Effectiveness of Neuromuscular Electrical Stimulation Added to Oral Motor Therapy in Cerebral Palsy

NCT ID: NCT07069257

Last Updated: 2026-01-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

30 participants

Study Classification

INTERVENTIONAL

Study Start Date

2026-03-01

Study Completion Date

2026-06-01

Brief Summary

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This randomized, controlled, single-blind trial aims to investigate the effectiveness of neuromuscular electrical stimulation (NMES) combined with oral motor therapy in reducing drooling severity among children with cerebral palsy. Participants will be allocated to an intervention group (oral motor therapy plus NMES), a control group (oral motor therapy alone) and a sham group (oral motor therapy with placebo NMES).

Detailed Description

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Drooling is a common and disabling problem in children with cerebral palsy, adversely affecting health, social participation, and quality of life. Oral motor therapy is frequently used to improve oral control, and neuromuscular electrical stimulation (NMES) has been suggested as an adjunctive treatment to enhance orofacial muscle function.

This randomized, controlled, single-blind study will include children aged 4 to 17 years diagnosed with cerebral palsy and presenting with moderate to severe drooling (Drooling Severity and Frequency Scale score ≥3). Participants will be randomly assigned to one of three groups: oral motor therapy alone, oral motor therapy plus active NMES, and oral motor therapy with sham NMES. The intervention comprises twelve therapy sessions over four weeks, delivered by a trained therapist.

Oral motor therapy involves exercises targeting lips, tongue, cheeks, and jaw, in addition to thermal and tactile stimulation (using brushes, spoons, cold packs, and heat packs). NMES will be applied bilaterally to the masseter muscles and to the orbicularis oris muscle using a Chattanooga NMES device. Sham NMES will simulate the procedure without delivering active stimulation.

Outcome measures will be assessed before and after the intervention and will include both subjective and objective drooling scales: Drooling Severity and Frequency Scale (DSFS), Drooling Impact Scale (DIS), Visual Analog Scale for drooling severity, Drooling Quotient (DQ5), and caregiver reports of bib usage. Orofacial muscle thickness will be measured with ultrasound imaging. Additional assessments will include functional classification systems (GMFCS, MACS, CFCS, VFCS, EDACS, FOIS) and the Pediatric Eating Assessment Tool (PEDI EAT-10).

This study is approved by the Ethics Committee of Istanbul Medipol University.

Conditions

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Cerebral Palsy (CP) Drooling

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Participants were randomly assigned to three parallel groups: (1) oral motor therapy plus neuromuscular electrical stimulation (NMES), (2) oral motor therapy alone, and (3) oral motor therapy plus sham NMES.
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors
Participants are blinded to group assignment. The clinician performing ultrasound assessments is also blinded. The therapist delivering the interventions and administering the scales is not blinded.

Study Groups

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Oral Motor Therapy Plus NMES

Participants assigned to this arm will receive oral motor therapy combined with active neuromuscular electrical stimulation (NMES) applied to the masseter and orbicularis oris muscles.

Group Type EXPERIMENTAL

Oral Motor Therapy

Intervention Type BEHAVIORAL

Structured oral motor exercises will be applied to the lips, tongue, cheeks, and jaw. Facial massage and thermal stimulation (warm and cold) will be performed. Intraoral sensory stimulation will be applied using a brush, lemon juice, and a cold metal probe.

Neuromuscular Electrical Stimulation (NMES)

Intervention Type DEVICE

Active NMES will be applied bilaterally to the masseter muscles and to the orbicularis oris muscle in addition to oral motor therapy sessions, using a Chattanooga NMES device. Each application will be performed in cycles of 5 seconds of stimulation and 10 seconds of rest. The stimulation parameters will be set to a frequency of 10-15 Hz and a pulse width of 300 microseconds. The current intensity will be gradually increased to a level just above the motor threshold, sufficient to elicit a noticeable pulling sensation without causing discomfort, and will be adjusted according to each participant's tolerance. NMES will be delivered for a total duration of 15 minutes per session. For the electrical stimulation of the orbicularis oris muscle, a pen-type electrode will be used. In this procedure, four regions of the orbicularis oris muscle (upper, lower, right, and left) will be stimulated in two cycles of 45 pulses each.

Oral Motor Therapy

Participants assigned to this arm will receive oral motor therapy without any NMES. This is a behavioral therapy.

Group Type OTHER

Oral Motor Therapy

Intervention Type BEHAVIORAL

Structured oral motor exercises will be applied to the lips, tongue, cheeks, and jaw. Facial massage and thermal stimulation (warm and cold) will be performed. Intraoral sensory stimulation will be applied using a brush, lemon juice, and a cold metal probe.

Oral Motor Therapy Plus Sham NMES

Participants assigned to this arm will receive oral motor therapy combined with sham NMES that does not deliver active stimulation.

Group Type SHAM_COMPARATOR

Oral Motor Therapy

Intervention Type BEHAVIORAL

Structured oral motor exercises will be applied to the lips, tongue, cheeks, and jaw. Facial massage and thermal stimulation (warm and cold) will be performed. Intraoral sensory stimulation will be applied using a brush, lemon juice, and a cold metal probe.

Sham Neuromuscular Electrical Stimulation (Sham NMES)

Intervention Type DEVICE

Simulated neuromuscular electrical stimulation will be applied without delivering active electrical current after oral motor therapy sessions to mimic the treatment experience without producing physiological effects.

Interventions

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Oral Motor Therapy

Structured oral motor exercises will be applied to the lips, tongue, cheeks, and jaw. Facial massage and thermal stimulation (warm and cold) will be performed. Intraoral sensory stimulation will be applied using a brush, lemon juice, and a cold metal probe.

Intervention Type BEHAVIORAL

Neuromuscular Electrical Stimulation (NMES)

Active NMES will be applied bilaterally to the masseter muscles and to the orbicularis oris muscle in addition to oral motor therapy sessions, using a Chattanooga NMES device. Each application will be performed in cycles of 5 seconds of stimulation and 10 seconds of rest. The stimulation parameters will be set to a frequency of 10-15 Hz and a pulse width of 300 microseconds. The current intensity will be gradually increased to a level just above the motor threshold, sufficient to elicit a noticeable pulling sensation without causing discomfort, and will be adjusted according to each participant's tolerance. NMES will be delivered for a total duration of 15 minutes per session. For the electrical stimulation of the orbicularis oris muscle, a pen-type electrode will be used. In this procedure, four regions of the orbicularis oris muscle (upper, lower, right, and left) will be stimulated in two cycles of 45 pulses each.

Intervention Type DEVICE

Sham Neuromuscular Electrical Stimulation (Sham NMES)

Simulated neuromuscular electrical stimulation will be applied without delivering active electrical current after oral motor therapy sessions to mimic the treatment experience without producing physiological effects.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Diagnosis of cerebral palsy (unilateral/bilateral spastic, ataxic, dyskinetic, or mixed type)
* Presence of drooling control problems
* Age between 4 and 17 years
* Gross Motor Function Classification System (GMFCS) levels 2, 3, 4, or 5
* Stable drooling severity for at least one month prior to enrollment
* Drooling Severity and Frequency Scale (DSFS) score of 3 or higher

Exclusion Criteria

* Diagnosis of dysphagia
* Use of medications affecting drooling within the past 72 hours
* Upper respiratory tract infection and/or salivary gland infection during the study period
* History of botulinum toxin injection to the salivary glands
Minimum Eligible Age

4 Years

Maximum Eligible Age

17 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Fatih Sultan Mehmet Training and Research Hospital

OTHER

Sponsor Role collaborator

Aslinur Keles Ercisli, MD, PhD

OTHER

Sponsor Role lead

Responsible Party

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Aslinur Keles Ercisli, MD, PhD

Investigator

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Zehra Aycan

Role: PRINCIPAL_INVESTIGATOR

Health Sciences University Fatih Sultan Mehmet Training and Research Hospital

Esra Giray, Assoc. Prof.

Role: STUDY_CHAIR

Istanbul University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital

Aslinur Keles Ercisli, MD, PhD

Role: STUDY_DIRECTOR

Istanbul University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital

Locations

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Fatih Sultan Mehmet Training and Research Hospital

Ataşehir, Istanbul, Turkey (Türkiye)

Site Status

Countries

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Turkey (Türkiye)

Central Contacts

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ZEHRA AYCAN

Role: CONTACT

+90 553 450 00 22

Aslinur Keles

Role: CONTACT

References

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Assoratgoon I, Shiraishi N, Tagaino R, Ogawa T, Sasaki K. Sensory neuromuscular electrical stimulation for dysphagia rehabilitation: A literature review. J Oral Rehabil. 2023 Feb;50(2):157-164. doi: 10.1111/joor.13391. Epub 2022 Nov 28.

Reference Type BACKGROUND
PMID: 36357332 (View on PubMed)

Sigan SN, Uzunhan TA, Aydinli N, Eraslan E, Ekici B, Caliskan M. Effects of oral motor therapy in children with cerebral palsy. Ann Indian Acad Neurol. 2013 Jul;16(3):342-6. doi: 10.4103/0972-2327.116923.

Reference Type BACKGROUND
PMID: 24101813 (View on PubMed)

2. Awan, W. A., Aftab, A., Janua, U. I., Ramzan, R., & Khan, N. (2017). EFFECTIVENESS OF KINESIO TAPING WITH OROMOTOR EXERCISES IN IMPROVING DROOLING AMONG CHILDREN WITH CEREBRAL PALSY: soi: 21-2017/re-trjvol01iss02p21. The Rehabilitation Journal, 1(02), 21-27.

Reference Type BACKGROUND

1. Fatima et al (2019), Study of the effectiveness of oromotor exercises to reduce drooling in cerebral palsy children

Reference Type BACKGROUND

Other Identifiers

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Ethics Committee No: 1295 (20-

Identifier Type: OTHER

Identifier Source: secondary_id

2025-SP-SC-NMESOMT-01

Identifier Type: -

Identifier Source: org_study_id

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