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Hatzikiriakidis K, Ayton D, O'Connor A, Cox R, MacRae A, Gulline H, Callaway L. Biopsychosocial determinants of physical activity and healthy eating for people with disability living in supported accommodation: A systematic review of qualitative research. Disabil Health J 2024; 17:101618. [PMID: 38548523 DOI: 10.1016/j.dhjo.2024.101618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND People with disability living in supported accommodation experience ongoing health disparities. Physical activity and dietary quality are factors that may minimise the risk of chronic disease, however this population may experience a range of biopsychosocial barriers to physical activity and healthy eating. OBJECTIVE The aim of this review was to synthesise the biopsychosocial determinants of physical activity and healthy eating for people with disability living in supported accommodation, as reported by existing qualitative research. METHODS A systematic review of qualitative evidence was conducted according to the JBI's methodological guidance. In September 2023, five academic databases were searched for relevant literature published since database inception. A secondary analysis of the results of included studies was guided by the International Framework for Functioning, Disability, and Health (ICF), using the ICF Linking Rules. RESULTS A total of 31 articles were included. The analysis identified 154 determinants of physical activity and 112 determinants of healthy eating. Determinants were most prominently representative of environmental factors that captured the health promoting role and attitudes of staff, alongside the influence of the organisational context. CONCLUSION This review provided evidence for the complex interactions between body functions and structures, activities and participation, personal factors, and the environment that influence physical activity and healthy eating within supported accommodation. Although there is a limited body of evidence to guide practice, the findings highlight the multifactorial nature of interventions that can be utilised by direct care professionals and adapted to the individual needs and interests of people with disability.
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Affiliation(s)
- Kostas Hatzikiriakidis
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Darshini Ayton
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Amanda O'Connor
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Rachael Cox
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Ann MacRae
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Hannah Gulline
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Libby Callaway
- Rehabilitation, Ageing, and Independent Living (RAIL) Research Centre, School of Allied Health and Primary Care, Monash University, Australia; Occupational Therapy Department, School of Primary and Allied Health Care, Monash University, Australia.
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İslamoğlu AH, Berkel G, Yildirim HS, Aktaç Ş, Bayram F, Sabuncular G, Güneş FE. Chewing difficulties, oral health, and nutritional status in adults with intellectual disabilities: A cross-sectional study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13225. [PMID: 38504582 DOI: 10.1111/jar.13225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/11/2024] [Accepted: 02/25/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Chewing difficulty, poor oral health, inadequate and imbalanced nutrition are serious health problems in individuals with intellectual disabilities. The participants' chewing abilities, oral health and nutritional status were analysed in this study. METHODS Forty-five adult participants with intellectual disabilities were included. Anthropometric measurements, oral health assessments, chewing ability evaluations and dietary intake analyses were conducted. RESULTS A 56.8% of the participants were classified as overweight or obese. Teeth grinding was reported in 33.3% of the participants, while 40.0% experienced drooling. All participants with Down syndrome and 58.6% of the participants with developmental delay had chewing difficulties. Inadequate nutrient intake was observed and the fibre, vitamins B1, B3, B9, sodium, phosphorus and iron intakes were significantly lower than reference values in those with chewing difficulty (p < .05). CONCLUSIONS Chewing difficulties were associated with lower intake of certain nutrients, highlighting the importance of addressing oral health and dietary counselling in this population.
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Affiliation(s)
- Ayşe Hümeyra İslamoğlu
- Department of Nutrition and Dietetics, Marmara University, Faculty of Health Sciences, İstanbul, Türkiye
| | - Gülcan Berkel
- Department of Oral and Maxillofacial Surgery, Marmara University, Faculty of Dentistry, Clinical Sciences, İstanbul, Türkiye
| | - Hatice Selin Yildirim
- Department of Periodontics, Marmara University, Faculty of Dentistry, Clinical Sciences, İstanbul, Türkiye
| | - Şule Aktaç
- Department of Nutrition and Dietetics, Marmara University, Faculty of Health Sciences, İstanbul, Türkiye
| | - Ferit Bayram
- Department of Oral and Maxillofacial Surgery, Marmara University, Faculty of Dentistry, Clinical Sciences, İstanbul, Türkiye
| | - Güleren Sabuncular
- Department of Nutrition and Dietetics, Marmara University, Faculty of Health Sciences, İstanbul, Türkiye
| | - Fatma Esra Güneş
- Department of Nutrition and Dietetics, İstanbul Medeniyet University, Faculty of Health Sciences, İstanbul, Türkiye
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Öztürk ME, Yabanci Ayhan N. The relationship between the severity of intellectual and developmental disabilities (IDDs) in adults with IDDs and eating and drinking problems and nutritional status. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:325-339. [PMID: 38183317 DOI: 10.1111/jir.13114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Adults with intellectual and developmental disabilities (IDDs) experience eating, drinking and swallowing problems, such as chewing problems, choking, gagging, coughing during eating, aspiration and rumination syndrome, which may lead to poor nutritional status. This study aimed to determine the relationship between IDD levels, eating, drinking and swallowing problems and nutritional status in adults with IDDs. METHODS The sample consisted of 71 participants (37 men and 34 women) with a mean age of 22.5 ± 7 years (range 18-60 years). Professionals classified intellectual disability as mild, moderate or severe. The Screening Tool of Feeding Problems scale was applied to the caregivers of adults with IDDs to identify eating, drinking and swallowing problems. Dietary intake was assessed using a 24-h dietary recall and a food and nutrition photograph catalogue. The researchers measured body weight, height and middle upper arm circumference. Body mass index was calculated. Four body mass index categories were determined: underweight (<18.5 kg/m2 ), normal weight (18.5-24.9 kg/m2 ), overweight (25.0-29.9 kg/m2 ) and obese (≥30 kg/m2 ). Chi-squared tests were used to detect the relationship between IDD levels and eating and drinking problems, and analysis of variance tests were conducted to detect the relationship between IDD levels with anthropometric measurements and dietary intake. RESULTS Participants had mild (42.3%; n = 30), moderate (29.6%; n = 21) or severe IDD (28.2%; n = 20). They were underweight (12.7%; n = 9), normal weight (59.2%; n = 42) or overweight and/or obese (28.2%; n = 20). Participants with severe IDD had significantly higher Screening Tool of Feeding Problems 'nutrition-related behaviour' and 'eating and drinking skill deficit problem' sub-scale scores than those with mild IDD. However, the groups had no significant difference in 'food refusal and selectivity' sub-scale scores. Participants with severe IDD also had anorexia prevalence similar to those with mild IDD. The groups did not significantly differ in anthropometric measurements, daily energy intake and macronutrient and micronutrient intake. CONCLUSIONS While adults with severe IDD had more eating and drinking skill deficits (e.g. chewing problems and independent eating difficulties) and nutrition-related behaviour problems than those with mild IDD, the eating, drinking and swallowing problems, which may critically affect their food intake, were similar to adults with mild IDD. The anthropometric measurements and energy and nutrient intakes of adults with severe IDD were not significantly different from those with mild IDD consistently. Findings indicate that nutritional deficiencies and nutritional behaviour problems may be avoidable in adults with IDDs.
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Affiliation(s)
- M E Öztürk
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Karamanoğlu Mehmetbey University, Karaman, Turkey
| | - N Yabanci Ayhan
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Ankara University, Ankara, Turkey
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Vishak MS, Ramasamy K. Swallowing Rehabilitation: Tracing the Evolution of Assessment and Intervention Approaches for Dysphagia over 30 Years. Indian J Otolaryngol Head Neck Surg 2024; 76:2171-2175. [PMID: 38566735 PMCID: PMC10982211 DOI: 10.1007/s12070-023-04325-9] [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: 10/06/2023] [Accepted: 10/26/2023] [Indexed: 04/04/2024] Open
Abstract
Dysphagia or difficulty in swallowing is a common condition affecting millions worldwide. It can occur due to structural problems, neurological disorders, cancer treatment, aging, etc. Swallowing rehabilitation aims to help patients regain safe and efficient swallowing function through compensatory strategies and exercises. This literature review examines the recent advancements in swallowing rehabilitation techniques over the past three decades, with a focus on innovations in diagnostics, personalized medicine, and patient care.
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Affiliation(s)
- M. S. Vishak
- Department of Otorhinolaryngology, JIPMER, Puducherry, Karaikal India
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Watkins L, Kulkarni A, Webber E, Bassett P, Lamb K, Sawhney I, Laugharne R, Heslop P, Jones A, Napier G, Crocker A, Sivan M, Shankar R. People with Intellectual Disabilities, Dysphagia and Post-Covid Syndrome. Dysphagia 2024:10.1007/s00455-024-10679-1. [PMID: 38498202 DOI: 10.1007/s00455-024-10679-1] [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: 05/28/2023] [Accepted: 02/01/2024] [Indexed: 03/20/2024]
Abstract
People with Intellectual Disability (ID) were more likely to contract COVID-19 infection and more likely to die from the consequences. However, there is no evidence on the long-term impact of COVID-19 infection in people with ID. Post-Covid Syndrome (PCS) is an established diagnosis that requires specialist clinical support. To date there is no data on how common PCS is in people with ID, or how symptoms present. Dysphagia is identified as a clinical marker because of the known association with PCS, and the clear objective diagnostic criteria applicable through specialist assessment. This investigation presents a cohort of people with ID, who developed dysphagia/worsening of dysphagia post diagnosis with COVID-19. Cases were identified through support from the Royal College of Speech and Language Therapists. Data was collected by electronic survey, including application of the COVID-19 Yorkshire Rehabilitation Scale-modified (C19-YRSm). The C19-YRSm is a validated assessment tool for PCS and it's impact upon functional disability. This case series identifies that symptoms consistent with PCS are present in people with ID, post-COVID-19 infection. The risk of diagnostic overshadowing or misdiagnosis is high due to the subjective nature and the quality of PCS symptoms. People with ID who develop PCS may not be readily identified by clinical services and therefore not be accessing the specialist medical support required. Furthermore, changes in behaviour secondary to PCS may lead to unnecessary increased prescribing of psychotropic medication which in itself risks worsening dysphagia. Dysphagia could be an important bellwether to identify PCS in people with ID.
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Affiliation(s)
- Lance Watkins
- University of South Wales, Pontypridd, UK
- Swansea Bay University Health Board, Port Talbot, UK
- Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, UK
| | - Amit Kulkarni
- Royal College of Speech & Language Therapists, London, UK
- University of Central Lancashire, Preston, UK
| | - Emma Webber
- Royal College of Speech & Language Therapists, London, UK
| | | | - Kirsten Lamb
- Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, UK
| | - Indermeet Sawhney
- Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
| | - Richard Laugharne
- Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, UK
- Cornwall Partnership NHS Foundation Trust, Threemilestone Industrial Estate, Truro, TR 4 9LD, UK
| | - Pauline Heslop
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Angela Jones
- Swansea Bay University Health Board, Port Talbot, UK
- Royal College of Speech & Language Therapists, London, UK
| | - Geraldine Napier
- Royal College of Speech & Language Therapists, London, UK
- South Eastern Health and Social Care Trust, Belfast, UK
| | - Angela Crocker
- Royal College of Speech & Language Therapists, London, UK
| | - Manoj Sivan
- School of Medicine, University of Leeds, Leeds, UK
| | - Rohit Shankar
- Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, UK.
- Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK.
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Li H, Huang S, Jing J, Yu H, Gu T, Ou X, Pan S, Zhu Y, Su X. Dietary intake and gastrointestinal symptoms are altered in children with Autism Spectrum Disorder: the relative contribution of autism-linked traits. Nutr J 2024; 23:27. [PMID: 38419087 PMCID: PMC10900601 DOI: 10.1186/s12937-024-00930-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 02/23/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Dietary and gastrointestinal (GI) problems have been frequently reported in autism spectrum disorder (ASD). However, the relative contributions of autism-linked traits to dietary and GI problems in children with ASD are poorly understood. This study firstly compared the dietary intake and GI symptoms between children with ASD and typically developing children (TDC), and then quantified the relative contributions of autism-linked traits to dietary intake, and relative contributions of autism-linked traits and dietary intake to GI symptoms within the ASD group. METHODS A sample of 121 children with ASD and 121 age-matched TDC were eligible for this study. The dietary intake indicators included food groups intakes, food variety, and diet quality. The autism-linked traits included ASD symptom severity, restricted repetitive behaviors (RRBs), sensory profiles, mealtime behaviors, and their subtypes. Linear mixed-effects models and mixed-effects logistic regression models were used to estimate the relative contributions. RESULTS Children with ASD had poorer diets with fewer vegetables/fruits, less variety of food, a higher degree of inadequate/unbalanced dietary intake, and more severe constipation/total GI symptoms than age-matched TDC. Within the ASD group, compulsive behavior (a subtype of RRBs) and taste/smell sensitivity were the only traits associated with lower vegetables and fruit consumption, respectively. Self-injurious behavior (a subtype of RRBs) was the only contributing trait to less variety of food. Limited variety (a subtype of mealtime behavior problems) and ASD symptom severity were the primary and secondary contributors to inadequate dietary intake, respectively. ASD symptom severity and limited variety were the primary and secondary contributors to unbalanced dietary intake, respectively. Notably, unbalanced dietary intake was a significant independent factor associated with constipation/total GI symptoms, and autism-linked traits manifested no contributions. CONCLUSIONS ASD symptom severity and unbalanced diets were the most important contributors to unbalanced dietary intake and GI symptoms, respectively. Our findings highlight that ASD symptom severity and unbalanced diets could provide the largest benefits for the dietary and GI problems of ASD if they were targeted for early detection and optimal treatment.
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Affiliation(s)
- Hailin Li
- Research Center of Children and Adolescent Psychological and Behavioral Development, Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, 510080, P.R. China
| | - Saijun Huang
- Department of Child Healthcare, Foshan Women and Children Hospital, Foshan, Guangdong, 528000, P.R. China
| | - Jin Jing
- Research Center of Children and Adolescent Psychological and Behavioral Development, Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, 510080, P.R. China
| | - Hong Yu
- Department of Child Healthcare, Foshan Women and Children Hospital, Foshan, Guangdong, 528000, P.R. China
| | - Tingfeng Gu
- Research Center of Children and Adolescent Psychological and Behavioral Development, Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, 510080, P.R. China
| | - Xiaoxuan Ou
- Research Center of Children and Adolescent Psychological and Behavioral Development, Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, 510080, P.R. China
| | - Shuolin Pan
- Research Center of Children and Adolescent Psychological and Behavioral Development, Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, 510080, P.R. China
| | - Yanna Zhu
- Research Center of Children and Adolescent Psychological and Behavioral Development, Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, 510080, P.R. China.
- Department of Maternal and Child Health, School of Public Health, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, Guangdong, 510080, P.R. China.
| | - Xi Su
- Department of Child Healthcare, Foshan Women and Children Hospital, Foshan, Guangdong, 528000, P.R. China.
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Cox G, Breen LJ, Cocks N. Being practically, professionally and personally prepared: Supporting people with intellectual disability and dysphagia to eat and drink outside the home. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:256-268. [PMID: 35225105 DOI: 10.1080/17549507.2022.2039765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE Eating and drinking outside the home is important for participation and social inclusion for people with intellectual disability and dysphagia (swallowing difficulties) but is likely to come with additional challenges. This qualitative research aimed to identify the challenges and strategies used by people with intellectual disability and dysphagia and their carers when eating outside the home. METHOD This study used a qualitative research design and reflexive researcher stance following an interpretive phenomenological methodology to understand the nature of the phenomenon "supporting people to eat and drink outside the home". Participants (n = 20) including those with intellectual disability and dysphagia (ages 20-30 years), their support staff and families were interviewed about eating and drinking outside the home. Semi-structured interviews were used. Interviews were analysed thematically. RESULT Three overarching themes were extracted using thematic analysis. These were being fully prepared; being a confident and respectful advocate; and being open to the varied responses of other people. CONCLUSION The findings of this study suggest that there are unique challenges for people with intellectual disability and dysphagia and their carers when eating outside the home. There was a need to be practically, professionally, and personally prepared for eating outside the home. There is a need, therefore, to specifically address the challenges of eating outside the home and sharing the strategies used by others to overcome these challenges.
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Affiliation(s)
- Gillian Cox
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Lauren J Breen
- Curtin School of Population Health, Curtin University, Perth, Australia
| | - Naomi Cocks
- Curtin School of Allied Health, Curtin University, Perth, Australia
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Hemsley B, Darcy S, Given F, Murray BR, Balandin S. Going thirsty for the turtles: Plastic straw bans, people with swallowing disability, and Sustainable Development Goal 14, Life Below Water. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:15-19. [PMID: 36503285 DOI: 10.1080/17549507.2022.2127900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE This paper relates to the Sustainable Development Goal (SDG) Life Below Water (SDG 14) and the need to consider Better Health and Well-Being (SDG 3) in interventions designed to reduce plastic straw waste. The aim of this paper is to explore the competing demands of saving the world's oceans and sea life from plastic straw waste, and simultaneously meeting the health and social needs of people with swallowing or physical disability who use plastic straws for drinking. RESULT In order to meet both SDG 14 and not compromise SDG 3 there is a need for collaborative and interdisciplinary, person-centred, inclusive innovation approaches to finding suitable and acceptable alternatives to plastic straws. Many people with swallowing disability will need a durable, flexible, and single-use straw that is resilient enough to withstand jaw closure without breaking. Co-design considerations include the alternative straw being (a) soft and flexible so as not to damage the teeth of people who bite to stabilise the jaw or who have a bite reflex; (b) suitable for both hot and cold drinks; (c) flexible for angling to the mouth; (d) readily, thoroughly and easily cleaned to a high standard of hygiene; (e) widely available for low or no cost wherever drinks are served; and (f) safe for people to use while reducing impact on the environment and being sustainable. CONCLUSION Plastic straws are an assistive technology critical for the social inclusion of people with disability. In an inclusive society, reaching a policy position on the provision of plastic straws must include seeking out and listening to the voices of people with sensory, intellectual, physical, or multiple disabilities who use plastic straws.
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Affiliation(s)
- Bronwyn Hemsley
- The University of Technology Sydney, Sydney, Australia
- The University of Newcastle, Newcastle, Australia and
| | - Simon Darcy
- The University of Technology Sydney, Sydney, Australia
| | - Fiona Given
- The University of Technology Sydney, Sydney, Australia
| | - Brad R Murray
- The University of Technology Sydney, Sydney, Australia
| | - Susan Balandin
- The University of Technology Sydney, Sydney, Australia
- Deakin University, Melbourne, Australia
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Nicholson C, Finlay WML, Stagg S. Self-determination and co-operation in supported mealtimes involving people with severe intellectual disabilities. Disabil Rehabil 2022:1-10. [PMID: 36005211 DOI: 10.1080/09638288.2022.2104941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE People with severe intellectual disabilities are often supported during mealtimes. However, little information exists about how they and care staff co-ordinate their mealtime behaviours. METHOD Four people with severe intellectual disabilities and 12 members of care staff participated in this research. Video data were collected from two services for people with intellectual disabilities. Approximately 30 eating or drinking interactions were filmed, totalling approximately 9.5 h of footage. This footage was analysed using conversation analysis (CA). Ethnographic notes were made. CA is a fine-grained systematic approach which allows examination of how mealtimes are achieved, looking closely at verbal and non-verbal behaviours. RESULTS Results show how people with severe intellectual disabilities can demonstrate whether they are ready, or not, for a mouthful of food or drink despite their limited language abilities. Ways in which readiness and unreadiness were demonstrated are outlined and staff responses are also considered. CONCLUSIONS There are wider implications for self-determination among people with severe intellectual disabilities. Examples provided suggest that people with severe intellectual disabilities can, and do, make decisions about how fast they eat and when they prefer to complete other activities. Respecting these decisions, carers better support the autonomy of individuals with severe intellectual disabilities.
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Affiliation(s)
- Clare Nicholson
- Faculty of Sports, Health and Applied Science, St Mary's University, London, UK
| | - W Mick L Finlay
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, UK
| | - Steven Stagg
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, UK
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Adolfsson P, Umb Carlsson Õ, Ek P. Significant others' perspectives on experiences of meal-oriented support and diet counselling for adults with intellectual disabilities who live in supported housing. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 70:435-443. [PMID: 38699502 PMCID: PMC11062285 DOI: 10.1080/20473869.2022.2095860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/27/2022] [Indexed: 05/05/2024]
Abstract
The quality of meal-oriented support for people with intellectual disabilities is important for their health. The aim of the present study was to explore the experiences of meal-oriented support and diet counselling for adults with intellectual disabilities living in supported housing, from the perspective of housing staff and mothers. Five focus group interviews, including nine supporting staff members and nine mothers, were conducted. The interviews were analyzed using systematic text condensation. Five themes appeared; Extensive needs of the individual, Staff skills determine the food intake, Informal caregivers make up for shortage of support, Effective collaboration with a registered dietitian is needed and Responsibility of the organization state that professionalization of staff is needed. Lacking resources, such as time and nutritional knowledge, insufficient considerations of individual needs, and high staff turnover influence the meal-orientated services negatively. This study brings to the fore, staff working practices and the complexity of providing meal-oriented support for people with intellectual disabilities. Staff need skills to perform individually tailored support. This is best accomplished through effective collaboration between housing staff and relatives underpinned by knowledge from a registered dietitian. The working practices must be structured at the organizational level of the services.
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Affiliation(s)
- Päivi Adolfsson
- Department of Public Health and Caring Sciences, Health Equity and Working Life/HEAL, Uppsala University, Uppsala, Sweden
- Department of Public Health and Caring Sciences, Centre for Disability Research, Uppsala University, Uppsala, Sweden
| | - Õie Umb Carlsson
- Department of Public Health and Caring Sciences, Disability and Habilitation, Uppsala University, Uppsala, Sweden
| | - Pia Ek
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
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Curtis JS, Kennedy SE, Attarha B, Edwards L, Jacob R. Upper Gastrointestinal Disorders in Adult Patients with Intellectual and Developmental Disabilities. Cureus 2021; 13:e15384. [PMID: 34094790 PMCID: PMC8170855 DOI: 10.7759/cureus.15384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The purpose of this literature review is to address the diagnosis and treatment of upper gastrointestinal (GI) disorders in patients with intellectual and developmental disabilities (IDD). Manifestations of upper GI dysmotility and disorders include dysphagia, pulmonary aspiration, malnutrition, gastroesophageal reflux, and gastritis, all of which can impact a person’s quality of life and lead to chronic, life-threatening conditions. This article will explore the existing diagnostic methods and treatments for gastrointestinal disorders as they relate to patients with IDD.
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Affiliation(s)
- Jack S Curtis
- Internal Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Sara E Kennedy
- Internal Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Barrett Attarha
- Internal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Linda Edwards
- Internal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Rafik Jacob
- Internal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
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Leader G, O'Reilly M, Gilroy SP, Chen JL, Ferrari C, Mannion A. Comorbid Feeding and Gastrointestinal Symptoms, Challenging Behavior, Sensory Issues, Adaptive Functioning and Quality of Life in Children and Adolescents with Autism Spectrum Disorder. Dev Neurorehabil 2021; 24:35-44. [PMID: 32496834 DOI: 10.1080/17518423.2020.1770354] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 12/12/2022]
Abstract
AIM Children and adolescents diagnosed with an autism spectrum disorder (ASD) often demonstrate difficulties with feeding. The goal of the current study was to investigate co-occurring issues that often accompany feeding problems in 120 children and adolescents with ASD. Method: This study investigated the relationship between feeding problems and gastrointestinal symptoms, challenging behavior and sensory issues, quality of life, adaptive functioning and use of complementary and alternative medicine (CAM). Results: High rates of feeding problems, gastrointestinal symptoms, challenging behavior and sensory issues were endorsed by caregivers. Considerable differences were observed in the levels of gastrointestinal symptoms, challenging behavior, sensory issues, quality of life and CAM practices.Conclusion: The results of this study extend the present literature by highlighting comorbid conditions related to feeding problems and how feeding problems impact quality of life and adaptive behavior.
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Affiliation(s)
| | | | | | - June L Chen
- East China Normal University , Shanghai, China
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Redley M. Mealtime support for adults with intellectual disabilities: Understanding an everyday activity. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:111-117. [PMID: 32939903 DOI: 10.1111/jar.12790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/30/2020] [Accepted: 07/10/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mealtime support has a direct bearing on the diet-related health of men and women with intellectual disabilities as well as opportunities for expressing dietary preferences. METHOD Semi-structured interviews with a sample of direct support staff providing mealtime support to adults with intellectual disabilities. RESULTS When managing tensions between a person's dietary preferences and ensuring safe and adequate nutrition and hydration, direct support staff are sensitive to a wide range of factors. These include the following: clinical advice; service users' rights to choose; their (in)capacity to weigh up risks; how service users communicate; the constituents of a healthy diet; and a duty to protect service users' health. CONCLUSIONS Those responsible for setting standards and regulating the care practices need to look beyond too simple ideas of choice and safety to recognize ways in which providing support at mealtimes is a complex activity with serious consequences for people's health and well-being.
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Affiliation(s)
- Marcus Redley
- School of Health Sciences, University of East Anglia, Norwich, UK
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McCulloch E, Cuckler A, Valdes E, Hughes MC. Effectiveness of Online Training and Supervisor Feedback on Safe Eating and Drinking Practices for Individuals With Developmental Disabilities. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2020; 58:111-125. [PMID: 32240050 DOI: 10.1352/1934-9556-58.2.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Dysphagia is common in individuals with developmental disabilities. Little research exists on the impact of trainings aimed at improving Direct Care Staff's (DCS) use of safe eating and drinking practices. This article presents two studies using pre-and postexperimental design, evaluating online training to improve DCSs' knowledge and ability to identify nonadherence to diet orders. A pilot study (n = 18) informed improvements to the intervention. The follow-up study (n = 64) compared those receiving training with those receiving training plus supervisor feedback. There was no significant difference between groups after training. Both groups increased in knowledge and identification of nonadherence to diet orders. Online training may be an effective tool for training DCS in safe eating and drinking practices.
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Affiliation(s)
- Emaley McCulloch
- Emaley McCulloch, Relias Institute; Audra Cuckler, Easter Seals; Elise Valdes, Relias Institute; and M. Courtney Hughes, Northern Illinois University
| | - Audra Cuckler
- Emaley McCulloch, Relias Institute; Audra Cuckler, Easter Seals; Elise Valdes, Relias Institute; and M. Courtney Hughes, Northern Illinois University
| | - Elise Valdes
- Emaley McCulloch, Relias Institute; Audra Cuckler, Easter Seals; Elise Valdes, Relias Institute; and M. Courtney Hughes, Northern Illinois University
| | - M Courtney Hughes
- Emaley McCulloch, Relias Institute; Audra Cuckler, Easter Seals; Elise Valdes, Relias Institute; and M. Courtney Hughes, Northern Illinois University
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Hemsley B, Steel J, Sheppard JJ, Malandraki GA, Bryant L, Balandin S. Dying for a Meal: An Integrative Review of Characteristics of Choking Incidents and Recommendations to Prevent Fatal and Nonfatal Choking Across Populations. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:1283-1297. [PMID: 31095917 DOI: 10.1044/2018_ajslp-18-0150] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose The purpose of this study was to conduct an integrative review of original research, across adult populations relating to fatal or nonfatal choking on food, to understand ways to respond to and prevent choking incidents. Method Four scientific databases (CINAHL, Medline, Web of Science, and EMBASE) were searched for original peer-reviewed research relating to fatal or nonfatal choking on foods. Data were extracted on study characteristics; factors leading up to, events at the time of, and actions taken after the choking incident; and impacts of choking incidents. An integrative review of the findings across studies identified several risk factors and recommendations to reduce the risk of choking. Results In total, 52 studies met the criteria for inclusion in this review, of which 31 were quantitative, 17 were qualitative, and 4 were of a mixed methods design. Studies reported the observations and narratives of bystanders or researchers, or else were large-scale autopsy studies, and included both the general public and people at risk of dysphagia. A range of food types were involved, and several actions were reported in response to food choking. Strategies to reduce the risk of choking were identified in the studies and are presented in 5 main categories. Conclusions Factors leading up to choking incidents extend well beyond the individual to the environment for mealtimes; the provision of appropriate mealtime assistance and oral care; and regular monitoring of general health, oral health, and medications. Bystanders' increased awareness and knowledge of how to respond to choking are vital. The results of this review could be used to inform service policy and training, for individuals at risk of choking, the people who support them, and the general public. Further research is needed to explore choking prevention and airway protection in individuals with dysphagia. Supplemental Material https://doi.org/10.23641/asha.8121131.
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Affiliation(s)
- Bronwyn Hemsley
- Graduate School of Health, The University of Technology, NSW, Sydney, Australia
| | - Joanne Steel
- Graduate School of Health, The University of Technology, NSW, Sydney, Australia
- The University of Newcastle, NSW, Australia
| | - Justine Joan Sheppard
- Department of Biobehavioral Sciences, Teacher's College, Columbia University, New York, NY
| | - Georgia A Malandraki
- Department of Speech, Language and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Lucy Bryant
- Graduate School of Health, The University of Technology, NSW, Sydney, Australia
| | - Susan Balandin
- School of Health & Social Development, Deakin University, Melbourne, Victoria, Australia
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Manduchi B, Fainman GM, Walshe M. Interventions for Feeding and Swallowing Disorders in Adults with Intellectual Disability: A Systematic Review of the Evidence. Dysphagia 2019; 35:207-219. [PMID: 31372756 DOI: 10.1007/s00455-019-10038-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 05/14/2019] [Accepted: 07/20/2019] [Indexed: 12/11/2022]
Abstract
Feeding and swallowing disorders are prevalent in adults with Intellectual Disability (ID) and can potentially lead to discomfort, malnutrition, dehydration, aspiration, and choking. Most common interventions include: diet modification, compensatory strategies, swallowing therapy, and non-oral feeding. Despite their common use, the research evidence for these interventions is lacking. The current study aimed to systematically review the evidence for the safety and the effectiveness of interventions for feeding and swallowing disorders in adults with ID. Seven electronic databases, conference proceedings, and reference lists of relevant studies were reviewed from online availability to March 2019, with no language restrictions. Eligibility criteria encompassed experimental or non-experimental study design, adults (> 18 years) with ID and feeding and/or swallowing disorders (any etiology and severity) and any intervention for feeding and/or swallowing disorders. Methodological quality was assessed by two independent reviewers using the Downs and Black checklist. Four articles met the inclusion criteria. All included studies considered enteral feeding as an intervention strategy and had a retrospective observational design. Overall, included studies reported positive change in nutritional status and a high incidence of adverse events following enteral feeding initiation. Risk of bias was high with variability in methodological quality. The safety and effectiveness of interventions for feeding and swallowing in adults with ID is unclear. This review highlights the lack of evidence-based practice in this area. Directions for further research are provided. Before enteral feeding initiation, risks and benefits should be appropriately balanced on an individual basis, and caregivers should be involved in the decision-making process.
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Affiliation(s)
- Beatrice Manduchi
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, D02KF66, Ireland.
| | - Gina Marni Fainman
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, D02KF66, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, D02KF66, Ireland
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Chennubhotla S, Hertog R, Williams JE, Hanna D, Abell TL. An Algorithmic Approach to Nutritional Difficulties in People With Developmental Disabilities. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2019; 57:14-25. [PMID: 30716006 DOI: 10.1352/1934-9556-57.1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
With the increasing survival rate of people with developmental disabilities into adulthood and later life, nutritional support and feeding of these individuals frequently becomes a critical problem which must be addressed by their caregivers and healthcare providers. Problems surrounding mealtimes include difficulty with the mechanisms of feeding as well as medical complications including aspiration and gastrointestinal dysmotility. No comprehensive guidelines exist to aid caregivers and healthcare providers regarding the issues in feeding and nutrition in this population. We offer an algorithmic approach to the nutrition-related problems of aspiration, laborious meals and mealtime refusal, choosing the best route for tube feeding, and when to return patients with developmental disabilities back to oral feeding.
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Affiliation(s)
- Suma Chennubhotla
- Suma Chennubhotla and Rebecca Hertog, University of Louisville; John E. Williams, University of South Carolina School of Medicine-Greenville, Department of Developmental Pediatrics; Debra Hanna, Memphis, TN; and Thomas L. Abell, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Louisville
| | - Rebecca Hertog
- Suma Chennubhotla and Rebecca Hertog, University of Louisville; John E. Williams, University of South Carolina School of Medicine-Greenville, Department of Developmental Pediatrics; Debra Hanna, Memphis, TN; and Thomas L. Abell, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Louisville
| | - John E Williams
- Suma Chennubhotla and Rebecca Hertog, University of Louisville; John E. Williams, University of South Carolina School of Medicine-Greenville, Department of Developmental Pediatrics; Debra Hanna, Memphis, TN; and Thomas L. Abell, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Louisville
| | - Debra Hanna
- Suma Chennubhotla and Rebecca Hertog, University of Louisville; John E. Williams, University of South Carolina School of Medicine-Greenville, Department of Developmental Pediatrics; Debra Hanna, Memphis, TN; and Thomas L. Abell, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Louisville
| | - Thomas L Abell
- Suma Chennubhotla and Rebecca Hertog, University of Louisville; John E. Williams, University of South Carolina School of Medicine-Greenville, Department of Developmental Pediatrics; Debra Hanna, Memphis, TN; and Thomas L. Abell, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Louisville
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18
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Mac Giolla Phadraig C, Nunn J, McCallion P, Donnelly-Swift E, van Harten M, McCarron M. Total tooth loss without denture wear is a risk indicator for difficulty eating among older adults with intellectual disabilities. J Oral Rehabil 2018; 46:170-178. [DOI: 10.1111/joor.12738] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/18/2018] [Accepted: 10/19/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Caoimhin Mac Giolla Phadraig
- Department of Child and Public Dental Health; Dublin Dental University Hospital; Dublin Ireland
- School of Dental Science; Trinity College Dublin; Dublin Ireland
| | - June Nunn
- Department of Child and Public Dental Health; Dublin Dental University Hospital; Dublin Ireland
- School of Dental Science; Trinity College Dublin; Dublin Ireland
| | - Philip McCallion
- School of Nursing and Midwifery; Trinity College Dublin; Dublin Ireland
- School of Social Work; Temple University; Philadelphia Pennsylvania
| | - Erica Donnelly-Swift
- Department of Child and Public Dental Health; Dublin Dental University Hospital; Dublin Ireland
- School of Dental Science; Trinity College Dublin; Dublin Ireland
| | - Maria van Harten
- Department of Child and Public Dental Health; Dublin Dental University Hospital; Dublin Ireland
- School of Dental Science; Trinity College Dublin; Dublin Ireland
| | - Mary McCarron
- School of Nursing and Midwifery; Trinity College Dublin; Dublin Ireland
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19
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Hamzaid NH, Flood VM, Prvan T, O'Connor HT. General nutrition knowledge among carers at group homes for people with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:422-430. [PMID: 29484759 DOI: 10.1111/jir.12480] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 01/06/2018] [Accepted: 01/22/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Good nutrition knowledge among carers of people with intellectual disability (ID) living in group homes is essential as they have a primary role in food provision for residents. Research on the nutrition knowledge of carers is limited. METHOD This cross-sectional study assessed the level of general nutrition knowledge in a convenience sample of Australian carers (C) of people with ID and compared this to the general Australian community (CM). Nutrition knowledge was evaluated using the validated General Nutrition Knowledge Questionnaire. Total knowledge score as well as performance on instrument sub-sections (dietary guidelines, nutrient sources, healthy food choices and diet disease relationships) were assessed (expressed as %). Knowledge scores were adjusted for known confounders (age, sex, education level, BMI, living arrangement and English spoken at home) using generalised linear modelling. RESULTS A total of 589 participants were recruited (C: n = 40; CM: n = 549). Age (C: 40.8 ± 12.1 year; CM: 37.8 ± 13.3 years; P = 0.145), sex distribution (C: 62.5%; CM: 67.2% female; P = 0.602) and English spoken at home (C: 82.5%; CM: 89.6%; P = 0.183) were similar between groups, but BMI (C: 28.5 ± 5.7 kgm-2 ; CM: 25.3 kgm-2 ; P = 0.002) was significantly lower and tertiary education (C: 52.5%; CM: 85.1%; P < 0.0005) significantly higher for CM. Total knowledge score (C: 56.6 ± 12.6%; CM: 67.2 ± 12.6%; P < 0.0005) and performance on all instrument sub-sections (P ≤ 0.004) were significantly lower for carers. This remained after confounder adjustment except for the knowledge of dietary guidelines sub-section (P = 0.116). CONCLUSION Limited carer nutrition knowledge may compromise their ability to plan and adapt meals to support a healthy and appropriate diet for people with ID in group homes.
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Affiliation(s)
- N H Hamzaid
- Faculty of Health Sciences, The University of Sydney, Discipline of Exercise and Sport Science, Lidcombe, New South Wales, Australia
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Program of Dietetics, Kuala Lumpur, Malaysia
| | - V M Flood
- Faculty of Health Sciences, The University of Sydney, Discipline of Exercise and Sport Science, Lidcombe, New South Wales, Australia
- Westmead Hospital, Westmead, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - T Prvan
- Department of Statistics, Faculty of Science and Engineering, Macquarie University, New South Wales, Australia
| | - H T O'Connor
- Faculty of Health Sciences, The University of Sydney, Discipline of Exercise and Sport Science, Lidcombe, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
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20
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Chadwick DD. Dysphagia Management for People With Intellectual Disabilities: Practitioner Identified Processes, Barriers, and Solutions. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2017. [DOI: 10.1111/jppi.12216] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Darren D. Chadwick
- The University of Wolverhampton; Wolverhampton West Midlands United Kingdom
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21
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Robertson J, Chadwick D, Baines S, Emerson E, Hatton C. Prevalence of Dysphagia in People With Intellectual Disability: A Systematic Review. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2017; 55:377-391. [PMID: 29194030 DOI: 10.1352/1934-9556-55.6.377] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Dysphagia (feeding and swallowing disorder) is associated with serious health complications and psychosocial sequelae. This review summarizes international research relating to the prevalence of dysphagia in people with intellectual disability. Studies published from 1990 to July 2016 were identified using Medline, Cinahl, PsycINFO, Web of Science, email requests, and cross-citations. Twenty studies were identified. Dysphagia in people with intellectual disability appears to be associated with more severe levels of intellectual disability, comorbid cerebral palsy, and motor impairments. However, further research with representative samples of people with intellectual disability using adequate methods of assessment are required in order to provide more precise prevalence estimates and clarify factors that may be associated with dysphagia in this population.
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Affiliation(s)
- Janet Robertson
- Janet Robertson, Lancaster University, United Kingdom; Darren Chadwick, University of Wolverhampton, United Kingdom; Susannah Baines, Lancaster University, United Kingdom; Eric Emerson, Lancaster University, United Kingdom and University of Sydney, Australia; and Chris Hatton, Lancaster University, United Kingdom
| | - Darren Chadwick
- Janet Robertson, Lancaster University, United Kingdom; Darren Chadwick, University of Wolverhampton, United Kingdom; Susannah Baines, Lancaster University, United Kingdom; Eric Emerson, Lancaster University, United Kingdom and University of Sydney, Australia; and Chris Hatton, Lancaster University, United Kingdom
| | - Susannah Baines
- Janet Robertson, Lancaster University, United Kingdom; Darren Chadwick, University of Wolverhampton, United Kingdom; Susannah Baines, Lancaster University, United Kingdom; Eric Emerson, Lancaster University, United Kingdom and University of Sydney, Australia; and Chris Hatton, Lancaster University, United Kingdom
| | - Eric Emerson
- Janet Robertson, Lancaster University, United Kingdom; Darren Chadwick, University of Wolverhampton, United Kingdom; Susannah Baines, Lancaster University, United Kingdom; Eric Emerson, Lancaster University, United Kingdom and University of Sydney, Australia; and Chris Hatton, Lancaster University, United Kingdom
| | - Chris Hatton
- Janet Robertson, Lancaster University, United Kingdom; Darren Chadwick, University of Wolverhampton, United Kingdom; Susannah Baines, Lancaster University, United Kingdom; Eric Emerson, Lancaster University, United Kingdom and University of Sydney, Australia; and Chris Hatton, Lancaster University, United Kingdom
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22
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The Role of Food Antioxidants, Benefits of Functional Foods, and Influence of Feeding Habits on the Health of the Older Person: An Overview. Antioxidants (Basel) 2017; 6:antiox6040081. [PMID: 29143759 PMCID: PMC5745491 DOI: 10.3390/antiox6040081] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/17/2017] [Accepted: 10/18/2017] [Indexed: 02/07/2023] Open
Abstract
This overview was directed towards understanding the relationship of brain functions with dietary choices mainly by older humans. This included food color, flavor, and aroma, as they relate to dietary sufficiency or the association of antioxidants with neurodegenerative diseases such as dementia and Alzheimer’s disease. Impairment of olfactory and gustatory function in relation to these diseases was also explored. The role of functional foods was considered as a potential treatment of dementia and Alzheimer’s disease through inhibition of acetylcholinesterase as well as similar treatments based on herbs, spices and antioxidants therein. The importance of antioxidants for maintaining the physiological functions of liver, kidney, digestive system, and prevention of cardiovascular diseases and cancer has also been highlighted. Detailed discussion was focused on health promotion of the older person through the frequency and patterns of dietary intake, and a human ecology framework to estimate adverse risk factors for health. Finally, the role of the food industry, mass media, and apps were explored for today’s new older person generation.
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Sheppard JJ, Malandraki GA, Pifer P, Cuff J, Troche M, Hemsley B, Balandin S, Mishra A, Hochman R. Validation of the Choking Risk Assessment and Pneumonia Risk Assessment for adults with Intellectual and Developmental Disability (IDD). RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 69:61-76. [PMID: 28822297 DOI: 10.1016/j.ridd.2017.07.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/16/2017] [Accepted: 07/23/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Risk assessments are needed to identify adults with intellectual and developmental disability (IDD) at high risk of choking and pneumonia. AIM To describe the development and validation of the Choking Risk Assessment (CRA) and the Pneumonia Risk Assessment (PRA) for adults with IDD. METHODS Test items were identified through literature review and focus groups. Five-year retrospective chart reviews identified a positive choking group (PCG), a negative choking group (NCG), a positive pneumonia group (PPG), and a negative pneumonia group (NPG). Participants were tested with the CRA and PRA by clinicians blind to these testing conditions. RESULTS The CRA and PRA differentiated the PCG (n=93) from the NCG (n=526) and the PPG (n=63) from the NPG (n=209) with high specificity (0.91 and 0.92 respectively) and moderate to average sensitivity (0.53 and 0.62 respectively). Further analyses revealed associations between clinical diagnoses of dysphagia and choking (p=0.043), and pneumonia (p<0.001). CONCLUSIONS The CRA and PRA are reliable, valid risk indicators for choking and pneumonia in adults with IDD. Precautions for mitigating choking and pneumonia risks can be applied selectively thus avoiding undue impacts on quality of life and unnecessary interventions for low risk individuals.
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Affiliation(s)
- Justine Joan Sheppard
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA.
| | - Georgia A Malandraki
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN, USA
| | - Paula Pifer
- Woodward Resource Center, Department of Speech and Hearing, Woodward, IA, USA
| | - Jill Cuff
- Glenwood Resource Center, Department of Occupational Therapy, Glenwood, IA, USA
| | - Michelle Troche
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Bronwyn Hemsley
- School of Humanities and Social Sciences, The University of Newcastle, Newcastle, NSW, Australia
| | - Susan Balandin
- School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
| | - Avinash Mishra
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Roberta Hochman
- Woodbridge Developmental Center, Department of Speech and Hearing (retired), Woodbridge, NJ, USA
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Perez CM, Wagner AP, Ball SL, White SR, Clare ICH, Holland AJ, Redley M. Prognostic models for identifying adults with intellectual disabilities and mealtime support needs who are at greatest risk of respiratory infection and emergency hospitalisation. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:737-754. [PMID: 28497469 PMCID: PMC5518212 DOI: 10.1111/jir.12376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 11/15/2016] [Accepted: 03/15/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Among adults with intellectual disabilities (ID), problems with eating, drinking and swallowing (EDS), and an associated need for mealtime support, are common, with an estimated 15% of adults known to specialist ID services requiring mealtime support. We set out to identify which adults with ID who receive mealtime support are at an increased risk of respiratory infections and emergency hospitalisation related to EDS problems. METHOD An exploratory, prospective cohort study was undertaken in the East of England. At baseline, structured interviews with the caregivers of 142 adults with ID and any type of mealtime support needs were used to gather information on health and support needs over the previous 12 months. These interviews were repeated at follow-up, 12 months later. The resulting dataset, covering a 24-month period, was analysed with logistic regression, using model averaging to perform sensitivity analysis, and backwards step-wise variable selection to identify the most important predictors. RESULTS Individuals with a history of respiratory infections (in the first year of study), those who had epilepsy and those with caregiver-reported difficulty swallowing were most likely to have respiratory infections in the second year. Adults with increasing mealtime support needs, epilepsy and/or full mealtime support needs (fed mainly or entirely by a caregiver or enterally) were at increased risk of emergency hospitalisation for EDS-related problems. CONCLUSIONS Our findings highlight the importance of carefully monitoring health issues experienced by adults with ID and EDS problems, as well as their eating, drinking and swallowing skills. However, the models developed in this exploratory research require validation through future studies addressing the EDS problems commonly experienced by adults with ID and their implications for health outcomes and quality of life. Further research into the relationship between epilepsy and EDS problems would provide much-needed insight into the complex relationship between the two areas.
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Affiliation(s)
- C. M. Perez
- Cambridge Intellectual and Developmental Disabilities Research Group, Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - A. P. Wagner
- Cambridge Intellectual and Developmental Disabilities Research Group, Department of PsychiatryUniversity of CambridgeCambridgeUK
- Health Economics Group, Norwich Medical SchoolUniversity of East AngliaNorwichUK
- National Institute of Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) East of EnglandCambridgeUK
| | - S. L. Ball
- Cambridge Intellectual and Developmental Disabilities Research Group, Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - S. R. White
- MRC Biostatistics UnitUniversity of CambridgeCambridgeUK
| | - I. C. H. Clare
- Cambridge Intellectual and Developmental Disabilities Research Group, Department of PsychiatryUniversity of CambridgeCambridgeUK
- National Institute of Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) East of EnglandCambridgeUK
| | - A. J. Holland
- Cambridge Intellectual and Developmental Disabilities Research Group, Department of PsychiatryUniversity of CambridgeCambridgeUK
- National Institute of Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) East of EnglandCambridgeUK
| | - M. Redley
- Cambridge Intellectual and Developmental Disabilities Research Group, Department of PsychiatryUniversity of CambridgeCambridgeUK
- National Institute of Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) East of EnglandCambridgeUK
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Robertson J, Chadwick D, Baines S, Emerson E, Hatton C. People with intellectual disabilities and dysphagia. Disabil Rehabil 2017; 40:1345-1360. [DOI: 10.1080/09638288.2017.1297497] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Janet Robertson
- Centre for Disability Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Darren Chadwick
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom
| | - Susannah Baines
- Centre for Disability Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Eric Emerson
- Centre for Disability Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
- Centre for Disability Research and Policy, University of Sydney, Sydney, Australia
| | - Chris Hatton
- Centre for Disability Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
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Cleary J, Doody O. Professional carers' experiences of caring for individuals with intellectual disability and dementia. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2017; 21:68-86. [PMID: 26976618 DOI: 10.1177/1744629516638245] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The number of people with intellectual disability living into old age and developing dementia continues to increase. Dementia presents a wide range of challenges for staff due to progressive deterioration. This article presents the findings from a narrative literature review of professional caregivers' experiences of caring for individuals with intellectual disability and dementia. Seven electronic databases were searched using Boolean operators and truncation to identify relevant literature. Search results were combined and narrowed to articles relevant to staff working with individuals with intellectual disability and dementia, and 14 articles met the criteria for review. Themes outlined in the review include staff knowledge of dementia, staff training in dementia, caregiving, challenging behaviour, pain management, mealtime support and coping strategies. Overall carers must review and adjust their care delivery and support to people with intellectual disability and dementia, not only in terms of identifying and responding to their health needs but also through collaborative team working within and across services.
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Guthrie S, Stansfield J. Teatime Threats. Choking Incidents at the Evening Meal. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2015; 30:47-60. [DOI: 10.1111/jar.12218] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Susan Guthrie
- Speech and Language Therapy; Lancashire Care Foundation Trust Whalley; UK
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Perez CM, Ball SL, Wagner AP, Clare ICH, Holland AJ, Redley M. The incidence of healthcare use, ill health and mortality in adults with intellectual disabilities and mealtime support needs. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2015; 59:638-652. [PMID: 25363017 DOI: 10.1111/jir.12167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/22/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Adults with intellectual disabilities (ID) experience a wide range of eating, drinking and/or swallowing (EDS) problems, for which they receive diverse mealtime support interventions. Previous research has estimated that dysphagia (difficulty swallowing) affects 8% of all adults with ID and that 15% require some form of mealtime support. People with ID (whether they require mealtime support or not) also experience a greater burden of ill health and die younger than their peers in the general population with no ID. METHODS Using an exploratory, population-based cohort study design, we set out to examine health-related outcomes in adults with ID who receive mealtime support for any eating, drinking or swallowing problem, by establishing the annual incidence of healthcare use, EDS-related ill health, and all-cause mortality. This study was conducted in two counties in the East of England. RESULTS In 2009, 142 adults with mild to profound ID and a need for any type of mealtime support were recruited for a baseline survey. At follow-up 1 year later, 127 individuals were alive, eight had died and seven could not be contacted. Almost all participants had one or more consultations with a general practitioner (GP) each year (85-95%) and, in the first year, 20% reportedly had one or more emergency hospitalizations. Although their annual number of GP visits was broadly comparable with that of the general population, one-fifth of this population's primary healthcare use was directly attributable to EDS-related ill health. Respiratory infections were the most common cause of morbidity, and the immediate cause of all eight deaths, while concerns about nutrition and dehydration were surprisingly minor. Our participants had a high annual incidence of death (5%) and, with a standardized mortality ratio of 267, their observed mortality was more than twice that expected in the general population of adults with ID (not selected because of mealtime support for EDS problems). CONCLUSIONS All Annual Health Checks now offered to adults with ID should include questions about respiratory infections and EDS functioning, in order to focus attention on EDS problems in this population. This has the potential to reduce life-threatening illness.
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Affiliation(s)
- C M Perez
- Cambridge Intellectual and Development Disabilities Research Group (CIDDRG), Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - S L Ball
- Cambridge Intellectual and Development Disabilities Research Group (CIDDRG), Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - A P Wagner
- Cambridge Intellectual and Development Disabilities Research Group (CIDDRG), Department of Psychiatry, University of Cambridge, Cambridge, UK
- NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Cambridgeshire and Peterborough, Cambridge, UK
| | - I C H Clare
- Cambridge Intellectual and Development Disabilities Research Group (CIDDRG), Department of Psychiatry, University of Cambridge, Cambridge, UK
- NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Cambridgeshire and Peterborough, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - A J Holland
- Cambridge Intellectual and Development Disabilities Research Group (CIDDRG), Department of Psychiatry, University of Cambridge, Cambridge, UK
- NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Cambridgeshire and Peterborough, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - M Redley
- Cambridge Intellectual and Development Disabilities Research Group (CIDDRG), Department of Psychiatry, University of Cambridge, Cambridge, UK
- NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Cambridgeshire and Peterborough, Cambridge, UK
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Ptomey LT, Wittenbrook W. Position of the Academy of Nutrition and Dietetics: Nutrition Services for Individuals with Intellectual and Developmental Disabilities and Special Health Care Needs. J Acad Nutr Diet 2015; 115:593-608. [DOI: 10.1016/j.jand.2015.02.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Indexed: 01/17/2023]
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Chadwick DD, Stubbs J, Fovargue S, Anderson D, Stacey G, Tye S. Training support staff to modify fluids to appropriate safe consistencies for adults with intellectual disabilities and dysphagia: an efficacy study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2014; 58:84-98. [PMID: 23336612 DOI: 10.1111/jir.12013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/05/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Modifying the consistency of food and drink is a strategy commonly used in the management of dysphagia for people with intellectual disabilities (ID). People with ID often depend on others for the preparation of food and drink and therefore depend on those caregivers achieving the correct consistency to keep them safe and avoid discomfort during mealtimes. Clinical experience and prior research have demonstrated that although training can improve modification, carers often find modification difficult and potentially stressful and recommend additional support for carers. Fluid consistency is often modified through the addition of powdered thickener. This study investigates the efficacy of typical training and use of consistency guides, the Thickness Indicator Model (TIM) tubes, in helping carers to modify fluids accurately. METHOD A 3 × 3 pre-post experimental design with a control group was employed to compare the observed accuracy of modification across three groups and at three time points (pre-intervention baseline, immediately post-training intervention and 3-10 months post-training). Sixty-two paid carers who supported people with ID were recruited to participate in the study and each was randomly allocated to one of the three groups: a control group given written guidance only, a group who received typical training and written guidance and a group who received training, written guidance and the TIM tubes. RESULTS & CONCLUSIONS Typical training resulted in significantly greater carer accuracy in modifying fluid consistencies when compared with written guidance alone. Use of the TIM tubes also significantly improved accuracy in the modification of drinks compared with the group who modified with the aid of written guidance alone. At 3-10-month follow-up only the group who received typical training alongside the TIM tubes were significantly more accurate than the Written Guidance group. Further research is warranted to ascertain the effectiveness of the training and the utility of the TIM tubes in improving accuracy over a longer time scale and in individuals' usual living environments.
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Affiliation(s)
- D D Chadwick
- School of Applied Sciences, The University of Wolverhampton, Wolverhampton, UK
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An Observational Study of Adults with Down Syndrome Eating Independently. Dysphagia 2013; 29:52-60. [DOI: 10.1007/s00455-013-9479-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 06/13/2013] [Indexed: 11/26/2022]
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Morgan AT, Dodrill P, Ward EC. Interventions for oropharyngeal dysphagia in children with neurological impairment. Cochrane Database Syst Rev 2012; 10:CD009456. [PMID: 23076958 DOI: 10.1002/14651858.cd009456.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Oropharyngeal dysphagia encompasses problems with the oral preparatory phase of swallowing (chewing and preparing the food), oral phase (moving the food or fluid posteriorly through the oral cavity with the tongue into the back of the throat) and pharyngeal phase (swallowing the food or fluid and moving it through the pharynx to the oesophagus). Populations of children with neurological impairment who commonly experience dysphagia include, but are not limited to, those with acquired brain impairment (for example, cerebral palsy, traumatic brain injury, stroke), genetic syndromes (for example, Down syndrome, Rett syndrome) and degenerative conditions (for example, myotonic dystrophy). OBJECTIVES To examine the effectiveness of interventions for oropharyngeal dysphagia in children with neurological impairment. SEARCH METHODS We searched the following electronic databases in October 2011: CENTRAL 2011(3), MEDLINE (1948 to September Week 4 2011), EMBASE (1980 to 2011 Week 40)
, CINAHL (1937 to current)
, ERIC (1966 to current), PsycINFO (1806 to October Week 1 2011), Science Citation Index (1970 to 7 October 2011), Social Science Citation Index (1970 to 7 October 2011), Cochrane Database of Systematic Reviews, 2011(3), DARE 2011(3), Current Controlled Trials (ISRCTN Register) (15 October 2011), ClinicalTrials.gov (15 October 2011) and WHO ICTRP (15 October 2011). We searched for dissertations and theses using Networked Digital Library of Theses and Dissertations, Australasian Digital Theses Program and DART-Europe E-theses Portal (11 October 2011). Finally, additional references were also obtained from reference lists from articles. SELECTION CRITERIA The review included randomised controlled trials and quasi-randomised controlled trials for children with oropharyngeal dysphagia and neurological impairment. DATA COLLECTION AND ANALYSIS All three review authors (AM, PD and EW) independently screened titles and abstracts for inclusion and discussed results. In cases of uncertainty over whether an abstract met inclusion criterion, review authors obtained the full-text article and independently evaluated each paper for inclusion. The data were categorised for comparisons depending on the nature of the control group (for example, oral sensorimotor treatment versus no treatment). Effectiveness of the oropharyngeal dysphagia intervention was assessed by considering primary outcomes of physiological functions of the oropharyngeal mechanism for swallowing (for example, lip seal maintenance), the presence of chest infection and pneumonia, and diet consistency a child is able to consume. Secondary outcomes were changes in growth, child's level of participation in the mealtime routine and the level of parent or carer stress associated with feeding. MAIN RESULTS Three studies met the inclusion criteria for the review. Two studies were based on oral sensorimotor interventions for participants with cerebral palsy compared to standard care and a third study trialled lip strengthening exercises for children with myotonic dystrophy type 1 compared to no treatment (Sjogreen 2010). A meta-analysis combining results across the three studies was not possible because one of the studies had participants with a different condition, and the remaining two, although using oral sensorimotor treatments, used vastly different approaches with different intensities and durations. The decision not to combine these was in line with our protocol. In this review, we present the results from individual studies for four outcomes: physiological functions of the oropharyngeal mechanism for swallowing, the presence of chest infection and pneumonia, diet consistency, and changes in growth. However, it is not possible to reach definitive conclusions on the effectiveness of particular interventions for oropharyngeal dysphagia based on these studies. One study had a high risk of attrition bias owing to missing data, had statistically significant differences (in weight) across experimental and control groups at baseline, and did not describe other aspects of the trial sufficiently to enable assessment of other potential risks of bias. Another study was at high risk of detection bias as some outcomes were assessed by parents who knew whether their child was in the intervention or control group. The third study overall seemed to be at low risk of bias, but like the other two studies, suffered from a small sample size. AUTHORS' CONCLUSIONS The review demonstrates that there is currently insufficient high-quality evidence from randomised controlled trials or quasi-randomised controlled trials to provide conclusive results about the effectiveness of any particular type of oral-motor therapy for children with neurological impairment. There is an urgent need for larger-scale (appropriately statistically powered), randomised trials to evaluate the efficacy of interventions for oropharyngeal dysphagia.
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Cushing P, Spear D, Novak P, Rosenzweig L, Wallace LS, Conway C, Wittenbrook W, Lemons S, Medlen JG. Academy of Nutrition and Dietetics: Standards of Practice and Standards of Professional Performance for Registered Dietitians (Competent, Proficient, and Expert) in Intellectual and Developmental Disabilities. J Acad Nutr Diet 2012; 112:1454-1464.e35. [DOI: 10.1016/j.jand.2012.06.365] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Indexed: 10/28/2022]
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