This original study evaluates the benefits of NESA non-invasive neuromodulation treatment for children with neurodevelopmental disorders, who have a very wide clinical variability. A common prevalent factor that these children experience is problems with defecatory symptoms and constipation. While there are multiple studies related to their evaluation, there is limited research on specific intervention. The objective of this study was to assess the efficacy and safety using the device as a treatment for constipation, as well as sleep quality, in children with neurodevelopmental disorders. 
We explore NESA non-invasive neuromodulation, since it can regulate the autonomic nervous system and it is a non-invasive and painless electrotherapy that uses low-frequency microcurrents. This device has demonstrated its effectiveness in sleep quality, chronic pain tolerance and other autonomic symptoms, therefore this study suggests that normalising the functions of the autonomic nervous system can alleviate various of the defecatory symptoms seen in these children. The effectiveness of the intervention in patients with these disorders needs to be tested (1, 2, 3).

This cross-sectional observational study included 23 children aged between 2 and 16. The subjects were treated with the NESA non-invasive neuromodulation device, which applies microcurrent therapy in different programming protocols using surface-applied microcurrent electrostimulation. The treatment was assessed three times per week for a total of four weeks, with each session lasting 60 minutes. 
All children were treated with the same intervention protocol, which consists in the application of two programmes, P2 and P7. During the course of the therapy, participants maintained their usual routines and interventions. 
The studied variables were measured throughout the weeks that lasted the intervention. Data was collected prior to the beginning of the treatment, four weeks into it and two weeks after the last intervention. These were:
- Bowel diary. Thanks to this instrument, we were able to register the number of bowel movements and the type of stool according to the Bristol Stool Form Scale (BSS)
- For sleep quality evaluation, a sleep diary was provided and answered. 
This information was obtained thanks to the families, therapist, teachers and other individuals in their environment. Every parent or legal guardian was informed about this study and all signed the informed consent. As well, this investigation was approved by the corresponding human research ethic committee.

During the course of the study, no adverse events or incidents occurred. Clinically relevant improvements were registered in defecation frequency and type, as well as in sleep related parameters. 
The results regarding the frequency of defecation indicate that all participants improved their bowel movements, with 60.9% of children having a defecation frequency of 3 to 6 times per week. Additionally, 30.4% of participants reported daily bowel movements. Two weeks after the intervention, most children kept on maintaining the benefits from the treatment.
Upon analysing the type of stool observed throughout the weeks, we can observe how prior to the intervention 69.6% of children had type 1 and 2 in the BBS scale. However, at the end of the treatment, this percentage decreases to 21.7%. On the other hand, normal considered stool increased its percentage from 21.7% to 78.3% of patients. 
Regarding sleep quality, some benefits can also be observed. The number of interruptions in their sleep lowered and the total hours of sleep increased, especially through the end of the intervention.

The treatment did not affect the children's quality of life or other treatments they were receiving. Additionally, exposure to NESA microcurrents improved their symptoms and overall quality of life. This may also lead to an improvement in the quality of life for their families and environment. 
The results recorded in the bowel diary indicate that this treatment is beneficial for children suffering from constipation. This treatment not only improves the frequency of defecation but also the consistency of stool. These improvements can be observed in a short period of time, with only four weeks of treatment, so we can guess that the intervention may have long-term benefits for these symptoms if applied consistently. 
Whatsmore, even though this study investigates children with neurodevelopmental disorders, due to the extensive spectrum that this implies, investigation with other disorders or neurotypical children may have similar benefits to the ones obtained in this research.

To improve quality of sleep and constipation in children with neurodevelopmental disorders, NESA microcurrents can be used as an effective and safe treatment. More studies with a larger sample may be needed in order to obtain statistically significant results.

Medina-Ramírez, R. I., Molina-Cedrés, F., Báez-Suárez, A., & Álamo-Arce, D. (2021). Nesa Non-Invasive Neuromodulation; A New Frontier of Treatment of the Autonomous Nervous System in Physiotherapy. CPQ Orthopaedics, 5(4), 01-04.
Teruel-Hernández, E., López-Pina, J. A., Souto-Camba, S., Báez-Suárez, A., Medina-Ramírez, R., & Gómez-Conesa, A. (2023). Improving Sleep Quality, Daytime Sleepiness, and Cognitive Function in Patients with Dementia by Therapeutic Exercise and NESA Neuromodulation: A Multicenter Clinical Trial. International Journal of Environmental Research and Public Health, 20(21), 7027.
Medina-Ramírez, R., Contreras-Polo, M., Teruel-Hernández, E., Vílchez-Barrera, M., Báez-Suárez, A., & Álamo Arce, D. (2023). Rehabilitation in Sleep, Pain, and Bladder Symptoms of NESA Neuromodulation Application in Multiple Sclerosis Patients: A Innovative Treatment. CPQ Medicine, 15(1), 1-11.