed without any devices & Equipment \\ \hline High—requires precise electrode placement & Lower—relatively easy to learn and implement & Application Complexity \\ \hline May require several sessions to get used to & Variable and less predictable adaptation time & Patient Adaptation Time \\ the stimulation & Variable and less predictable adaptation time & Patient Adaptation Time \\ \hline Muscle stimulation can be quantified using & Difficult to objectively measure the strength of muscle & \\ device parameters & contractions during exercises & Possibility of Objective Evaluation \\ \hline \end{tabular}
\end{table} 
Table 1: Differences between NMES and traditional dysphagia therapy.