Oral

ABSTRACT

INTRODUCTION:
Colonic hypomotility is one of the possible causes of constipation in cerebral palsy (CP) children. Improving colonic transit time (CTT) using transcutaneus electrical nerve stimulation (TENS) needs to be considered for constipated CP children. 

OBJECTIVE:
To evaluate the TENS study in constipated CP children with slow colonic transit (CTT) time on defecation frequency and stool consistency.

METHODS:
A cross-sectional study (Feb 2020 – March 2022) on slow transit constipated CP children (n=17) and divided into lactulose (n=8) and lactulose+TENS (n=9) groups. Constipation was defined by <3 defecation/week and or type 1-2 Bristol’s stool chart. Slow CTT evaluated using Sitzmark radiopaque marker (Metclaf methods). Lactulose and TENS were given for 1 month. TENS was done 3 times/week, 20 minutes for each session by physiatrist and reevaluated CTT afterward.

RESULTS:
Mean age was 74.81±39.66 months old; range 30–154 months old. Nine (52.9%) children were male. Most of the children (11; 64.7%) had quadriplegia spastic type and GMFCS IV-V. Improvement in defecation frequency experienced in both groups, 1.25±0.46 to 2.75±1.83 times/week (p=0.033) in lactulose group and 1.33±0.5 to 3.56±2.00 times/week in lactulosa+TENS group (p=-0.019). No significant difference in consistency of stool in both groups (pre vs post treatment). Nine children had finished the TENS combined with lactulose and significantly improved total CTT after TENS (64.667±4.53 h vs 38.444±3.72 h; p=0.039). Only 3/9 (33.3%) children with delayed total CTT after TENS. Improvement in the right colon segmental CTT observed after TENS as well (19.778±10.75 h vs 5.333±11.17 h; p=0.025).

CONCLUSION:
TENS improved the CTT in total and right colon segmental among slow transit constipated CP children. The use of TENS can be considered as one of therapeutic modality in CP children with slow transit constipation.

KEYWORDS:
cerebral palsy (CP), constipation, slow transit, colonic transit time (CTT), transcutaneus electrical nerve stimulation (TENS)