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Malandraki GA, Kantarcigil Ç, Craig BA, Zhang Y, Gordon AM. Day-to-Day Variability of Clinical Feeding and Swallowing Performance in School-Age Self-Feeding Children With Cerebral Palsy. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:190-200. [PMID: 36492292 DOI: 10.1044/2022_ajslp-22-00137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE We aimed to examine the day-to-day variability of feeding and swallowing performance and mealtime duration in school-age self-feeding children with spastic cerebral palsy (SCP) across 15 days. METHOD Thirteen children with SCP (ages 5;10 [years;months]-17;6) participated. Children were divided into unilateral (UCP, n = 6) and bilateral (BCP, n = 7) SCP groups. Feeding/swallowing assessments using the Dysphagia Disorder Survey (DDS) were conducted and total mealtime durations (TMDs) were calculated for all days. DDS Part 1 (factors related to feeding) and DDS Part 2 (signs of oropharyngeal difficulties) components were rated. Mixed-effects models were used to compare group means and estimate between- and within-subject variances in each group. Likelihood ratio tests were used to determine best covariance structure and compare variance types across groups. RESULTS Within-subject variance for all three variables, DDS Part 1, 2, and TMD, across days was larger in the BCP group than the UCP group (Part 1: p = .0036, Part 2: p = .0002, and TMD: p = .0005) and the between-subject variance was larger in the BCP group for DDS Part 2 (p = .0362). The UCP group presented with lower (milder) DDS scores (Part 1: p = .0160; Part 2: p = .0141) and shorter TMD (p = .0077) than the BCP group across days. Furthermore, both groups exhibited greater variability in DDS Part 2 than 1 (p < .0001). CONCLUSION These preliminary results emphasize the need to account for day-to-day variability when evaluating swallowing especially in children with BCP and provide preliminary ranges of performance that could be useful for clinical prognosis and future treatment research. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21669611.
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Affiliation(s)
- Georgia A Malandraki
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Çagla Kantarcigil
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Bruce A Craig
- Department of Statistics, Purdue University, West Lafayette, IN
| | - Yumin Zhang
- Department of Statistics, Purdue University, West Lafayette, IN
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
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Oral Motor Treatment Efficacy: Feeding and Swallowing Skills in Children with Cerebral Palsy. Behav Neurol 2021; 2021:6299462. [PMID: 34733374 PMCID: PMC8560295 DOI: 10.1155/2021/6299462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/24/2021] [Indexed: 11/22/2022] Open
Abstract
This study is aimed at identifying the relationship between oral motor treatment and the improvement of abilities for feeding and swallowing in boys and girls with CP residing in the state of Yucatán. The sample consisted of 30 patients with a diagnosis of CP and the presence of ADT, with gross motor function levels from II to V, between 3 and 14 years old, of which 50% received oral motor treatment. The predominant diagnosis was spastic CP and tetraplegia. An interview was carried out with the tutor, the application of the gross motor skills scale, and an assessment of feeding skills. The feeding and swallowing skills that improved significantly with the oral motor treatment were mandibular mobility, tongue activity, abnormal reflexes, control of breathing, and general oral motor skills (p ≤ 0.05). Within the sample that did not receive oral motor treatment, 46% presented low or very low weight and 40% referred recurrent respiratory diseases. In the end, it was concluded that feeding skills improve significantly with oral motor treatment, regardless of the severity of gross motor involvement. Likewise, oral motor treatment was associated with a lower presence of respiratory diseases and nutritional compromise.
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Wilson E, Simione M, Polley L. Paediatric oral sensorimotor interventions for chewing dysfunction: A scoping review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:1316-1333. [PMID: 34423521 PMCID: PMC8585681 DOI: 10.1111/1460-6984.12662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Chewing dysfunction can have adverse effects on growth, development and quality of life. There is a lack of evidence-based consensus guidelines for sensorimotor intervention. To address this, we need to understand the current state of the science in clinical sensorimotor interventions for paediatric chewing dysfunction and systematically plan a research agenda and priorities for the field. AIMS The purpose of this scoping review was to examine the extent, range and nature of evidence for oral sensorimotor interventions for paediatric chewing dysfunction. METHODS & PROCEDURES This scoping review entailed five phases that included: identification of the research question; identification of relevant studies; study selection; data charting; and collation, summarization and report of the results. Treatment studies that were peer-reviewed and written in English were included. All studies involved a paediatric population and included an oral sensorimotor and/or chewing intervention. Information regarding study design, population, intervention, comparator, outcome measures and findings were extracted. MAIN CONTRIBUTION Of the 21 studies included in this scoping review, 53% were specific to children with cerebral palsy. All interventions were multi-component in nature and the treatment studies included a range of study designs, but few were controlled trials with comparators. A wide variety of outcomes measures were used within and across studies to determine treatment effectiveness. CONCLUSIONS & IMPLICATIONS The findings suggest that in a small number of studies, sensorimotor interventions provide preliminary evidence for effectiveness in specific populations. These and other treatment protocols must be trialled in additional clinical populations and settings to improve the evidence base for sensorimotor treatment of paediatric chewing dysfunction. This review also serves to help prioritize research agendas and further motivates the need for consensus-based clinical guidelines for paediatric chewing treatment. WHAT THIS PAPER ADDS What is already known on the subject Paediatric feeding disorders are highly prevalent and children often have chewing dysfunction that results in significant negative consequences. We lack evidence-based sensorimotor treatment approaches for chewing dysfunction, which directly impacts the care clinicians can provide children. What this study adds to existing knowledge This scoping review is the first step in examining the literature to understand the current state of the science for oral sensorimotor interventions for paediatric chewing dysfunction. Few randomized controlled studies were identified and a majority included children with cerebral palsy. Most of the interventions were multi-component and included a variety of treatment approaches. What are the potential or actual clinical implications of this work? The results of this scoping review can be used as an initial reference for clinicians selecting treatment approaches for chewing dysfunction. It also serves to help prioritize research agendas and further motivates the need for consensus-based clinical guidelines for paediatric chewing treatment.
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Affiliation(s)
- Erin Wilson
- Speech and Feeding Disorders Laboratory, MGH Institute of Health Professions, Boston, MA, USA
| | - Meg Simione
- Division of General Pediatrics, Mass General Hospital for Children, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Lydia Polley
- Department of Speech Pathology, Akron Children's Hospital, Akron, OH, USA
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Ozturk S, Ozsin Ozler C, Serel Arslan S, Demir N, Olmez MS, Uzamis Tekcicek M. Orofacial functions and oral health: An analysis on children aged 5-8 years old. J Texture Stud 2021; 53:31-40. [PMID: 34482536 DOI: 10.1111/jtxs.12628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/18/2021] [Accepted: 08/24/2021] [Indexed: 11/30/2022]
Abstract
The aim of this study is to assess the orofacial function performance and oral health status of healthy children as well as their potential correlations. In this descriptive study, the oral functions of four hundred systemically healthy children who applied for the pediatric dentistry clinic were evaluated. Three scales, namely Karaduman Chewing Performance Scale (KCPS), Pediatric version of the Eating Assessment Tool (PEDI-EAT-10), and Nordic Orofacial Test Screening (NOT-S) protocol, are used to collect the data. These children's carious lesions were evaluated by using the decayed, missing, filled tooth/surface (DMFT/S, dmft/s) indices, the International Caries Detection and the Assessment-II System (ICDAS-II). In total, 400 (6.5 years [78.02 months]) children were participated in the study. Their KCPS scores indicate that 58.0% of the children were at level 0 and 35.8% were at level 1. The results of the KCPS levels and the DMFT, dmft, DT, dt, MT, mt (as =0 and ≥1) were found to be statistically significant; p = .044, p = .009, p = .008, p = .000, p = .032, and p = .003, respectively. The total PEDI-EAT-10 score of 13.4% of the children was found to be 3 or higher, suggesting that they experience a problem in swallowing. According to the NOT-S, the most affected domains were "habits" (51.0%), "facial expression" (49.3%), and "chewing and swallowing" (45.3%). Among healthy children without a defined problem in swallowing and orofacial functions, the oral health status may affect orofacial functions. Decayed (particularly, extensive caries existence) or missing tooth may have critical importance for adequate chewing in children. Especially in the presence of so many decayed or missing teeth, evaluating the orofacial functions through different scales may considerably contribute to early diagnosis of functional problems.
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Affiliation(s)
- Seyma Ozturk
- Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Cansu Ozsin Ozler
- Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Selen Serel Arslan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Numan Demir
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Merih Seval Olmez
- Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Meryem Uzamis Tekcicek
- Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
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Serel Arslan S, Demir N, Karaduman AA. Turkish Version of the Mastication Observation and Evaluation (MOE) Instrument: A Reliability and Validity Study in Children. Dysphagia 2019; 35:328-333. [PMID: 31292728 DOI: 10.1007/s00455-019-10035-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/12/2019] [Accepted: 07/04/2019] [Indexed: 10/26/2022]
Abstract
The Mastication Observation and Evaluation (MOE) instrument is an objective assessment of the chewing process in children. This study aimed to translate the MOE into Turkish and to test its reliability and validity in children with cerebral palsy (CP). A total of 53 children with CP and 27 typical children were included in the study. The MOE was translated from Dutch into Turkish by using the forward, backward, forward translation method. The internal consistency, intra- and inter-observer reliability, criterion, and discriminant validity of the Turkish version of the MOE (T-MOE) were investigated. Internal consistency was excellent with a Cronbach's alpha value of 0.98. The Intraclass correlation coefficient ranged from 0.89 to 0.97 for intra-rater reliability and from 0.86 to 0.94 for inter-rater reliability. The median score from Karaduman Chewing Performance Scale (KCPS) was 7 (min = 1, max = 8). All of the items in the T-MOE and the total T-MOE score had a negative and strong correlation with the KCPS score. Typical children without chewing disorders had greater T-MOE scores than the children with CP suffering from chewing disorders (p < 0.01). The T-MOE is a reliable and valid instrument for evaluating the observed oral motor behaviors of chewing function in children. It can be used in clinical practice and research.Clinical trial number: NCT03811353.
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Affiliation(s)
- Selen Serel Arslan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Altındağ, 06100, Ankara, Turkey.
| | - Numan Demir
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Altındağ, 06100, Ankara, Turkey
| | - Aynur Ayşe Karaduman
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Altındağ, 06100, Ankara, Turkey
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Mishra A, Sheppard JJ, Kantarcigil C, Gordon AM, Malandraki GA. Novel Mealtime Duration Measures: Reliability and Preliminary Associations With Clinical Feeding and Swallowing Performance in Self-Feeding Children With Cerebral Palsy. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:99-107. [PMID: 29273816 DOI: 10.1044/2017_ajslp-16-0224] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 08/03/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE The purpose of this study is to examine (a) the reliability of newly developed measures of mealtime duration and (b) their relationship to clinical feeding/swallowing performance in children with spastic cerebral palsy (SCP). METHOD Seventeen self-feeding children (9 boys, 8 girls) with SCP (age range = 5;1 [years;months] to 17;6, Gross Motor Function Classification System range = I-IV) were assessed during mealtimes using the Dysphagia Disorder Survey (DDS; Sheppard, Hochman, & Baer, 2014). Children were divided into 2 groups, children with primarily unilateral or bilateral brain involvement. Duration measures included mealtime duration and total sip/bite duration for each bolus type (liquid and solid). RESULTS Excellent intra- and inter-rater reliability for all duration measures was observed (intraclass correlation coefficient [ICC] = 1.00 and 0.955, respectively, for mealtime duration; ICC = 1.00 and 0.963, respectively, for solid/bite duration; ICC = 1.00 and 0.957, respectively, for liquid/sip duration). Positive correlations were found between total mealtime duration and DDS Part 1, rs = .514 [.045-.797], p = .035; Part 2, rs = .528 [.064-.804], p = .029; and total scores, rs = .665 [.271-.868], p = .004, and between total solid/bite duration and DDS Part 1, rs = .579 [.137-.828], p = .015; Part 2, rs = .620 [.199-.847], p = .007; and total scores, rs = .762 [.444-.909], p < .001. Children with unilateral brain involvement exhibited significantly lower DDS total (p = .049) and Part 2 scores (p = .026), indicating better feeding/swallowing performance/skills. They also had shorter mealtime duration (p = .019) and solid/bite duration (p = .025) compared with children with bilateral involvement. CONCLUSIONS Our new mealtime duration measures are reliable and correlate with feeding/swallowing performance in a sample of self-feeding children with SCP. Therefore, they may be useful supplements to feeding/swallowing assessments for this population. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.5715076.
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Affiliation(s)
- Avinash Mishra
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Justine J Sheppard
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Cagla Kantarcigil
- Department of Speech, Language, & Hearing Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, IN
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Georgia A Malandraki
- Department of Speech, Language, & Hearing Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, IN
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Abstract
BACKGROUND Swallowing is a systematic process. Any structural, physiological or neurological disturbance in this process may cause dysphagia. Although there are studies that report head/neck movements during mastication, there are fewer studies that show the effect of different head/neck postures on difficulty while swallowing. OBJECTIVES To observe the effect of different body postures on the self-perceived difficulty while swallowing in normal healthy subjects. METHODS Participants were asked to swallow 25 ml of water in one go while sitting upright, sitting with head/neck flexed, head/neck extended and lying supine. Following this, they had to rate their self-perceived difficulty while swallowing on a scale of 0-10, 0 being most easy and 10 being most difficult. RESULTS 186 subjects with mean age 32.7 SD 9.04 participated in this study. It was found to be least difficult to swallow when subjects were asked to swallow in upright sitting position. Statistically significant differences were found between sitting upright, sitting with head/neck flexed, head/neck extended and lying supine. CONCLUSION Postural modification may help in rehabilitation of patients with dysphagia by affecting bolus flow to improve speed and safety of swallowing by closure of airways to prevent aspiration.
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Affiliation(s)
- Ahmad H Alghadir
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, KSA
| | - Hamayun Zafar
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, KSA
| | - Einas S Al-Eisa
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, KSA
| | - Zaheen A Iqbal
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, KSA
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Abstract
This article provides a critical assessment of evidence for the claim of experienced clinicians that proper body alignment will ameliorate the feeding problems of patients with cerebral palsy and related neuromotor disorders and reduce the risk of aspiration. While there is evidence that alignment reduces extensor tone and improves feeding, further research is needed to determine whether this population's high risk for aspiration can be reduced by alignment.
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Affiliation(s)
- Joyce F West
- Department of Speech-Language-Hearing Sciences, Lehman College, City University of New York, Bronx 10468-1569, USA.
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Remijn L, Speyer R, Groen BE, van Limbeek J, Nijhuis-van der Sanden MWG. Validity and reliability of the Mastication Observation and Evaluation (MOE) instrument. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:1551-1561. [PMID: 24770467 DOI: 10.1016/j.ridd.2014.03.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 02/28/2014] [Accepted: 03/14/2014] [Indexed: 06/03/2023]
Abstract
The Mastication Observation and Evaluation (MOE) instrument was developed to allow objective assessment of a child's mastication process. It contains 14 items and was developed over three Delphi rounds. The present study concerns the further development of the MOE using the COSMIN (Consensus based Standard for the Selection of Measurement Instruments) and investigated the instrument's internal consistency, inter-observer reliability, construct validity and floor and ceiling effects. Consumption of three bites of bread and biscuit was evaluated using the MOE. Data of 59 healthy children (6-48 mths) and 38 children (bread) and 37 children (biscuit) with cerebral palsy (24-72 mths) were used. Four items were excluded before analysis due to zero variance. Principal Components Analysis showed one factor with 8 items. Internal consistency was >0.70 (Chronbach's alpha) for both food consistencies and for both groups of children. Inter-observer reliability varied from 0.51 to 0.98 (weighted Gwet's agreement coefficient). The total MOE scores for both groups showed normal distribution for the population. There were no floor or ceiling effects. The revised MOE now contains 8 items that (a) have a consistent concept for mastication and can be scored on a 4-point scale with sufficient reliability and (b) are sensitive to stages of chewing development in young children. The removed items are retained as part of a criterion referenced list within the MOE.
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Affiliation(s)
- Lianne Remijn
- Department of Child Rehabilitation, Rehabilitation Centre, Sint Maartenskliniek, Postbox 9011, 6500 GM Nijmegen, The Netherlands; Institute of Health Studies, HAN University of Applied Sciences, Postbox 6960, 6503 GL Nijmegen, The Netherlands.
| | - Renée Speyer
- School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville City, Queensland 4811, Australia; Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Postbox 9600, 2300 RC Leiden, The Netherlands
| | - Brenda E Groen
- Sint Maartenskliniek Research, Postbox 9011, 6500 GM Nijmegen, The Netherlands
| | - Jacques van Limbeek
- Achmea Health Insurance Company, Postbox 1717, 3800 BS Amersfoort, The Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Radboud University Medical Center, Scientific Institute for Quality of Healthcare, Postbox 9101, 6500 HB Nijmegen, The Netherlands
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Sellers D, Pennington L, Mandy A, Morris C. A systematic review of ordinal scales used to classify the eating and drinking abilities of individuals with cerebral palsy. Dev Med Child Neurol 2014; 56:313-22. [PMID: 24127728 DOI: 10.1111/dmcn.12313] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2013] [Indexed: 11/29/2022]
Abstract
AIM The aim of this review was to examine systematically the scope, validity, and reliability of ordinal scales used to classify the eating and drinking ability of people with cerebral palsy (CP). METHOD Six electronic databases were searched to identify measures used to classify eating and drinking ability; in addition, two databases were used to track citations of key texts. The constructs assessed by each measure were examined in relation to the World Health Organization International Classification of Functioning, Disability and Health. Evidence of validity and reliability of the identified scales was appraised from peer-reviewed studies using standard criteria. RESULTS Fifteen scales were identified in 23 papers. Clinician or researcher assessment was required for 13 scales; nine scales made use of information from parents and carers through interviews or questionnaires. Eight scales used the terms mild, moderate, and severe (with varying definitions) to describe different aspects of eating and drinking impairment. There was an assessment of either content validity and/or reliability for five scales; however, none met the recommended psychometric quality standards. INTERPRETATION Currently, there is a lack of evidence of the validity and reliability of ordinal scales of functional eating and drinking abilities of people with CP.
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Affiliation(s)
- Diane Sellers
- Chailey Heritage Clinical Services, Sussex Community NHS Trust, Brighton, UK
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Affiliation(s)
- Sophie Scott
- Principal Speech and Language Therapist, North West London Hospitals NHS Trust, London, UK
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Gerek M, Çiyiltepe M. Dysphagia Management of Pediatric Patients with Cerebral Palsy. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/096979505799103849] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Weir KA, Bell KL, Caristo F, Ware RS, Davies PS, Fahey M, Rawicki B, Boyd RN. Reported Eating Ability of Young Children With Cerebral Palsy: Is There an Association With Gross Motor Function? Arch Phys Med Rehabil 2013; 94:495-502. [DOI: 10.1016/j.apmr.2012.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 09/04/2012] [Accepted: 10/15/2012] [Indexed: 10/27/2022]
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Benfer KA, Weir KA, Boyd RN. Clinimetrics of measures of oropharyngeal dysphagia for preschool children with cerebral palsy and neurodevelopmental disabilities: a systematic review. Dev Med Child Neurol 2012; 54:784-95. [PMID: 22582745 DOI: 10.1111/j.1469-8749.2012.04302.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIM The aim of this study was to determine the psychometric properties and clinical utility of objective measures of oropharyngeal dysphagia (OPD) in children with cerebral palsy or neurodevelopmental disabilities aged 12 months to 5 years. METHOD Five electronic databases were searched to identify measures of OPD. The Consensus-based Standards for the Selection of Measurement Instruments (COSMIN) Checklist was used to assess psychometric properties and a Modified CanChild Outcome Rating Form was used for clinical utility. RESULTS Nine measures of OPD from 27 papers were assessed: the Brief Assessment of Motor Function - Oral Motor Deglutition Scale; the Behavioral Assessment Scale of Oral Functions in Feeding; the Dysphagia Disorders Survey; the Feeding Behaviour Scale; the Functional Feeding Assessment, modified; the Gisel Video Assessment; the Oral Motor Assessment Scale; the Pre-Speech Assessment Scale; and the Schedule for Oral Motor Assessment. INTERPRETATION The Schedule for Oral Motor Assessment and the Functional Feeding Assessment, modified, proved to be the strongest measures based on published psychometric properties of validity and reliability. The Schedule for Oral Motor Assessment and the Dysphagia Disorders Survey were found to have the strongest clinical utility. Further studies to test the psychometric properties of existing measures, in particular predictive validity, responsiveness, and test-retest reliability, would be beneficial for selecting an appropriate measure for both clinical and research contexts.
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Affiliation(s)
- Katherine A Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Brisbane, QLD, Australia.
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Shipster C, Morgan A, Dunaway D. Psychosocial, feeding, and drooling outcomes in children with Beckwith Wiedemann syndrome following tongue reduction surgery. Cleft Palate Craniofac J 2011; 49:e25-34. [PMID: 21905916 DOI: 10.1597/10-232] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Macroglossia is a common feature of Beckwith Wiedemann Syndrome (BWS). Tongue reduction surgery (TRS) is advocated to overcome, or reduce, the secondary effects of macroglossia. Macroglossia may affect a child's cosmetic appearance, feeding, and drooling function. However, no study has systematically reported on feeding, drooling, or psychosocial outcomes preoperatively and postoperatively in this group. This study aimed to describe the presurgical and postsurgical psychosocial, feeding, and drooling outcomes of children with macroglossia associated with BWS and to determine the effect of TRS on these areas. DESIGN Clinical cohort study. PARTICIPANTS Ten consecutively admitted children with BWS (age at surgery from 9 months to 4 years, 9 months [4;9]; mean, 2;7) were assessed preoperatively, 3 months postoperatively, and at long-term follow-up. MAIN OUTCOME MEASURES A parental report questionnaire, the Brodsky drooling scale, and a feeding rating scale. RESULTS Parents reported that macroglossia had a negative impact cosmetically that was ameliorated following surgery. Macroglossia caused a range of feeding difficulties presurgically by preventing lip seal and bolus manipulation during the oral preparatory phase. Excessive drooling was present in all cases presurgically. This resolved partially across the group postsurgically, with almost complete recovery at longer-term follow-up assessment. CONCLUSIONS Presurgically, children show a common profile of feeding and drooling impairment with negative effects on cosmetic appearance. Our preliminary results demonstrate that TRS has a positive impact on these features with good outcomes for children with BWS.
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Affiliation(s)
- C Shipster
- Craniofacial Unit, Great Ormond Street Hospital, London, United Kingdom
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Abstract
OBJECTIVE To examine differences in feeding among children with cerebral palsy (CP) who varied in the severity of their oral motor involvement; to examine longitudinal change in feeding behaviours for different severity groups. METHOD Twenty-three children with CP participated (mean age = 4.53 years at the first time point). Feeding data were collected from parent questionnaires at 6 month intervals over 30 months. RESULTS Significant differences were observed among severity groups for all feeding variables except coughing and choking during meals. Only one variable, coughing, showed significant change over time. CONCLUSIONS Children with CP who had severe oral-motor involvement had marked and pervasive feeding difficulties which showed some fluctuation with time, but generally were stable. Children with CP who did not have oral motor involvement and those who had mild-moderate involvement also showed little-to-no change over time and had fewer problems than those in the severe group.
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Arvedson J, Clark H, Lazarus C, Schooling T, Frymark T. The effects of oral-motor exercises on swallowing in children: an evidence-based systematic review. Dev Med Child Neurol 2010; 52:1000-13. [PMID: 20497451 DOI: 10.1111/j.1469-8749.2010.03707.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of this unregistered evidence-based systematic review was to determine the state and quality of evidence on the effects of oral motor exercises (OME) on swallowing physiology, pulmonary health, functional swallowing outcomes, and drooling management in children with swallowing disorders. METHOD A systematic search of 20 electronic databases was completed to identify relevant peer-reviewed literature published in English between 1960 and 2007. Experimental or quasi-experimental design studies examining OME as a treatment for children with swallowing disorders were appraised for methodological quality by two assessors and reviewed by a third. RESULTS Sixteen studies of varying methodological quality were included. No study examining the effects of OME on pulmonary health in children was identified. The included studies incorporated a wide variety of OME, and mixed findings were noted across all of the outcomes targeted in this review. INTERPRETATION Based on the results of this evidence-based systematic review, there is insufficient evidence to determine the effects of OME on children with oral sensorimotor deficits and swallowing problems. Well-designed studies are needed to provide clinicians with evidence that can be incorporated into the preferences of the client and the clinicians' knowledge of anatomy, physiology, and neurodevelopment in the management of this group of children.
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Affiliation(s)
- Joan Arvedson
- Children's Hospital of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Bell KL, Boyd RN, Tweedy SM, Weir KA, Stevenson RD, Davies PSW. A prospective, longitudinal study of growth, nutrition and sedentary behaviour in young children with cerebral palsy. BMC Public Health 2010; 10:179. [PMID: 20370929 PMCID: PMC2867996 DOI: 10.1186/1471-2458-10-179] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 04/06/2010] [Indexed: 12/02/2022] Open
Abstract
Background Cerebral palsy is the most common cause of physical disability in childhood, occurring in one in 500 children. It is caused by a static brain lesion in the neonatal period leading to a range of activity limitations. Oral motor and swallowing dysfunction, poor nutritional status and poor growth are reported frequently in young children with cerebral palsy and may impact detrimentally on physical and cognitive development, health care utilisation, participation and quality of life in later childhood. The impact of modifiable factors (dietary intake and physical activity) on growth, nutritional status, and body composition (taking into account motor severity) in this population is poorly understood. This study aims to investigate the relationship between a range of factors - linear growth, body composition, oral motor and feeding dysfunction, dietary intake, and time spent sedentary (adjusting for motor severity) - and health outcomes, health care utilisation, participation and quality of life in young children with cerebral palsy (from corrected age of 18 months to 5 years). Design/Methods This prospective, longitudinal, population-based study aims to recruit a total of 240 young children with cerebral palsy born in Queensland, Australia between 1st September 2006 and 31st December 2009 (80 from each birth year). Data collection will occur at three time points for each child: 17 - 25 months corrected age, 36 ± 1 months and 60 ± 1 months. Outcomes to be assessed include linear growth, body weight, body composition, dietary intake, oral motor function and feeding ability, time spent sedentary, participation, medical resource use and quality of life. Discussion This protocol describes a study that will provide the first longitudinal description of the relationship between functional attainment and modifiable lifestyle factors (dietary intake and habitual time spent sedentary) and their impact on the growth, body composition and nutritional status of young children with cerebral palsy across all levels of functional ability.
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Affiliation(s)
- Kristie L Bell
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Discipline of Paediatrics and Child Health, School of Medicine, The University of Queensland, Brisbane, Australia.
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Ortega ADOL, Ciamponi AL, Mendes FM, Santos MTBR. Assessment scale of the oral motor performance of children and adolescents with neurological damages. J Oral Rehabil 2009; 36:653-9. [PMID: 19627455 DOI: 10.1111/j.1365-2842.2009.01979.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Among the conditions that classify individuals as special needs patients are those resulting from neurological sequelae, particularly cerebral palsy (CP), which is a disorder of high prevalence. Innumerable alterations can be found in individuals with CP but the inability to control striated muscles, due to damages suffered by the central nervous system, should be emphasized. Changes in tonus, speed and strength of oral muscles, reduction of mandibular mobility amplitude and difficulty to passively seal the lips are characteristics observed in such individuals. Categorization of the individual's mastication pattern is important in order to establish diagnosis and treatment protocols and prognosis. The aim of this study was to develop an Oral Motor Assessment Scale (OMAS) and evaluate its performance in terms of construct validity and reliability in a cohort of 53 children and individuals with CP. Two dentists examined the same patients on two different occasions. Good interexaminer (kappa > 0.85) and intra-examiner (kappa > 0.90) agreement was obtained for the majority of the OMAS items. This study shows that the OMAS is an accurate and valid method of assessment of oral motor skills in children and adolescents with neurological damages.
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Affiliation(s)
- A De Oliveira Lira Ortega
- Group for the Study and Treatment of Special Needs Patients of the Pediatric Dentistry Discipline of the University of São Paulo, São Paulo, Brazil.
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20
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Gisel E. Interventions and outcomes for children with dysphagia. ACTA ACUST UNITED AC 2008; 14:165-73. [DOI: 10.1002/ddrr.21] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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21
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Marchand V, Motil KJ. Nutrition support for neurologically impaired children: a clinical report of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 2006; 43:123-35. [PMID: 16819391 DOI: 10.1097/01.mpg.0000228124.93841.ea] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Undernutrition, growth failure, overweight, micronutrient deficiencies, and osteopenia are nutritional comorbidities that affect the neurologically impaired child. Monitoring neurologically impaired children for nutritional comorbidities is an integral part of their care. Early involvement by a multidisciplinary team of physicians, nurses, dieticians, occupational and speech therapists, psychologists, and social workers is essential to prevent the adverse outcomes associated with feeding difficulties and poor nutritional status. Careful evaluation and monitoring of severely disabled children for nutritional problems are warranted because of the increased risk of nutrition-related morbidity and mortality.
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Affiliation(s)
- Valerie Marchand
- Department of Pediatrics, University of Montreal, Montreal, Canada
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22
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Samuels R, Chadwick DD. Predictors of asphyxiation risk in adults with intellectual disabilities and dysphagia. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2006; 50:362-70. [PMID: 16629929 DOI: 10.1111/j.1365-2788.2005.00784.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND Adults with learning disabilities referred for assessment of their eating and drinking are frequently reported to cough and choke when eating and drinking. The research literature investigating dysphagia has often overlooked asphyxiation risk, highlighting coughing and choking as indicators of aspiration only. This is a notable oversight due to the prevalence of asphyxia as a cause of mortality in this population. AIM This study aims to identify the physiological and environmental factors that predict asphyxiation risk in adults with intellectual disabilities and dysphagia. METHOD Data were collected from dysphagia-trained speech and language therapists (SLTs) working with the participant adults with intellectual disabilities and dysphagia. The SLTs used case notes, clinical assessment and videofluoroscopic assessment reports to gather the data. RESULTS Speed of eating, cramming food and premature loss of the bolus into the pharynx were identified as significant predictors of asphyxiation risk in this population. CONCLUSIONS The findings highlight the importance of maladaptive eating strategies in exacerbating the risk of asphyxiation and choking. These factors should be considered in the assessment of asphyxiation and choking risk and management. Finally, the need for joint assessment and management with other members of the multidisciplinary team is advocated.
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Affiliation(s)
- R Samuels
- Department of Psychology and Speech Pathology, Manchester Metropolitan University, Manchester, UK
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23
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Abstract
Patients with cerebral palsy (CP) frequently manifest oral-ingestive problems ranging from mild to severe. Drooling, rejection of solid foods, choking, coughing and spillage during eating may contribute to these problems. The aim of this study was to assess functional feeding skills of patients with CP, aged 4-25 years. They were assessed with the Modified Functional Feeding Assessment Scale (FFAm). Mothers had expressed concern regarding drooling and reluctance in accepting solid foods. None of the mothers thought that there was a major problem with adequate ingestion. However, the study revealed that patients had disabilities in spoon feeding, biting, chewing, cup drinking, straw drinking, swallowing and clearing.
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Affiliation(s)
- Sule Yilmaz
- Armagan Donertas Rehabilitation Center, Trakya University, Edirne, Turkey.
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Cook S, Hooper V, Nasser R, Larsen D. Effect of Gastrostomy on Growth in Children with Neurodevelopmental Disabilities. CAN J DIET PRACT RES 2005; 66:19-24. [PMID: 15780152 DOI: 10.3148/66.1.2005.19] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Chronic malnutrition and growth failure are frequent consequences of feeding difficulties in neurodevelopmentally disabled children. Gastrostomy feeding has been used successfully to alleviate chronic malnutrition as well as distress and frustration associated with feeding. Unfortunately, caregivers are often resistant to gastrostomy placement. In order to determine the impact of gastrostomies in 20 children with neurodevelopmental disability (NDD), a questionnaire was used to collect caregivers’ perceptions both before and after gastrostomy. The questionnaire assessed caregivers’ retrospective perceptions of quality of life, feeding difficulties, and the burdens and benefits of gastrostomies. To determine impact on growth, height and weight were measured once before and three times after gastrostomy (at six, 12, and 24 months). The number of times a child was fed and the amount of time spent feeding decreased significantly following gastrostomy (p<0.001 and p<0.05, respectively). Growth for all children improved following gastrostomy (p<0.001). Pregastrostomy problems improved significantly following gastrostomy, as did caregivers’ perceptions of quality of life for both themselves and their child (p<0.001). These results indicate that gastrostomy has a positive impact on growth for neurodevelopmentally disabled children, and on quality of life for both children and caregivers. Caregivers may find these results encouraging if they are faced with a decision about gastrostomy placement for their child.
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Affiliation(s)
- Stephanie Cook
- Clinical Nutrition, Regina Qu'Appelle Health Region, Regina, SK, Canada
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Morgan A, Ward E, Murdoch B. Clinical Characteristics of Acute Dysphagia in Pediatric Patients Following Traumatic Brain Injury. J Head Trauma Rehabil 2004; 19:226-40. [PMID: 15247845 DOI: 10.1097/00001199-200405000-00004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PRIMARY OBJECTIVE To document the clinical characteristics of acute dysphagia in a group of pediatric patients after traumatic brain injury (TBI). RESEARCH DESIGN Prospective group study. METHODS Fourteen subjects (7 males, 7 females), aged 4 years 1 month to 15 years, with moderate or severe TBI (Glasgow Coma Scale [GCS] < 12). Subjects were assessed via clinical bedside examination documenting cognitive status, oromotor function, feeding function, dietary recommendations, and an indication of overall feeding severity. RESULTS A pattern of impaired cognition, altered behavior related to feeding, severe tonal and postural deficits, oromotor, respiratory, and laryngeal impairments, and oral sensitivity issues was revealed. CONCLUSIONS Swallowing impairment was affected by multilevel deficits, which both individually and in combination had a negative impact on swallowing competence and safety. In light of deficits identified, which could not be observed on videofluoroscopic investigation alone, this study highlighted the importance of the clinical bedside examination in assessing dysphagia in pediatric patients post-TBI for identifying targets for intervention.
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Affiliation(s)
- Angela Morgan
- The Department of Speech Pathology and Audiology, University of Queensland, Brisbane, Queensland, Australia.
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Basar P, Yilmaz S, Haberfellner H. Use of an Innsbruck sensorimotor activator and regulator (ISMAR) in the treatment of oral motor dysfunctions: a single case report. Int J Rehabil Res 2003; 26:57-9. [PMID: 12601269 DOI: 10.1097/00004356-200303000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Many patients with cerebral palsy have difficulties during the oral preparatory phase and also during the food transport phase (swallowing), and oral-sensorimotor therapy is practised with these individuals. With oral-sensorimotor therapies, the functioning of the lips, cheeks, tongue and pharyngeal structures, and the interplay between these structures, can be improved. An Innsbruck sensorimotor activator and regulator (ISMAR) is one of the appliances used for oral-motor therapy. The purpose of this study is to describe the appliance and report a patient using ISMAR.
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Affiliation(s)
- P Basar
- T.U. Armagan Donertas, Engelli Cockular Merkezi, 22030 Edine, Turkey
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Manrique D, Melo ECMD, Bühler RB. Avaliação nasofibrolaringoscópica da deglutição em crianças. ACTA ACUST UNITED AC 2001. [DOI: 10.1590/s0034-72992001000600007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introdução: As alterações da deglutição em crianças têm sido pouco estudadas, especialmente nas portadoras de doenças neurológicas, como a paralisia cerebral. No entanto, estas são freqüentes, levando a grande comprometimento das condições clínicas, devido às infecções pulmonares crônicas e complicações decorrentes da desnutrição. Forma de estudo: Prospectivo clínico não randomizado. Objetivo: Verificar a aplicabilidade da nasofibrolaringoscopia na avaliação funcional da deglutição em crianças e as alterações observadas à fase faríngea. Material e método: No período de março de 1998 a março de 2000, realizamos a avaliação funcional da deglutição, através da nasofibrolaringoscopia, em 134 crianças portadoras de paralisia cerebral, com quadro clínico sugestivo de disfagia e idade entre quatro meses e 14 anos (idade média de 5,3 anos), sendo 126 meninos (57,8%) e 92 meninas (42,2%). Resultados: No nosso estudo, nenhuma criança apresentou complicação ou intercorrências durante o exame ou complicação infecciosa decorrente de aspiração após o mesmo. Entre as alterações da deglutição, o escape precoce do alimento para a faringe foi a mais freqüente, ocorrendo em 72 crianças (53,7%). A aspiração traqueal ocorreu mais na testagem da consistência líquida, sendo observada em 45 crianças (33,6%), enquanto que a consistência pastosa deu-se em 20 crianças (14,9%). Houve concordância regular entre a ocorrência de escape precoce e aspiração traqueal. Conclusão: Concluímos que o exame é seguro para ser realizado em crianças, e permite a avaliação objetiva da fase faríngea da deglutição, fornecendo importantes informações, que poderão contribuir na orientação da alimentação dessas crianças.
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Affiliation(s)
- Dayse Manrique
- Hospital do Servidor Público Estadual - Francisco Morato de Oliveira
| | | | - Rogério B Bühler
- Hospital do Servidor Público Estadual - Francisco Morato de Oliveira
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Lambert HC, Gisel EG, Wood-Dauphinee S. The Functional Assessment of Dysphagia. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2001. [DOI: 10.1080/j148v19n03_01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Heather C. Lambert
- School of Physical and Occupational Therapy, McGill University, Montreal, QC
| | - Erika G. Gisel
- School of Physical and Occupational Therapy, McGill University, Montreal, QC
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Abstract
Decisions for management of feeding and swallowing problems in infants and children are likely to be most effective in a professional team approach with caregivers. Optimal management relies on optimal assessment. This article focuses on management strategies that involve "food rules," the position and posture changes, alterations in food and liquid attributes, oral-motor and swallow function, utensil changes, adjustments in feeding schedules and pacing, and behavioral intervention with failure to thrive in the context of global issues for children who are oral and nonoral feeders.
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Affiliation(s)
- J C Arvedson
- Speech-Language-Hearing Department, Children's Hospital of Buffalo, Buffalo, New York, USA
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Abstract
Oral motor patterns during feeding were investigated in 58 patients with severe physical disability. Five patients showed a pattern resembling sucking. Twenty-nine exhibited an up-and-down movement of the jaw and protrusion of the tongue. Among these, the mouth opened when the food entered and the lips closed before swallowing in 20 patients; the mouth was constantly open in nine. Eight had an up-and-down movement of the jaw without protrusion of the tongue. These patterns were frequently seen in patients with spastic tetraplegia caused by neonatal asphyxia and compensated for oral motor impairment. Sixteen patients showed lateral movement of the jaw at some time during feeding; in these patients the texture of the food was more coarse than in those with other patterns.
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Affiliation(s)
- K Yokochi
- Department of Rehabilitation, Ohzora Hospital, Inasa, Shizuoka, Japan.
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Gisel EG. Effect of oral sensorimotor treatment on measures of growth and efficiency of eating in the moderately eating-impaired child with cerebral palsy. Dysphagia 1996; 11:48-58. [PMID: 8556879 DOI: 10.1007/bf00385800] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Thirty-five children with cerebral palsy and moderate eating impairment were studied to determine the effect of oral sensorimotor treatment (OST) on eating efficiency and measures of growth (weight gain). After taking effects of maturation into account, 11 children who received OST (group A) exceeded their expected centile line by 1.7 percentile points after 10 weeks of treatment. Chewing exercises alone (group B) had no effect on weight gain. Although small decreases occurred in the time needed to eat three standard textures of food (solid, viscous, puree) in groups A and B, these were not significant. Children maintained their weight-for-age percentile line although at the lower end of expected norms. These children will be at risk of growth failure because of the increased energy demands once they enter their teenage growth spurt. The clinical implications of these findings are that prolonged mealtime and oral-motor therapies may be adequate through the childhood years. Thereafter, children's growth must be monitored carefully, and oral caloric supplementation is suggested to provide the necessary energy for growth.
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Affiliation(s)
- E G Gisel
- School of Physical and Occupational Therapy, McGill University, Montreal, Québec, Canada
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33
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Gisel EG, Applegate-Ferrante T, Benson JE, Bosma JF. Effect of oral sensorimotor treatment on measures of growth, eating efficiency and aspiration in the dysphagic child with cerebral palsy. Dev Med Child Neurol 1995; 37:528-43. [PMID: 7789662 DOI: 10.1111/j.1469-8749.1995.tb12040.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Twenty-seven children (mean age 5.1 years) with cerebral palsy and moderate eating impairment were studied to determine frequency of aspiration and the effect of 10 and 20 weeks of oral sensorimotor therapy on eating efficiency and measures of growth (weight, skinfold thickness). The eating efficiency of the children did not change markedly in response to oral sensorimotor therapy. Children maintained their centile rank in weight-for-age and skinfold-for-age measurements. However, there was no catch-up growth. The findings suggest that eating efficiency is not a good estimator of treatment outcome, but rather a diagnostic indicator of the severity of eating impairment. Monitoring of these children's growth is essential in order to provide nutritional rehabilitation as soon as their eating skills can no longer keep up with growth demands.
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Affiliation(s)
- E G Gisel
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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