Skip to main content
Download PDF

Application of non-invasive neuromodulation in children with neurodevelopmental disorders to improve their sleep quality and constipation

BMC Pediatrics volume 23, Article number: 465 (2023) Cite this article

Abstract

Background

Children with neurodevelopmental disorders have a very wide clinical variability. A common prevalent factor is problems with stool and sleep quality. Currently, there are multiple studies related to their evaluation, but not so much related to a specific intervention. The aim was to evaluate the effectiveness and safety of the application of non-invasive neuromodulation as a treatment in children with neurodevelopmental disorders to improve constipation and quality of sleep.

Methods

A total of 23 minors aged between 2 and 16 were included in this cross-sectional study. All participants were applied the microcurrent device for 60 min, 3 times per week for a total of 4 weeks. The technique was based on non-invasive neuromodulation using a surface-applied microcurrent electrostimulation device that administers an external, imperceptible, pulsed electrical stimulation. It is applied to the extremities, in a coordinated manner, using gloves and anklets connected with electrodes to a control console. Sleep latency and microarousals were evaluated through a sleep diary. To assess the evolution and type of defecation, the adapted and validated version in Spanish of the Bristol Stool Form Scale was used.

Results

No adverse events occurred during the study and no incidences were registered. Clinically relevant improvements were registered in defecation frequency and type as well as in sleep related parameters. An increase in the hours of sleep was registered, from 7,35 (0,83) to 9,09 (1,35), and sleep interruptions decreased from 3,83 (1,95) to 1,17 (1,11), (p < .001).

Conclusion

Microcurrents can be used as an effective and safe treatment to improve quality of sleep and constipation in children with neurodevelopmental disorders. More studies are needed in order to obtain statistically significant results.

Trial Registration

ClinicalTrials.gov ID: NCT05265702.

First registration

03/03/2022

Protocol

https://clinicaltrials.gov/ct2/show/NCT05265702?term=baez+suarez&draw=2&rank=4

Peer Review reports

Background

Neurodevelopmental disorders belong to a ‘heterogeneous group of conditions characterized by a delay or alteration in the acquisition of skills in several development areas including motor, social, language and cognition’. They are grouped in a variety of clinical disorders that cause symptoms in early stages of life, which affect development evolution in the aforesaid areas. The severity of the deterioration and the variety of symptoms associated with it, reflect dysfunctions -focal or global, structural or functional- in neural networks. [1] It affects between 15 and 20% of children, being a frequent reason for consultation during childhood and adolescence. Lack of detection, diagnosis and treatment result in underdiagnosed effects in adulthood, with loss of opportunities in developing individual potential in their personal, family and professional life. [1, 2]

The majority of these children, present a delay in the acquisition of skills according to the phases of typical psychomotor development. Added to this difficulty, and main element of concern for family members, there are another series of signs that appear with some frequency and, which despite being unnoticed over other major problems, also represent basic and fundamental factors for a correct development and performance of children, such as constipation problems and sleep disorders. [3].

Focusing on these two variables, the relationship between constipation and sleep disturbance has been studied in healthy adults, [4, 5] or adults with a pathology, mostly based on people with Parkinson’s disease. [6,7,8]. In adults with functional gastrointestinal disorder, inadequate sleep, delayed sleep onset, and poor sleep quality are common and contribute to increased abdominal pain and gastrointestinal symptom severity concurrently and next-day [9, 10]. At younger ages, most youth with chronic pain complain about sleep disturbances, including short sleep duration, poor quality sleep, and frequent night awakenings. However, current evidence provides little or no information on this relationship in children with neurodevelopmental impairment, with the majority focusing on incontinence problems. [11,12,13] Paediatric patients with neurological involvement have comorbidities at different levels of the gastrointestinal tract, which represents a complex problem requiring long-term multidisciplinary follow-up. It is therefore of great interest to be able to respond to this problem.

Sleep disorder treatment in children with neurodevelopmental disorders, frequently require not only adequate sleep hygiene measures but also pharmacological treatment with the aim of minimizing the impact of sleeping disorders in the child. [14]Therefore, there is an interest in evaluating new non-pharmacological approaches, such as non-invasive neuromodulation.

Non-invasive global neuromodulation is based on a superficial treatment, with very subtle electrical microcurrents, provoking imperceptible sensations which are very comfortable for the patient. The effect of the electrical microcurrent is multiplied, as it is delivered by multiple pathways that structurally cover the whole body through electrodes in the limbs and a directing electrode. Due to its characteristics, non-invasive neuromodulation has an enormous potential for clinical applications in the rehabilitation field.

The main objective of this study is to evaluate the effectiveness and safety of the application of non-invasive neuromodulation as a treatment in children with neurodevelopmental disorders to improve constipation and quality of sleep.

Methods

Study design

In this observational study, the sample was selected through a non-probability sampling by convenience, due to its characteristics, availability and type of study design. The research was conducted according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Population

The study population were students at ‘Centro Ciudad San Juan de Dios’ in Las Palmas de Gran Canaria, Spain, with a diagnosis associated to neurodevelopmental disorders. Data was collected between May and April 2022. The type of recruitment consisted of a non-probabilistic convenience method.

The inclusion criteria was to present a neurodevelopmental disorder (Level I to V according to the Gross Motor Function Measure, GMFM), aged between 2 and 18, to be a student at the centre of reference of the study, meet the requirements of the constipation scale of the Rome IV Criteria, and that the informed consent was signed by the family, guardian or legal representative.

Intervention

Participants who met the inclusion and exclusion criteria, were treated with the non-invasive neuromodulation device (NESA XSignal) for 60 min, three times a week for a total of 12 sessions. The parameters applied consist of a low frequency oscillating microcurrent from 1,3 Hz to 14,28 Hz, with an intensity of 0.5 milliamperes and a potential difference of ± 3 V and ± 6 V. Impulses are fired in a coordinated manner between 24 electrodes (6 electrodes per limb) which fire simultaneously. 6 electrodes are placed in each limb, in different points of the peripheral nerve with low impedance, in the form of a set of gloves and adapted socks for hands and feet. Electrodes are connected to the main control unit and an adhesive electrode is placed on the cervical spine at C7 level. The protocol used was the application of program 2 for 15 min followed by the application of program 7 for the remaining 45 min.

During treatment time, all participants continued with their usual routine in the centre.

In order to assess and ensure safety during the intervention, an adverse event registry was kept. Participants reactions were observed during the sessions. As it is an imperceptible procedure from a sensation point of view and easily manageable, participants were allowed to conduct other activities (school/rehabilitation) simultaneously.

Description of outcome measures

A bowel movement registry was kept. It consisted on a daily assessment of the number of bowel movements and the type of stool according to the criteria set with the Bristol Stool Form Scale (BSS). The BSS is the most used standardized tool to assess the consistency of stools in children in clinical settings and in research. According to the BSS, which classifies stools in 7 categories, types 1 and 2 are hard and indicate constipation, types 3 to 5 are considered to be the normal stool forms (being type 4 the most normal) and type 6 and 7, loose and liquid, indicate diarrhea. [15] The BSS image table was accompanied by descriptors, using the translated and validated Spanish version. [16].

A sleep diary was the tool used to calculate the number of hours of sleep, sleep latency, sleep arousal and sleep routines. The validity of the data obtained with this resource is comparable to that obtained with actigraphy. [17,18,19]A sleep diary is easily completed, and it provides a global vision of sleep for several days. This diary included questions about bedtime, estimated time to fall asleep (sleep onset latency) and wake-up time. Also, on how many occasions did the person wake up during the night and the duration of total time awake, between lying down and getting up, was recorded.

Data was collected by people who surround the child: carers, physiotherapists, speech and language therapists, occupational therapists and/or the classroom teacher when at the centre. Data was also collected by the family, guardian or legal representative of the place where the child was staying. To avoid bias in data collection, families were informed to start recording the data, however, neuromodulation was not applied for a week after announcing that the study had begun.

All variables were registered at an initial stage (first week without intervention), during the four weeks where non-invasive neuromodulation was applied and two weeks after the intervention.

Ethics

Parents/legal guardians of the participants were informed of the aim of the study and informed consent was obtained in writing. The study was conducted according to the principles described in the Declaration of Helsinki. The study protocol was approved by the Human Research Ethics Committee of ‘Dr. Negrín’ University Hospital of Gran Canaria, Spain (ID: CEIm- 2022-096-1), and the study was registered at ClinicalTrials.gov on 03/03/2022. (ID: NCT05265702).

Statistical analysis

For the statistical analysis of data, Statistical Package for the Social Sciences (SPSS) version 20.0 software was used. To obtain the data, a univariate and bivariate descriptive analysis was performed.

For the univariate analysis, qualitative variables were expressed as absolute frequencies and percentages, with an estimated 95% confidence interval. Quantitative variables were expressed as means ± standard deviation.

To compare the means between two independent samples, T-Student was used or its non-parametric equivalent of Mann-Whitney and/or Wilcoxon test, whereas in order to determine the association between qualitative variables the Chi-squared Test of Independence was used. Previously, a Kolmogorov-Smirnov Test of Normality was performed.

Results

The sample consisted of 23 individuals whose general characteristics are summarized in the following tables. No incidences occurred that had to be registered in 100% of cases. The general characteristics of the sample, in relation with age and degree of disability, are represented in Table 1.

Table 1 General Characteristics
Full size table

The registry that measured the evolution in defecation frequency, indicated that from 87% (20) who presented a frequency of less than 3 times per week at a basal level, it decreased to an 8.7% (2) after the fourth week of intervention. In addition to this, it could also be observed after four weeks of intervention, that 60.9% (14) of individuals had a defecation frequency of 3 to 6 times per week, and some even had a daily bowel movement (30.4%). This information can be observed in detail in Fig. 1.

Fig. 1
figure 1

Evolution of the stool frequency

Full size image

There is not a significant association of the Basal Defecation Frequency before the intervention and after 4 weeks of intervention, with a Kendall Tau-b coefficient = 0.295 (P = .181). Nevertheless, a relevant change was detected in the weekly Frequency of Defecation as an increase of frequency was observed. Of 20 cases who had a frequency of less than 3 times per week, 90% (18) started having a frequency of 3 to 6 times per week or even daily.

Regarding the 2 cases who maintained a frequency of less than 3 times per week after the 4 weeks of intervention, both were classified at Level V according to the GMFM and were aged 4 and 16 (both with stool type 1–2 hard). The 16-year-old female used 4 enemas per week.

When analyzing the evolution of children, with regards to Defecation Frequency, between the 4th week of intervention and 2 weeks post-intervention, a Kendall Tau-b coefficient = 0.661 (P = .013) was obtained. Change was observed in the group of 7 minors who had a daily bowel movement in the 4th week of intervention. After 2 weeks post-intervention, 5 cases (71.4%) now have a frequency of defecation of 3 to 6 times per week. These cases correspond to: 1 female aged 12 with a classification of Level IV and whose stools changed from type 3–5 normal (4th week) to type 1–2 hard (after 2 weeks post-intervention); 2 Level III; 1 Level II and 1 Level I.

Approximate results were observed when interpreting the evolution of the type of defecation through the BSS. 16 of the participants (69.6%) presented a hard stool at a basal stage and after 4 weeks of intervention it decreased to 5 participants (21.7%). Stools considered normal changed from a 21.7% registered at a basal stage to a 78.3% of participants in the 4th week of intervention. This information can be observed in further detail in Fig. 2.

Fig. 2
figure 2

Evolution of the stool consistency

Full size image

The relation between the Type of Basal Stool before the application of NESA and after 4 weeks of intervention does not seem to be significant with a Kendall Tau-b coefficient = -0.334 (P = .150). However, there seems to be a relevant change in the Type of Stool after applying NESA. Of 16 cases with a Type of Stool 1–2 Hard, on a basal state, 87.5% (14) changed to a Type of Stool 3–5 Normal.

When analyzing the evolution of children, in relation to the Type of Stool between the 4th week of intervention and 2 weeks post-intervention, a Kendall Tau-b coefficient = 0.657 (P = .001) was obtained. The change can be observed in the group of 18 minors with a type of stool 3–5 Normal in the 4th week of the application of NESA. After 2 weeks post-intervention, 4 cases (22.2%) changed to Type of Stool 1–2 hard.

With regard to the 5 cases who maintain a Type of Stool 1–2 Hard, they correspond to: 1 female Level V aged 16, 3 minors Level I aged 5 and 7, 1 Level II aged 6.

The average hours of sleep of participants, registered in mean values and standard deviation, could be observed to be 7.35 (0.83) in the basal registry, increasing to 9.09 (1.35) after the 4th week of intervention, and 8.17 (0.7) at 2 weeks post-intervention.

When comparing the hours of sleep between the basal stage and on the 4th week of NESA application, there is not a significant association (Pearson Correlation Coefficient = -0.069; P = .755). However, between the 4th week of intervention and 2 weeks post-intervention, a significant association is observed (Pearson Correlation Coefficient = 0.767; P < .001).

Regarding the number of interruptions recorder in the sleep diary, a 3.83 (1.95) of average interruptions were observed at a basal stage, decreasing to 1.17 (1.11) on the fourth week of intervention and stabilizing 2 weeks post-intervention in 1.61 (1.34) sleep interruptions.

The evolution of the data registered for the hours of sleep and number of interruptions are represented in Fig. 3.

Fig. 3
figure 3

Evolution on sleep characteristics

Full size image

When comparing the number of sleep interruptions or arousals during the night, it is observed that between the basal stage and the 4th week of NESA application, there is not a significant association (Pearson Correlation Coefficient = 0.224; P = .304). When comparing the variable between the 4th week of NESA application and 2 weeks post-intervention, a significant association is observed (Pearson Correlation Coefficient = 0.901; P < .001).

Discussion

The main findings of this study, are based on a sample integrated by 23 minors, aged between 2 and 16 (78.2% are 8 years old or younger and 21.7% are older than 8), the majority are female (73.9%) and with a Level of III or below according to the GMFM (86.9%). We must emphasize that there were no adverse events in 100% of cases during the study and no incidences were registered. In the descriptive analysis of data, relevant improvements were detected in relation with the Frequency of Defecation, Type of Stool, number of hours of sleep and the number of interruptions occurred during sleep. It can also be observed that 91.3% of cases did not require enemas during the time the study was conducted.

An essential aim of the study was to ensure safety of participants in the application of microcurrents. The applied level of intensity of microcurrents in the present study, was significantly below the sensation threshold of children, therefore participants did not experience anything during the application of microcurrents. As expected, and similarly to previous studies, there were no adverse effects or events, as the stimulation with microcurrents is done in microamperes, which mimics the electrical intensity found on live tissue. [20,21,22] Nevertheless, it must be highlighted, that the present study is the first one that evaluates its effects on constipation and quality of sleep in children with neurodevelopmental disorders. With regard to healthy children, there is only one article registered where only one participant was treated. [22].

Regarding safety and its relation to the application of microcurrents in the treatment of children of a similar age group, some studies have established clinically relevant results in the application of low frequency electrotherapy and its influence on urinary incontinence problems or in overactive bladder. [23,24,25] Other previous studies demonstrate good results and lack of complications using non-invasive neuromodulation in fecal incontinence, however, the methodology used was completely different as most of them are based on the stimulation with neuromodulation of the posterior tibial nerve or of the sacral plexus. [26, 27] Other important factor to bear in mind is the characteristics of participants, as up to the present, interventions have been carried out on children without added or associated pathologies.

Family members and professionals who attended to the children in the Centre of the study, reported that they had observed a lesser effort of the child when defecating. From a physiopathologic perspective, pain during defecation has traditionally been considered an important etiological and perpetual factor of constipation physiopathology. Pain or overexertion during defecation can induce a feces retention behavior. [28].

Feces with a retention behavior can lead to fecal impaction with the presence of a large fecal mass in the rectum and the inability to pass stool. [29] In contrast with the previously mentioned studies, most participants could not verbally express the level of pain of effort due to their disability level, so it was based on observing their expressions and communication during defecation.

There is agreement with other research in that parents had assessed the consistency of the feces based on the memory of the feces of their child. This is very relevant in clinical practice, as parents are usually the ones who report the consistency of the feces of their child, both, in clinical settings and in clinical trials. [15] In addition, the analysis methods performed in the detection of the type of feces was similar to previous studies. [30,31,32].

Regarding the evaluation of the quality of sleep, even though polysomnograpy is considered the Gold Standard, previous studies indicate that a sleep diary is within acceptable limits for all sleep parameters, and that the differences between a sleep diary and actigraphy, are acceptable for the beginning of sleep and wake time. [33, 34].

If the focus is on the management of sleeping disorders in children with neurodevelopmental problems, evidence is limited due to small sample sizes, observational studies without a control group, lack of objective measures results and lack of generalizability. [35] Up to the present, sleep hygiene has been the therapy of first choice [36, 37] and pharmacological treatment as a complementary therapy with the aim of minimizing sleep alterations in children. The role of medication as a treatment for sleep problems in these children, remains controversial. Many studies have indicated that using hypnotics and sedatives in the treatment of sleep disorders in children is a very common practice. [38,39,40] It was observed that in all cases, there is a heterogeneity in the clinical presentation of the type of population. In our study, in order to ensure the possible influence of non-invasive neuromodulation in sleep, no sleeping habits in relation with sleep hygiene or pharmacological treatment were modified.

The current study must recognise some limitations. In the first place, it was a cross-sectional study, therefore, it did not allow any definitive causal inference. In a near future, it would be necessary to develop a randomized controlled trial, even with the possibility of narrowing down to a specific disability level according to the GMFM. In the second place, influence could not be determined of different structural and postural underlying pathologies, as a thorough assessment of imaging studies was not performed. In the third place, the number of subjects was small and further research is needed with a larger population to evaluate the usefulness of microcurrents as a treatment to improve constipation and quality of sleep in children with neurodevelopmental disorders. In the fourth place, considering that this study was carried out in a relatively short period of time, although no-treatment effects were measured two weeks post intervention, additional studies must be performed to evaluate long term effects.

Conclusions

The Non-invasive neuromodulation has resulted to be a safe technique, easy to use and with clinically relevant results, it is suggested to widen lines of research that allow us to develop randomized controlled trials with larger samples, including a multicentric type intervention, and where an assessment of the quality of life of the child and their families could be added.

Availability of data and materials

All data generated or analysed during this study are included in this article.

Abbreviations

ADHD:

Attention deficit/hyperactivity disorder

BSS:

Bristol Stool Form Scale

GMFM:

Gross Motor Function Measure

NESA:

Non-invasive Superficial Neuromodulation

PLMS:

Periodic limb movements in sleep

RLS:

Restless leg syndrome

SPSS:

Statistical Package for the Social Sciences

STROBE:

Strengthening the Reporting of Observational Studies in Epidemiology

References

  1. Thapar A, Cooper M, Rutter M. Neurodevelopmental disorders. Lancet Psychiatry. 2017;4:339–46.

    Article  PubMed  Google Scholar 

  2. Adolescent mental health. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health. Accessed 16 Jul 2022.

  3. Ambartsumyan L, Rodriguez L. Gastrointestinal motility disorders in children. Gastroenterol Hepatol (N Y). 2014;10:16–26.

    PubMed  Google Scholar 

  4. Yang S, Li S-Z, Guo F-Z, Zhou D-X, Sun X-F, Tai J-D. Association of sleep duration with chronic constipation among adult men and women: findings from the National Health and Nutrition Examination Survey (2005–2010). Front Neurol. 2022;13:903273.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Gwee K-A. Disturbed sleep and disturbed bowel functions: implications for constipation in healthy individuals. J Neurogastroenterol Motil. 2011;17:108–9.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Woo KA, Kim S, Nam H, Kim YK, Jeon B, Lee J-Y. Constipation is linked to accelerated cognitive and motor decline in isolated REM sleep behavior disorder. Parkinsonism Relat Disord. 2023;:105775.

  7. Kong WL, Huang Y, Qian E, Morris MJ. Constipation and sleep behaviour disorder associate with processing speed and attention in males with Parkinson’s disease over five years follow-up. Sci Rep. 2020;10:19014.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Schapira AHV, Chaudhuri KR, Jenner P. Non-motor features of Parkinson disease. Nat Rev Neurosci. 2017;18:435–50.

    Article  CAS  PubMed  Google Scholar 

  9. Jansen J, Shulman R, Ward TM, Levy R, Self MM. Sleep disturbances in children with functional gastrointestinal disorders: demographic and clinical characteristics. J Clin Sleep Med. 2021;17:1193–200.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Patel A, Hasak S, Cassell B, Ciorba MA, Vivio EE, Kumar M, et al. Effects of disturbed sleep on gastrointestinal and somatic pain symptoms in irritable bowel syndrome. Aliment Pharmacol Ther. 2016;44:246–58.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Pedersen MJ, Rittig S, Jennum PJ, Kamperis K. The role of sleep in the pathophysiology of nocturnal enuresis. Sleep Med Rev. 2020;49:101228.

    Article  PubMed  Google Scholar 

  12. Dhondt K, Baert E, Van Herzeele C, Raes A, Groen L-A, Hoebeke P, et al. Sleep fragmentation and increased periodic limb movements are more common in children with nocturnal enuresis. Acta Paediatr. 2014;103:e268–272.

    Article  CAS  PubMed  Google Scholar 

  13. Fernandes AER, Roveda JRC, Fernandes CR, Silva DF, de Oliveira Guimarães IC, Lima EM, et al. Relationship between nocturnal enuresis and sleep in children and adolescents. Pediatr Nephrol. 2023;38:1427–38.

    Article  PubMed  Google Scholar 

  14. Bruni O, Angriman M, Melegari MG, Ferri R. Pharmacotherapeutic management of sleep disorders in children with neurodevelopmental disorders. Expert Opin Pharmacother. 2019;20:2257–71.

    Article  CAS  PubMed  Google Scholar 

  15. Koppen IJN, Velasco-Benitez CA, Benninga MA, Di Lorenzo C, Saps M. Using the Bristol Stool scale and parental report of Stool consistency as part of the Rome III Criteria for Functional Constipation in Infants and Toddlers. J Pediatr. 2016;177:44–48e1.

    Article  PubMed  Google Scholar 

  16. Parés D, Comas M, Dorcaratto D, Araujo MI, Vial M, Bohle B, et al. Adaptación y validación de las escalas de Bristol a la lengua española por profesionales sanitarios y pacientes. Revista Española de Enfermedades Digestivas. 2009;101:312–6.

    PubMed  Google Scholar 

  17. Dietch JR, Taylor DJ. Evaluation of the Consensus Sleep Diary in a community sample: comparison with single-channel electroencephalography, actigraphy, and retrospective questionnaire. J Clin Sleep Med. 2021;17:1389–99.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Short MA, Arora T, Gradisar M, Taheri S, Carskadon MA. How many sleep Diary entries are needed to reliably Estimate adolescent sleep? Sleep. 2017;40:zsx006.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Derks IPM, Gillespie AN, Kerr JA, Wake M, Jansen PW. Associations of Infant Sleep duration with body composition and Cardiovascular Health to Mid-Adolescence: the PEAS Kids Growth Study. Child Obes. 2019;15:379–86.

    Article  PubMed  Google Scholar 

  20. Mäenpää H, Jaakkola R, Sandström M, Von Wendt L. Does microcurrent stimulation increase the range of movement of ankle dorsiflexion in children with cerebral palsy? Disabil Rehabil. 2004;26:669–77.

    Article  PubMed  Google Scholar 

  21. Ahn JK, Kwon DR, Park G-Y, Lee K-H, Rim JH, Jung WB, et al. Therapeutic effect of Microcurrent Therapy in Children with In-toeing Gait caused by increased femoral anteversion: a pilot study. Ann Rehabil Med. 2017;41:104–12.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Thompson R, Kaplan SL. Frequency-specific microcurrent for treatment of longstanding congenital muscular Torticollis. Pediatr Phys Ther. 2019;31:E8–15.

    Article  PubMed  Google Scholar 

  23. Sillén U, Arwidsson C, Doroszkiewicz M, Antonsson H, Jansson I, Stålklint M, et al. Effects of transcutaneous neuromodulation (TENS) on overactive bladder symptoms in children: a randomized controlled trial. J Pediatr Urol. 2014;10:1100–5.

    Article  PubMed  Google Scholar 

  24. de Alcantara ACA, de Mello MJG, Costa e Silva EJ da, Silva BBR da, Ribeiro Neto JPM. Transcutaneous electrical neural stimulation for the treatment of urinary urgency or urge-incontinence in children and adolescents: a Phase II clinica. J Bras Nefrol. 2015;37:422–6.

  25. Bouali O, Even L, Mouttalib S, Moscovici J, Galinier P, Game X. [Tibial nerve transcutaneous stimulation for refractory idiopathic overactive bladder in children and adolescents]. Prog Urol. 2015;25:665–72.

    Article  CAS  PubMed  Google Scholar 

  26. Iacona R, Ramage L, Malakounides G. Current state of Neuromodulation for Constipation and fecal incontinence in children: a systematic review. Eur J Pediatr Surg. 2019;29:495–503.

    Article  PubMed  Google Scholar 

  27. Rego RMP, Machado NC, Carvalho M, de Graffunder A, Ortolan JS. Lourenção PLT de A. Transcutaneous posterior tibial nerve stimulation in children and adolescents with functional constipation: a protocol for an interventional study. Med (Baltim). 2019;98:e17755.

    Article  Google Scholar 

  28. Mugie SM, Di Lorenzo C, Benninga MA. Constipation in childhood. Nat Rev Gastroenterol Hepatol. 2011;8:502–11.

    Article  PubMed  Google Scholar 

  29. Koppen IJN, Lammers LA, Benninga MA, Tabbers MM. Management of functional constipation in children: Therapy in Practice. Pediatr Drugs. 2015;17:349–60.

    Article  Google Scholar 

  30. Chumpitazi BP, Self MM, Czyzewski DI, Cejka S, Swank PR, Shulman RJ. Bristol Stool form scale reliability and agreement decreases when determining Rome III stool form designations. Neurogastroenterology & Motility. 2016;28:443–8.

    Article  CAS  Google Scholar 

  31. Ghanma A, Puttemans K, Deneyer M, Benninga M, Vandenplas Y. Amsterdam infant stool scale is more useful for assessing children who have not been toilet trained than Bristol stool scale. Acta Paediatr. 2014;103:e91–2.

    Article  CAS  PubMed  Google Scholar 

  32. Bekkali N, Hamers SL, Reitsma JB, Van Toledo L, Benninga MA. Infant Stool Form Scale: development and results. J Pediatr. 2009;154:521–526e1.

    Article  PubMed  Google Scholar 

  33. Gregory AM, Cousins JC, Forbes EE, Trubnick L, Ryan ND, Axelson DA, et al. Sleep items in the child behavior checklist: a comparison with Sleep Diaries, Actigraphy, and Polysomnography. J Am Acad Child Adolesc Psychiatry. 2011;50:499–507.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Monk TH, Buysse DJ, Kennedy KS, Pods JM, DeGrazia JM, Miewald JM. Measuring sleep habits without using a diary: the sleep timing questionnaire. Sleep. 2003;26:208–12.

    Article  PubMed  Google Scholar 

  35. Blackmer AB, Feinstein JA. Management of Sleep Disorders in Children with Neurodevelopmental Disorders: a review. Pharmacotherapy. 2016;36:84–98.

    Article  CAS  PubMed  Google Scholar 

  36. Jan JE, Owens JA, Weiss MD, Johnson KP, Wasdell MB, Freeman RD, et al. Sleep hygiene for children with neurodevelopmental disabilities. Pediatrics. 2008;122:1343–50.

    Article  PubMed  Google Scholar 

  37. Simard-Tremblay E, Constantin E, Gruber R, Brouillette RT, Shevell M. Sleep in children with cerebral palsy: a review. J Child Neurol. 2011;26:1303–10.

    Article  PubMed  Google Scholar 

  38. Morash-Conway J, Gendron M, Corkum P. The role of sleep quality and quantity in moderating the effectiveness of medication in the treatment of children with ADHD. ADHD Atten Def Hyp Disord. 2017;9:31–8.

    Article  Google Scholar 

  39. Cuomo BM, Vaz S, Lee EAL, Thompson C, Rogerson JM, Falkmer T. Effectiveness of sleep-based interventions for children with Autism Spectrum disorder: a Meta-synthesis. Pharmacotherapy. 2017;37:555–78.

    Article  PubMed  Google Scholar 

  40. Rigney G, Ali NS, Corkum PV, Brown CA, Constantin E, Godbout R, et al. A systematic review to explore the feasibility of a behavioural sleep intervention for insomnia in children with neurodevelopmental disorders: a transdiagnostic approach. Sleep Med Rev. 2018;41:244–54.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank all the families who participated in this study.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. University of Las Palmas de Gran Canaria, Las Palmas, Spain

    Aníbal Báez-Suárez, María P. Quintana-Montesdeoca & Raquel Irina Medina-Ramirez

  2. Rehabilitation Department, Ciudad San Juan de Dios, Las Palmas, Spain

    Iraya Padrón-Rodríguez, Elizabeth Castellano-Moreno & Erica González-González

Authors
  1. Aníbal Báez-Suárez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Iraya Padrón-Rodríguez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elizabeth Castellano-Moreno
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Erica González-González
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. María P. Quintana-Montesdeoca
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Raquel Irina Medina-Ramirez
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study design: ABS, RMR. Data collection: ECM, EGG. Data analysis: MQM Study supervision: IPR, RMR. Manuscript writing: ABS, IPR, MQM. Critical revisions for important intellectual content: ABS, RMR, IPR. All authors performed data analysis in addition they read and approved the final manuscript.

Corresponding author

Correspondence to Aníbal Báez-Suárez.

Ethics declarations

Ethics approval and consent to participate

This research (ClinicalTrials.gov ID NCT05265702, first registration on 03/03/2022) was approved by the Ethic Committee of the Hospital Complejo Hospitalario Universitario Insular Materno Infantil of Las Palmas de Gran Canaria, Canary Islands, Spain, with the code CEIm- 2022-096-1. It followed the ethical guidelines set out in the Declaration of Helsinki. The participants were informed that they could withdraw from the study whenever they desired without negative consequences. They were also assured confidentiality for their personal information. Informed consent was signed by the parents or legal guardians as the study participants are minors (below 16) before starting the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Báez-Suárez, A., Padrón-Rodríguez, I., Castellano-Moreno, E. et al. Application of non-invasive neuromodulation in children with neurodevelopmental disorders to improve their sleep quality and constipation. BMC Pediatr 23, 465 (2023). https://doi.org/10.1186/s12887-023-04307-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12887-023-04307-4

Keywords

BMC Pediatrics

ISSN: 1471-2431

Contact us