A Rapid Review of Device Assisted Therapy for Pediatric Dysphagia Management

Abstract

Introduction Multiple device-assisted therapeutic modalities have been introduced to assist in the remediation of pediatric dysphagia, including Surface Electromyography (sEMG) and Neuromuscular Electrical Stimulation (NMES). These modalities are commercially available; however, consensus on the efficacy of these modalities has not been established. Therefore, the purpose of this project was to determine the effect of device assisted therapy on swallowing physiology and functional feeding outcomes in children with oropharyngeal dysphagia. Material and Methods This rapid review methodology identified relevant literature through a narrow search strategy applied to the following databases (PubMed, EMBASE and CINAHL) using search strategies specific to the electronic database and searching the following keywords and their variations: "pediatric“, "dysphagia“, "device-assisted“, and "therapy“.Results included peer-reviewed journal articles relating to device-assisted dysphagia therapy in pediatric patients with dysphagia, one - 18 years of age. Searches took place between February and March 2023. Device-assisted therapy was defined as therapy that utilized instruments capable of providing objective data about client performance and/or capable of providing mechanically controlled external stimulation to the client. Inclusion/exclusion criteria Results included peer-reviewed journal articles only, where research (observational or experimental) outcomes were presented. Inclusion criteria:Studies had to be published in English Studies had to explore device assisted therapeutic scenarios targeted at improving dysphagia in children between one and 18 years of age Studies had to be conducted on children with a diagnosis of dysphagia that included instrumental assessment (VFSS or FEES) Studies had to be published between 2000 - 2023.Studies had to be conducted on human children, animal studies were not included Data extraction and critical appraisal Covidence was used to record the critical appraisal of the included studies. Data extracted included topic, study design, methodology, outcomes, limitations and reasons for exclusion (if applicable). Reporting Extracted data was synthesized into a narrative that addressed the aims and objectives of this rapid review. Themes were extracted from the data pertaining to 1) type and description of device, 2) description of clinical populations the device was used to target, 3) functional feeding outcomes, and 4) swallowing physiology. Results This rapid review identified 12 different articles that met inclusion criteria. Most of the identified papers were observational in nature and reported on the impact of NMES on swallowing physiology and functional feeding outcomes in children. Analysis of the experimental articles reveals small sample size and low methodological quality. Analysis of the collected articles does not provide sufficient evidence to support the use of NMES in pediatric populations. There is no empirical data to support the use of other popular device-assisted therapeutic modalities for the treatment of dysphagia in pediatric populations. Discussion/Conclusion There appears to be a lack of empirical evidence to support the use of device-assisted therapeutic modalities in pediatric populations. There is an immediate need for further research into the effect of device-assisted therapeutic modalities on swallowing physiology and functional feeding outcomes in pediatric populations.