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Sugg JN, Lee JW. Neurologic Dysphagia. Otolaryngol Clin North Am 2024; 57:599-608. [PMID: 38664090 DOI: 10.1016/j.otc.2024.03.005] [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] [Indexed: 07/01/2024]
Abstract
Dysphagia is commonly associated with neurologic/neuromuscular disorders including prematurity, cerebral palsy, traumatic brain injury, brain tumors, genetic disorders, and neuromuscular diseases. This article aims to review the major categories of neurologic dysphagia, to outline specific findings and special considerations for each population, and to acknowledge the importance of integrating each patient's medical prognosis, goals of care, and developmental stage into a multidisciplinary treatment plan.
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Affiliation(s)
- Jillian Nyswonger Sugg
- Department of Head and Neck Surgery & Communication Sciences, Division of Speech Pathology and Audiology, Duke University, DUMC 3887, Durham, NC 27710, USA
| | - Janet Waimin Lee
- Department of Head and Neck Surgery & Communication Sciences, Division of Pediatric Otolaryngology, Duke University, DUMC 3805, Durham, NC 27710, USA.
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Otero GR, Mundiña BR, García-Mato E, Aneiros IV, López LS, Iglesias JRG. Development and evaluation of a new website on oral health and Down syndrome. SPECIAL CARE IN DENTISTRY 2024. [PMID: 38566329 DOI: 10.1111/scd.13000] [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: 02/28/2024] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/04/2024]
Abstract
AIMS The objective of this study was to develop a new website in Spanish on oral health and dental care for use by the relatives/caregivers of individuals with Down syndrome, with the aim of incorporating the strengths and avoids the deficiencies of existing websites. METHODS A freely accessible website was developed with dental content, whose access criteria included the age of the individual undergoing the consultation and the area of interest (tongue or teeth disease, oral functionality, oral hygiene, and dental visits). The definitive version of the website was analyzed by five external examiners, applying the DISCERN criteria and the Questionnaire to Evaluate Health Web Sites According to European Criteria (QEEC). The website's traffic during the first year of activity was recorded. RESULTS The new website is known as "DentiDown", and its access domain is https://odontoloxia-accessible.org/dentidown/. On the home screen, the age group of interest to the user can be accessed. A dropdown menu then opens, listing the various options according to the area of interest. The oral hygiene section provides advice for improving toothbrushing efficacy through demonstration videos. With the DISCERN tool, an overall score of 4.75 ± 0.5 was achieved. With the QEEC, the external examiners' general opinion was highly favorable. The website received the seal of quality from the Accredited Medical Web (AMW). During the first year of activity, a total of 4536 visits from a total of 45 countries were recorded. CONCLUSION A new Spanish website has been developed on oral health for use by the relatives/caregivers of individuals with Down syndrome. The website has been favorably evaluated by external experts and, to date, is the only one with these characteristics with the AMW seal of quality.
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Affiliation(s)
- Gemma Rey Otero
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - Berta Rivas Mundiña
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - Eliane García-Mato
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - Iván Varela Aneiros
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - Lucía Sande López
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - José Ramón García Iglesias
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
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Glass TJ, Russell JA, Fisher EH, Ostadi M, Aori N, Yu YE, Connor NP. Altered tongue muscle contractile properties coincide with altered swallow function in the adult Ts65Dn mouse model of down syndrome. Front Neurol 2024; 15:1384572. [PMID: 38585362 PMCID: PMC10995394 DOI: 10.3389/fneur.2024.1384572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/08/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose Down syndrome (DS) is a developmental disability associated with difficulties in deglutition. The adult Ts65Dn mouse model of DS has been previously shown to have differences in measures of swallowing compared with euploid controls. However, the putative mechanisms of these differences in swallowing function are unclear. This study tested the hypothesis that the Ts65Dn genotype is associated with atypical measures of tongue muscle contractile properties, coinciding with atypical swallow function. Methods Adult (5-month-old) Ts65Dn (n = 15 female, 14 male) and euploid sibling controls (n = 16 female, 14 male) were evaluated through videofluoroscopy swallow studies (VFSS) to quantify measures of swallowing performance including swallow rate and inter-swallow interval (ISI). After VFSS, retrusive tongue muscle contractile properties, including measures of muscle fatigue, were determined using bilateral hypoglossal nerve stimulation. Results The Ts65Dn group had significantly slower swallow rates, significantly greater ISI times, significantly slower rates of tongue force development, and significantly greater levels of tongue muscle fatigue, with lower retrusive tongue forces than controls in fatigue conditions. Conclusion Tongue muscle contractile properties are altered in adult Ts65Dn and coincide with altered swallow function.
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Affiliation(s)
- Tiffany J. Glass
- Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, United States
| | - John A. Russell
- Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, United States
| | - Erin H. Fisher
- Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, United States
| | - Marziyeh Ostadi
- Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, United States
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, United States
| | - Nanyumuzi Aori
- Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, United States
| | - Y. Eugene Yu
- The Children’s Guild Foundation Down Syndrome Research Program, Department of Cancer Genetics and Genomics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
- Genetics, Genomics and Bioinformatics Program, State University of New York at Buffalo, Buffalo, NY, United States
| | - Nadine P. Connor
- Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, United States
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, United States
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Ross CF, Bernhard CB, Surette V, Hasted A, Wakeling I, Smith-Simpson S. The influence of food sensory properties on eating behaviours in children with Down syndrome. Food Res Int 2024; 175:113749. [PMID: 38128994 DOI: 10.1016/j.foodres.2023.113749] [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: 06/08/2023] [Revised: 11/15/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023]
Abstract
Developing new food products for children is challenging, particularly in vulnerable groups including children with Down syndrome (DS). Focusing on children with DS, the aim of this study was to study the influence of parent liking on acceptance of food products by children with DS and demonstrate the influence of food sensory properties on indicators of food acceptance, food rejection, and challenging eating behaviours. Children (ages 1158 months) with DS (n = 111) participated in a home use test evaluating snack products with varying sensory properties as profiled by a trained sensory panel. Parents recorded their children's reactions to each food product; trained coders coded videos for eating behaviours. To understand the influence of each sensory modality on eating behaviour, ordered probit regression models were run. Results found a significant correlation between the parent liking and overall child disposition to the food (p < 0.05). From the regression analysis, the inclusion of all food sensory properties, including texture, flavour, taste, product shape and size, improved the percentage of variance explained in child mealtime behaviours and overall disposition over the base model (containing no sensory modalities), with texture having the largest influence. Overstuffing the mouth, a challenging eating behaviour, was most influenced by product texture (children ≥ 30 months), and product texture and size (children < 30 months). In both age groups, coughing/choking/gagging was most influenced by food texture and was associated with a product that was grainy and angular (sharp corners). In both age groups, product acceptance was associated with a product that was dissolvable, crispy, and savoury while rejection was associated with a dense, gummy and fruity product. These results suggest that a dissolvable, crispy texture, with a cheesy or buttery flavour are the sensory properties important in a desirable flavoured commercial snack product for children with DS; however, overall disposition must be balanced against mouth overstuffing.
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Affiliation(s)
- Carolyn F Ross
- School of Food Science, Washington State University, Pullman, WA, USA.
| | - C B Bernhard
- School of Food Science, Washington State University, Pullman, WA, USA
| | - Victoria Surette
- School of Food Science, Washington State University, Pullman, WA, USA
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Syed Mohamed AMF, Wei TZ, Sean CJ, Rosli TI. Comparison of the malocclusion and orthodontic treatment needs of Down syndrome and non-syndromic subjects by using the dental aesthetics index. SPECIAL CARE IN DENTISTRY 2023; 43:554-560. [PMID: 36269010 DOI: 10.1111/scd.12790] [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: 08/29/2022] [Revised: 10/19/2022] [Accepted: 09/25/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the prevalence and significance of the malocclusion traits and orthodontic treatment needs of Down syndrome (DS) subjects with matched non-syndromic (NS) controls. METHODOLOGY This cross-sectional study involved 222 subjects (50% DS, 50% NS) who were matched by gender and age. The casts were digitized into three-dimensional images. These images were used alongside the ten occlusal characteristics of the Dental Aesthetic Index (DAI) to determine malocclusion severity and the need for orthodontic treatment. RESULTS There were 58 (52.3%) females and 53 (47.7%) males with a mean age of 18.4 ± 8.4 years in both groups. The most common and significant (p < .05) malocclusion traits among the DS subjects were missing teeth (56.2%), incisal spacing segments (73.0%), anterior maxillary irregularity (95.5%), mandibular overjet (36.0%), and full cusp deviation of the molar relationship (61.3%). On the other hand, increased maxillary overjet (69.3%) is a more significant (p < .05) trait amongst NS subjects. There were 85 (76.6%) DS subjects who presented severe malocclusion, which implies a highly orthodontic treatment need (DAI > 30). The DS showed some impact of malocclusion traits components of the DAI. CONCLUSION The occurrence of malocclusion was higher in DS, implying a higher need for orthodontic treatments than for NS subjects.
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Affiliation(s)
- Alizae Marny Fadzlin Syed Mohamed
- Discipline of Orthodontics, Department of Family Oral Health, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Tan Zhen Wei
- Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- T-Care Dental Clinic, Skudai, Johor, Malaysia
| | - Cheh Jing Sean
- Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Oasis Dentalcare Dental Clinic, Ipoh, Perak, Malaysia
| | - Tanti Irawati Rosli
- Discipline of Dental Public Health, Department of Family Oral Health, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Wijaya IC, Yohana W, Chemiawan E, Saptarini R, Irmaleni I, Nuraeni N, Soewondo W. Effects of Midface Hypoplasia and Facial Hypotonia at Rest and During Clenching on Drooling in Down syndrome Children. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND: Down syndrome is a chromosome 21 disorder and the most common cause of physical abnormalities including midface hypoplasia, facial hypotonia, and also drooling. Drooling is unintentional anterior salivary flow from the mouth. The objectives of the study is to determine and analyze the effects of midfacial hypoplasia and facial hypotonia on drooling in Down syndrome children. Subject and method:
METHODS: of the research is analytic correlational. Sample retrievement using purposive sampling technique and obtained 20 samples that fulfills the inclusive criterias, consisting of 13 boys and 7 girls with an age range of 6 to 16 years old.
RESULTS AND DISCUSSION: The results were tested statistically by Kendall Coefficient of Concordance Test and Spearman Coefficient of Rank Correlation Test. The results showed that the effect of midfacial hypoplasia, facial hypotonia at rest, and during clenching on drooling is very significant (p-value 0.0002) with Kendall Coefficient of Concordance. Spearman Coefficient of Rank Correlation test results show correlation of midface hypoplasia on drooling is not significant (p-value 0,1265). Facial hypotonia at rest has a very significant correlation on drooling (p-value 0,0000) and during clenching also has a very significant correlation (p-value 0,0000).
CONCLUSION: Conclusion of the research is there are effects of midface hypoplasia, facial hypotonia at rest and facial hypotonia during clenching on drooling, also facial hypotonia at rest and facial hypotonia during clenching on drooling, but no effect of midface hypoplasia on drooling in Down syndrome children.
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Ross CF, Bernhard CB, Surette V, Hasted A, Wakeling I, Smith-Simpson S. Eating behaviors in children with down syndrome: Results of a home-use test. J Texture Stud 2022; 53:629-646. [PMID: 35696524 DOI: 10.1111/jtxs.12703] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/30/2022] [Accepted: 06/04/2022] [Indexed: 11/29/2022]
Abstract
Children with Down syndrome (DS) display a disproportionate number of health challenges, including feeding and swallowing difficulties and food texture sensitivities. To start addressing food texture challenges early in life, the aim of this research was to understand mealtime behaviors and identify preferred food textures of children with DS. Children (aged 11 to 58 months) with DS (n = 111) and without (typically developing, TD; n = 107) participated in a home use test evaluating snack products of varying textures. Parents recorded their children's reactions to each food product; a panel of trained coders coded videos for mealtime behaviors. Children were also identified as food texture sensitive (TS) or non-texture sensitive (NTS). Results showed that age, TS, the presence of a DS diagnosis and the TS*DS interaction influenced the child's behaviors to the food products. Children with DS were more likely to increase distance from the food, mouth/suck on the food, and less likely to chew/much on the food compared to children TD. Children with DS also ate significantly less than typically developing children. Similar mealtime behaviors were observed between the children with TD/<30 months of age and children with DS regardless of age (p < .05). While children with DS/TS had a higher disposition for the dissolvable texture, along with products that were salty and cheesy, children with DS/NTS had a greater tolerance for more textures in general, including crunchy and grainy. Overall, this research identified mealtime behaviors in children with DS, determined overall disposition of children with DS to foods of differences sensory properties, and demonstrated the influence of TS on a child's disposition to a food. This research will be extended to develop acceptable and innovative food products for children with DS/TS.
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Affiliation(s)
- Carolyn F Ross
- School of Food Science, Washington State University. Pullman, Washington, USA
| | | | - Victoria Surette
- School of Food Science, Washington State University. Pullman, Washington, USA
| | - Anne Hasted
- Qi Statistics Ltd. West Malling, Washington, UK
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Cañizares-Prado S, Molina-López J, Moya MT, Planells E. Oral Function and Eating Habit Problems in People with Down Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2616. [PMID: 35270327 PMCID: PMC8909609 DOI: 10.3390/ijerph19052616] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/25/2021] [Accepted: 11/26/2021] [Indexed: 12/10/2022]
Abstract
BACKGROUND Down syndrome (DS) is a genetic disorder in which there is an increased risk of developing clinical comorbidities that require regular attention: health problems, alterations in maxillomandibular development, chewing and swallowing problems, as well as dietary habits that may influence diet and nutritional status. This study will analyze the frequency of occurrence of these factors with increasing age in this population. METHODS A descriptive cross-sectional study was conducted with 18 participants aged 30-45 years. The condition of orofacial structures, chewing and swallowing function and oral and eating habits were assessed to observe the frequency of occurrence of these problems with increasing age. RESULTS A high frequency of digestive problems was observed. There was also a presence of problems in the introduction of new tastes and consistencies. In addition, unilateral chewing was reported in 100% of the participants, severe anatomical dysfunction of the mandible/maxilla and high hypotonicity reflected in tongue movements. CONCLUSIONS it is necessary to educate, through specific intervention protocols, the younger generations with DS, as well as their environment, as harmful habits are developed in childhood and consolidated throughout life.
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Affiliation(s)
- Sonia Cañizares-Prado
- Department of Physiology, Faculty of Pharmacy, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, 18071 Granada, Spain;
- Granadown, Down Syndrome Association of Granada, 18014 Granada, Spain;
| | - Jorge Molina-López
- Department of Physiology, Faculty of Pharmacy, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, 18071 Granada, Spain;
- Faculty of Education, Psychology and Sports Sciences, University of Huelva, 21007 Huelva, Spain
| | | | - Elena Planells
- Department of Physiology, Faculty of Pharmacy, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, 18071 Granada, Spain;
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Ferraz IS, Vieira DMC, Ciampo LAD, Ued FDV, Almeida ACF, Jordão AA, Aragon DC, Martinez EZ, Martinelli CE, Nogueira-de-Almeida CA. Vitamin A deficiency and association between serum retinol and IGF-1 concentrations in Brazilian children with Down syndrome. J Pediatr (Rio J) 2022; 98:76-83. [PMID: 34000230 PMCID: PMC9432046 DOI: 10.1016/j.jped.2021.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/05/2021] [Accepted: 04/05/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To determine the prevalence of vitamin A deficiency (VAD) and serum concentrations of retinol, correlating them with IGF-1 concentrations in preschoolers with DS. METHODS Cross-sectional study was conducted on 47 children with DS aged 24 to 72 months, in Ribeirão Preto, Brazil. VAD was determined by the relative dose-response (RDR) test. Retinol serum concentration ≤ 0.70 µmol/L and IGF-1 serum concentration below the 3rd percentile for sex and age were considered to represent deficiency. C-reactive protein (CRP) was determined at the beginning of the study. Weight, height, and information about fever and/or diarrhea were obtained at the beginning of the study. RESULTS VAD prevalence was 25.5% (12/47), and 74.5% (35/47) of the children had deficient retinol before the intervention. CRP was not associated with VAD. Mean IGF-1 were 103.5 ng/mL (SD = 913) for the group with VAD and 116.3 ng/mL (SD = 54.9) for the group with no VAD (p-value = 0.85); 8.5% (4/47) of the children showed deficient IGF-1, but without VAD. No association was observed between VAD and IGF-1 deficiency. A moderate positive correlation was observed between pre-intervention retinol and IGF-1 (ρ = 0.37; p-value = 0.01). CONCLUSION a high prevalence of VAD and deficient retinol was observed and there was a positive correlation between serum retinol and IGF-1.
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Affiliation(s)
- Ivan Savioli Ferraz
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Ribeirão Preto, SP, Brazil
| | - Débora Mônica Costa Vieira
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Ribeirão Preto, SP, Brazil
| | - Luiz Antonio Del Ciampo
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Ribeirão Preto, SP, Brazil.
| | - Fábio da Veiga Ued
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Ciências da Saúde, Ribeirão Preto, SP, Brazil
| | - Ane Cristina Fayão Almeida
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Ribeirão Preto, SP, Brazil
| | - Alceu Afonso Jordão
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Ciências da Saúde, Ribeirão Preto, SP, Brazil
| | - Davi Casale Aragon
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Ribeirão Preto, SP, Brazil
| | - Edson Zangiacomi Martinez
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Medicina Social, Ribeirão Preto, SP, Brazil
| | - Carlos Eduardo Martinelli
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Ribeirão Preto, SP, Brazil
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Ross CF, Surette VA, Bernhard CB, Smith-Simpson S, Lee J, Russell CG, Keast R. Development and application of specific questions to classify a child as food texture sensitive. J Texture Stud 2021; 53:3-17. [PMID: 34435671 DOI: 10.1111/jtxs.12627] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/30/2021] [Accepted: 08/05/2021] [Indexed: 11/26/2022]
Abstract
Understanding food texture sensitivity in children is important in guiding food selection. The objective of this work was to develop a short questionnaire that could be completed by parents in nonclinical settings to provide a categorization for food texture sensitivity in children. This study evaluated the distribution of children as texture sensitive (TS) or non-texture sensitive (NTS) and the predictive validity of these questions to explain rejection of specific food textures. Three sets of survey data were examined, including data from a home-use test (HUT) in children with and without Down syndrome (DS), and lingual tactile sensitivity measured by grating orientation task (GOT). From three parent-completed surveys, the use of the questionnaire yielded a similar distribution of children in the TS category (16-22%) as previously reported. TS children (4-36 months) were more likely to reject specific food textures, including chewy, hard, lumpy, and "tough meat" (p < .05). A higher percentage of children with a diagnosis of DS were TS (36.9%). Children who were TS showed increased negative behaviors to foods and ate less than NTS children. In older children (5-12 years), TS children were fussier than NTS children (p < .001). Lingual tactile sensitivity was not significantly different by TS/NTS categorization (p = .458). This study demonstrated that the use of these five questions specific to food texture provides a useful tool in categorizing a child as TS/NTS, with this information being useful in selecting preferred food textures. Future studies involving these TS questions should perform psychometric assessments and measures of criterion validity using other questionnaires.
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Affiliation(s)
- Carolyn F Ross
- School of Food Science, Washington State University, Pullman, Washington, USA
| | - Victoria A Surette
- School of Food Science, Washington State University, Pullman, Washington, USA
| | - Charles B Bernhard
- School of Food Science, Washington State University, Pullman, Washington, USA
| | | | - Jookyeong Lee
- CASS Food Research Centre, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Catherine G Russell
- CASS Food Research Centre, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Russell Keast
- CASS Food Research Centre, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
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Farpour HR, Moosavi SA, Mohammadian Z, Farpour S. Comparing the Tongue and Lip Strength and Endurance of Children with Down Syndrome with Their Typical Peers Using IOPI. Dysphagia 2021; 37:966-972. [PMID: 34432140 DOI: 10.1007/s00455-021-10359-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 08/16/2021] [Indexed: 11/30/2022]
Abstract
Muscular hypotonia is a feature of Down syndrome (DS), and it affects the tongue and lips. A study on oral dysfunction in children with DS concluded that most of them did not have the tongue strength for completing the oral phase of swallowing. Recognizing the weakness of the oral muscles and improving its motor function positively affects mastication and swallowing, and prevents complications. This cross-sectional study aimed to measure the lip and tongue strength and endurance of children with DS and their typical peers, and compare these two groups with each other using Iowa Oral Performance Instrument (IOPI). Eight children with DS and 33 typical children aged 8-13 years were enrolled in this study. To examine the effect of age on the tongue strength and endurance, we divided the children into three groups of 8-9, 10-11, and 12-13 years old. The results showed that both anterior and posterior tongue strength were significantly lower in children with DS (p = 0.004 and 0.003). But, it was not the case with tongue endurance. Also, in 10-11 years old age group, the mean posterior tongue strength and in 12-13 years old age group the lip endurance was significantly lower in children with DS (p = 0.05 for both). Lips strength and endurance were both remarkably lower in children with DS (p = 0.004 and 0.02). In this study, tongue, and lip strength and endurance in both children with DS and typical ones were measured with IOPI for the first time. Moreover, it provided quantitative data on the strength and endurance of the muscles of the tongue and lips, which can contribute to future studies.
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Affiliation(s)
- Hamid Reza Farpour
- Bone and Joint Diseases Research Center, Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran
- Shiraz Geriatric Research Center, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Faculty of Medicine, Shiraz University of Medical Sciences, Zand Ave., 7187646610, Shiraz, Iran
| | - Seyed Ali Moosavi
- Faculty of Medicine, Shiraz University of Medical Sciences, Zand Ave., 7187646610, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zhila Mohammadian
- Faculty of Medicine, Shiraz University of Medical Sciences, Zand Ave., 7187646610, Shiraz, Iran
- Student Research Committee, Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sima Farpour
- Faculty of Medicine, Shiraz University of Medical Sciences, Zand Ave., 7187646610, Shiraz, Iran.
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran.
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12
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Hudson AS, Stratton-Gadke K, Hatchette J, Blake KD. New Feeding Assessment Scale for individuals with genetic syndromes: Validity and reliability in the CHARGE syndrome population. J Paediatr Child Health 2021; 57:1234-1243. [PMID: 33682238 DOI: 10.1111/jpc.15434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/05/2021] [Accepted: 02/23/2021] [Indexed: 11/28/2022]
Abstract
AIM To develop a feeding scale for parents/care givers of individuals of all ages with genetic syndromes experiencing extensive feeding and swallowing problems. Second, to assess its validity and reliability in CHARGE syndrome. METHODS The new Feeding Assessment Scale (FAS) was adapted from a scale for children who need prolonged tube feeding (Paediatric Assessment Scale for Severe Feeding Problems, PASSFP). Ten parents piloted the new scale before it was sent out with the PASSFP and feeding history questions. A subset completed the new scale again 4-8 weeks later. RESULTS One hundred parents of individuals with CHARGE syndrome participated from around the world. The new scale had good construct validity, with a significant effect for an increased number of feeding risk factors having higher scale scores (P < 0.001). Face validity was high, as scores significantly differed between individuals whose parents identified their feeding difficulties as very mild, mild, moderate, severe and very severe (P < 0.001). Test-retest reliability (r = 0.94, P < 0.001) and internal consistency (Cronbach's alpha 0.91) were both high. There was significant convergent validity between the new scale and the PASSFP (r = -0.79, P < 0.001). CONCLUSIONS This new tool is reliable and valid for parents/care givers of individuals with CHARGE syndrome. It can be used to assess the current severity of feeding difficulties and to track progress before and after treatment. It expands upon previous existing tools in that it can be used in both individuals who are not tube fed, as well as in those who are, as well as across the life-span.
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Affiliation(s)
- Alexandra S Hudson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Kasee Stratton-Gadke
- Department of Counseling, Educational Psychology & Foundations, Mississippi State University, Starkville, Mississippi, USA
| | - Jill Hatchette
- Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Kim D Blake
- Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada.,Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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13
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Wintergerst A, López-Morales MP. Masticatory function in children with Down syndrome. Physiol Behav 2021; 235:113390. [PMID: 33736969 DOI: 10.1016/j.physbeh.2021.113390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 03/07/2021] [Accepted: 03/13/2021] [Indexed: 11/27/2022]
Abstract
The objective was to study masticatory function of 8 to 10-year-old children with Down syndrome (DS) through the evaluation of maximum occlusal force and masticatory performance (via medium particle size) and compare it to that of children of the same age without DS. METHODS A convenience sample of eight, 8-10-year-old children with DS were included in this cross-sectional study. The study had ethical approval and parents provided informed consent. Exclusion criteria were large carious lesions, dental pain or previous orthodontic/orthopedic treatment. Masticatory performance was evaluated with an artificial test food (Optosil Comfort®) after 20 cycles and at swallowing threshold. The chewed material was collected, dried and sieved. The material on each sieve was weighed; the weights were used to calculate medium particle size. Maximum occlusal force (1st permanent molars) was determined using the GM10 Nagano Keiki Co.™ portable transducer. The number of cycles until swallowing threshold, cycle and sequence durations were also compared. The data for the reference group (n = 32) came from a previous study in children of the same age. Descriptive statistics as well as comparisons with Mann-Whitney tests and simple and multiple regression analysis were performed. Cutoff was set at p≤.05. RESULTS Medium particle size is larger by 44% after 20 chewing cycles and 75% at swallowing threshold (p<.05) in children with DS. Median maximum occlusal force was 254 kN in DS children and 499 kN in children without the syndrome (p<.001). 48% of the variance in maximum occlusal force is explained by having DS. There were also significant differences in sequence and cycle durations. All significant differences had large effect sizes (˃1). Although the children with DS chewed more cycles before swallowing threshold the difference was not significant. CONCLUSIONS Children with DS have approximately 50% of the masticatory performance and maximum occlusal force of children of the same age without DS. These findings can be associated to the feeding problems reported in children with DS.
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Affiliation(s)
- Ana Wintergerst
- División de Estudios de Posgrado e Investigación, Facultad de Odontología, Universidad Nacional Autónoma de México, Av. Universidad 3000, Col. Universidad Nacional Autónoma de México, CP 04510 Ciudad de México, México.
| | - Marcela Patricia López-Morales
- División de Estudios de Posgrado e Investigación, Facultad de Odontología, Universidad Nacional Autónoma de México, Av. Universidad 3000, Col. Universidad Nacional Autónoma de México, CP 04510 Ciudad de México, México
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14
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Takizawa H, Takahashi M, Maki K. Three-Dimensional Assessment of Craniofacial Features in Patients With Down Syndrome During the Mixed Dentition Period: A Case-Control Study. Cleft Palate Craniofac J 2021; 59:177-184. [PMID: 33685243 DOI: 10.1177/1055665621998181] [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] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Down syndrome (DS) is a common congenital chromosomal disorder related to trisomy 21. Lateral cephalometric radiography studies have shown that patients with DS have characteristic craniofacial morphology; however, no 3-dimensional analysis studies have been performed to investigate the craniofacial features, including volumetric aspects, of patients with DS. The present study was performed to evaluate the craniofacial features, including volumetric aspects, of patients with DS and to compare these findings with control participants using cone beam computed tomography (CBCT). MATERIALS AND METHODS The study sample consisted of 12 patients with DS and 12 control participants. All participants were examined by means of CBCT; the resulting images were used for evaluation of maxillary and mandibular volume, cranial base, and craniofacial measurements. Differences between patients with DS and control participants were statistically analyzed using Student t test. RESULTS Compared to control participants, patients with DS exhibited statistically significant reductions in maxillary and mandibular volumes. Both sagittal and axial cranial base linear measurements were shorter in patients with DS than in control participants. In contrast, the cranial base angle was enhanced in patients with DS, compared with control participants. Moreover, condylion (Co)-gnathion, anterior nasal spine-menton, and Co-subspinale (point A) measurements were shorter in patients with DS than in control participants; the sella-nasion-mandibular plane angle was significantly reduced in patients with DS, compared with control participants. CONCLUSION Our results suggest that patients with DS have distinct skeletal volume and craniofacial morphology features, relative to individuals without DS.
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Affiliation(s)
- Hideomi Takizawa
- Department of Orthodontics, School of Dentistry, Showa University, Tokyo, Japan
| | - Masahiro Takahashi
- Department of Orthodontics, School of Dentistry, Showa University, Tokyo, Japan
| | - Koutaro Maki
- Department of Orthodontics, School of Dentistry, Showa University, Tokyo, Japan
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15
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Santoro JD, Pagarkar D, Chu DT, Rosso M, Paulsen KC, Levitt P, Rafii MS. Neurologic complications of Down syndrome: a systematic review. J Neurol 2020; 268:4495-4509. [PMID: 32920658 DOI: 10.1007/s00415-020-10179-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 12/18/2022]
Abstract
Down syndrome (DS) is one of the most well-recognized genetic disorders. Persons with DS are known to have a variety of co-morbid medical problems, affecting nearly all organ systems. Improved healthcare interventions and research have allowed for increased life span of persons with DS, although disorders of the neurologic system remain underexplored. The purpose of this systematic review is to provide clinically pertinent information on the neurological phenotypes of frequently occurring or clinically relevant conditions. A retrospective review of MEDLINE, Scopus, and Pubmed were used to identify sources among seventeen, clinically relevant, search categories. MeSH terms all contained the phrase "Down Syndrome" in conjunction with the topic of interest. 'Frequently-occurring' was defined as prevalent in more than 10% of persons with DS across their lifespan, whereas 'clinically-relevant' was defined as a disease condition where early diagnosis or intervention can augment the disease course. In total, 4896 sources were identified with 159 sources meeting criteria for inclusion. Seventeen clinical conditions were grouped under the following subjects: hypotonia, intellectual and learning disability, cervical instability, autism spectrum disorder, epilepsy, cerebrovascular disease, Alzheimer's disease and neuropsychiatric disease. The results of this review provide a blueprint for the clinical neurologist taking care of persons with DS across the age spectrum and indicate that there are many underrecognized and misdiagnosed co-occurring conditions in DS, highlighting the need for further research.
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Affiliation(s)
- Jonathan D Santoro
- Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA. .,Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Dania Pagarkar
- Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Duong T Chu
- Faculty of Medicine, Queen's University, Kingston, ON, Canada
| | - Mattia Rosso
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Kelli C Paulsen
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Pat Levitt
- Department of Pediatrics and Program in Developmental Neuroscience and Developmental Neurogenetics, The Saban Research Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael S Rafii
- Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA.,Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Alzheimer's Therapeutic Research Institute (ATRI), Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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16
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Sena LDS, Palma LF, Marques SR, Sanches ML, de Moraes LOC. A home-based multidisciplinary programme for Down syndrome adults with muscular temporomandibular disorder. J Oral Rehabil 2020; 47:939-943. [PMID: 32484972 DOI: 10.1111/joor.13027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 05/11/2020] [Accepted: 05/24/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Patients with Down syndrome (DS) present functional and anatomical alterations that may negatively impact their health and quality of life. Down syndrome patients have been shown to have a high prevalence of temporomandibular disorder (TMD), but little is known about the diagnosis, treatment and prevention in these individuals. OBJECTIVE To evaluate the impact of a home-based multidisciplinary programme on muscular TMD in DS adults. METHODS After being diagnosed with TMD-related masticatory muscle disorder, 20 adult men and 20 adult women with DS received an educational material with instructions on how to perform daily home facial self-massage and exercises for orofacial and masticatory muscles. Participants were also provided with educational information on TMD. Those who failed to perform at least 50% of the programme (23 days) were considered non-adherent. Oral parafunctional behaviours, facial pressure-pain threshold and maximum mouth opening were assessed at baseline and after the intervention. RESULTS Twenty-five patients adhered to the programme as opposed to 15 non-adherent patients. Statistically significant improvements in all parameters were observed among adherent patients, except for the number of parafunctions. CONCLUSION The proposed home-based multidisciplinary programme seemed to be effective in improving some aspects related to muscular TMD in DS adults.
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Affiliation(s)
- Letícia da Silva Sena
- Discipline of Descriptive and Topographic Anatomy, Department of Morphology and Genetics, Federal University of São Paulo, São Paulo, Brazil
| | - Luiz Felipe Palma
- Discipline of Descriptive and Topographic Anatomy, Department of Morphology and Genetics, Federal University of São Paulo, São Paulo, Brazil.,MSc Dentistry Program, Ibirapuera University, São Paulo, Brazil
| | - Sérgio Ricardo Marques
- Discipline of Descriptive and Topographic Anatomy, Department of Morphology and Genetics, Federal University of São Paulo, São Paulo, Brazil
| | - Monique Lalue Sanches
- Discipline of Descriptive and Topographic Anatomy, Department of Morphology and Genetics, Federal University of São Paulo, São Paulo, Brazil
| | - Luís Otávio Carvalho de Moraes
- Discipline of Descriptive and Topographic Anatomy, Department of Morphology and Genetics, Federal University of São Paulo, São Paulo, Brazil
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17
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Slaoui Hasnaoui M, Arsenault I, Verdier D, Obeid S, Kolta A. Functional Connectivity Between the Trigeminal Main Sensory Nucleus and the Trigeminal Motor Nucleus. Front Cell Neurosci 2020; 14:167. [PMID: 32655373 PMCID: PMC7324845 DOI: 10.3389/fncel.2020.00167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/19/2020] [Indexed: 11/24/2022] Open
Abstract
The present study shows new evidence of functional connectivity between the trigeminal main sensory (NVsnpr) and motor (NVmt) nuclei in rats and mice. NVsnpr neurons projecting to NVmt are most highly concentrated in its dorsal half. Their electrical stimulation induced multiphasic excitatory synaptic responses in trigeminal MNs and evoked calcium responses mainly in the jaw-closing region of NVmt. Induction of rhythmic bursting in NVsnpr neurons by local applications of BAPTA also elicited rhythmic firing or clustering of postsynaptic potentials in trigeminal motoneurons, further emphasizing the functional relationship between these two nuclei in terms of rhythm transmission. Biocytin injections in both nuclei and calcium-imaging in one of the two nuclei during electrical stimulation of the other revealed a specific pattern of connectivity between the two nuclei, which organization seemed to critically depend on the dorsoventral location of the stimulation site within NVsnpr with the most dorsal areas of NVsnpr projecting to the dorsolateral region of NVmt and intermediate areas projecting to ventromedial NVmt. This study confirms and develops earlier experiments by exploring the physiological nature and functional topography of the connectivity between NVsnpr and NVmt that was demonstrated in the past with neuroanatomical techniques.
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Affiliation(s)
- Mohammed Slaoui Hasnaoui
- Groupe de Recherche sur le Systéme Nerveux Central, Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montréeal, QC, Canada
| | - Isabel Arsenault
- Groupe de Recherche sur le Systéme Nerveux Central, Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montréeal, QC, Canada
| | - Dorly Verdier
- Groupe de Recherche sur le Systéme Nerveux Central, Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montréeal, QC, Canada
| | - Sami Obeid
- Groupe de Recherche sur le Systéme Nerveux Central, Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montréeal, QC, Canada
| | - Arlette Kolta
- Groupe de Recherche sur le Systéme Nerveux Central, Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montréeal, QC, Canada.,Département de Stomatologie, Faculté de Médecine Dentaire, Université de Montreal, Montreal, QC, Canada
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18
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Assery MK, Albusaily HS, Pani SC, Aldossary MS. Bite Force and Occlusal Patterns in the Mixed Dentition of Children with Down Syndrome. J Prosthodont 2020; 29:472-478. [PMID: 32394526 DOI: 10.1111/jopr.13186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Oral function in Down Syndrome (DS) patients has been of interest to clinicians and researchers. This study aimed to evaluate the parameters of occlusal force and pattern of children with Down syndrome (DS) during mixed dentition when compared to age and gender-matched controls. MATERIALS AND METHODS Thirty DS and 30 healthy children, aged 7 to 12 years, participated in the evaluation of the parameters of the occlusal pattern and occlusal force distribution analysis. Both groups underwent clinical examination, occlusal force and pattern measurements using a computerized occlusal analysis system (T-Scan 8 occlusal analysis, Tekscan, Inc., S. Boston, MA). Occlusion time, percentage of force distribution, force outliers, center of force target area, center of force trajectory and evaluation of closure arc were compared between the two groups using the Pearson's Chi Square test. RESULTS Children with DS had more occlusal and vertical malocclusion compared to the control group (p < 0.001). The occlusion time for DS group (0.75 ± 0.7s) was significantly longer than the control group (0.015 ± 0.05s) (p < 0.001). The closure arc for DS group was mostly irregular (53%), while the control group showed ideal closure arc. In control group, the age had a significant influence on the occlusion time, while height, weight, and BMI had a significant influence on the mouth opening. None of these variables had such effect on children with DS. CONCLUSIONS The results of this study showed high prevalence of orofacial dysfunction among DS population. The occlusal analysis showed that children with DS had longer occlusion time and a lack of ideal occlusion pattern compared to age matched controls.
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Affiliation(s)
- Mansour K Assery
- Department of Prosthodontics, Vice Rector for Postgraduate Studies and Scientific Research, Riyadh Elm University, Riyadh, Saudi Arabia
| | | | - Sharat C Pani
- Division of Paediatric Dentistry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
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19
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Nutritional challenges in children and adolescents with Down syndrome. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 4:455-464. [DOI: 10.1016/s2352-4642(19)30400-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/15/2019] [Accepted: 11/27/2019] [Indexed: 12/14/2022]
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20
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Giannasi LC, Politti F, Dutra MTS, Tenguan VLS, Silva GRC, Mancilha GP, Silva DBD, Oliveira LVF, Oliveira CS, Amorim JBO, Salgado MAC, Gomes MF. Intra-Day and Inter-Day Reliability of Measurements of the electromyographic signal on masseter and temporal muscles in patients with Down syndrome. Sci Rep 2020; 10:7477. [PMID: 32366926 PMCID: PMC7198527 DOI: 10.1038/s41598-020-63963-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 04/01/2020] [Indexed: 11/24/2022] Open
Abstract
The aim of the present study was to evaluate intra-day (test) and inter-day (re-test) reliability of surface electromyography (sEMG) signals of the masseter and temporal muscles in patients with Down syndrome (DS). We determined the reliability of sEMG variables in 33 patients with DS. EMG signals were recorded at rest as well as during maximum voluntary clenching and maximum habitual intercuspation (MHI). The signals were analyzed considering the amplitude in the root mean square (RMS), mean frequency (MNF), median frequency (MDF) and approximate entropy (ApEn). The intraclass correlation (ICC2,1) for the three trials recorded during MHI in the two sessions (test and retest) revealed excellent intra-session and inter-session reliability (ICC2,1 = 0.76 to 0.97) for all sEMG variables and muscles. In the rest position, excellent reliability was found for RMS and ApEn (ICC2,1 = 0.75 to 1.00) and good to excellent reliability was found for MDF and MNF (ICC2,1 = 0.64 to 0.93). The intra-session (test) and inter-session (re-test) analyses demonstrated the reliability of nonlinear sEMG variables of the masticatory muscles in adults with Down Syndrome.
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Affiliation(s)
- Lilian Chrystiane Giannasi
- Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE), Institute of Science and Technology, São José dos Campos Campus, São Paulo State University-UNESP, São Paulo, SP, Brazil. .,Centro Universitário de Anápolis - UniEvangélica, São Paulo, Brazil.
| | | | - Marignês T S Dutra
- Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE), Institute of Science and Technology, São José dos Campos Campus, São Paulo State University-UNESP, São Paulo, SP, Brazil
| | - Vera L S Tenguan
- Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE), Institute of Science and Technology, São José dos Campos Campus, São Paulo State University-UNESP, São Paulo, SP, Brazil
| | - Gabriela R C Silva
- Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE), Institute of Science and Technology, São José dos Campos Campus, São Paulo State University-UNESP, São Paulo, SP, Brazil
| | - Gabriela P Mancilha
- Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE), Institute of Science and Technology, São José dos Campos Campus, São Paulo State University-UNESP, São Paulo, SP, Brazil
| | - Daniel Batista da Silva
- Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE), Institute of Science and Technology, São José dos Campos Campus, São Paulo State University-UNESP, São Paulo, SP, Brazil
| | | | | | - Jose B O Amorim
- Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE), Institute of Science and Technology, São José dos Campos Campus, São Paulo State University-UNESP, São Paulo, SP, Brazil
| | - Miguel Angel Castillo Salgado
- Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE), Institute of Science and Technology, São José dos Campos Campus, São Paulo State University-UNESP, São Paulo, SP, Brazil
| | - Mônica F Gomes
- Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE), Institute of Science and Technology, São José dos Campos Campus, São Paulo State University-UNESP, São Paulo, SP, Brazil
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21
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Capone G, Stephens M, Santoro S, Chicoine B, Bulova P, Peterson M, Jasien J, Smith AJ. Co-occurring medical conditions in adults with Down syndrome: A systematic review toward the development of health care guidelines. Part II. Am J Med Genet A 2020; 182:1832-1845. [PMID: 32338447 DOI: 10.1002/ajmg.a.61604] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 03/27/2020] [Accepted: 04/06/2020] [Indexed: 12/12/2022]
Abstract
Adults with Down syndrome (DS) represent a unique population who are in need of clinical guidelines to address their medical care. Many of these conditions are of public health importance with the potential to develop screening recommendations to improve clinical care for this population. Our workgroup previously identified and prioritized co-occurring medical conditions in adults with DS. In this study, we again performed detailed literature searches on an additional six medical conditions of clinical importance. A series of key questions (KQ) were formulated a priori to guide the literature search strategy. Our KQs focused on disease prevalence, severity, risk-factors, methodologies for screening/evaluation, impact on morbidity, and potential costs/benefits. The available evidence was extracted, evaluated and graded on quality. The number of participants and the design of clinical studies varied by condition and were often inadequate for answering most of the KQ. Based upon our review, we provide a summary of the findings on hip dysplasia, menopause, acquired cardiac valve disease, type 2 diabetes mellitus, hematologic disorders, and dysphagia. Minimal evidence demonstrates significant gaps in our clinical knowledge that compromises clinical decision-making and management of these medically complex individuals. The creation of evidence-based clinical guidance for this population will not be possible until these gaps are addressed.
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Affiliation(s)
- George Capone
- Down Syndrome Clinic and Research Center, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Mary Stephens
- Adult Down Syndrome Clinic, Christiana Care Health System, Wilmington, Delaware, USA
| | | | - Brian Chicoine
- Lutheran General Hospital, Advocate Adult Down Syndrome Center, Park Ridge, Illinois, USA
| | - Peter Bulova
- Adult Down Syndrome Clinic, Montefiore Hospital, Pittsburgh, Pennsylvania, USA
| | - Moya Peterson
- Adults with Down Syndrome Specialty Clinic, University of Kansas Medical Center, Kansas City, Missouri, USA
| | - Joan Jasien
- Department of Pediatrics and Child Neurology, Lenox Baker Children's Hospital, Durham, North Carolina, USA
| | - Anna Jo Smith
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland, USA
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22
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In't Veld WJA, de Pijper I, van Gerven M, van den Engel-Hoek L. Two mastication tests used in children with down syndrome: A feasibility study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:280-286. [PMID: 31981265 DOI: 10.1111/jir.12693] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 08/08/2019] [Accepted: 09/15/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Children with Down syndrome can have problems with chewing and swallowing. However, no objective tests are available that give information about the efficiency and endurance of mastication. In this study, the feasibility of two mastication tests is studied by answering two research questions: are the Test of Mastication and Swallowing of Solids and the 6-min mastication test feasible to use in children with Down syndrome? Do these tests give information about the mastication efficiency and endurance in these children? METHOD A total of 24 (4-18 years) children with Down syndrome participated. The collected variables in the Test of Mastication and Swallowing of Solids were masticatory time, discrete bites, masticatory cycles and number of swallows per cracker. The inter-rater reliability of these variables was tested. Collected variables in the 6-min mastication test were total masticatory cycles and percentage difference between minutes 1 and 6. Qualitative ratings of masticatory movements were made. In both tests, a comparison with a typically developing group was made. RESULTS In both tests, a total of 87.5% of the children completed the test. Both tests are feasible for children with Down syndrome with language comprehension skills of 3 years and over. CONCLUSIONS The tests give information about the function and endurance during mastication in children with Down syndrome. The results showed that children with Down syndrome do not have endurance problems during mastication, but there is a lack of efficiency in mastication.
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Affiliation(s)
| | | | - M van Gerven
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L van den Engel-Hoek
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
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23
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Feeding problems and gastrointestinal diseases in Down syndrome. Arch Pediatr 2019; 27:53-60. [PMID: 31784293 DOI: 10.1016/j.arcped.2019.11.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/26/2019] [Accepted: 11/11/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND METHOD Feeding problems and gastrointestinal disorders are the most common anomalies in people with Down syndrome (DS) and have a significant impact on their daily life. This study lists the various anomalies on the basis of 504 references selected from a PubMed search in October 2018. RESULTS The anomalies are grouped into three categories: anatomical anomalies: duodenal atresia and stenosis (3.9%), duodenal web and annular pancreas; aberrant right subclavian artery (12% of children with DS with cardiac anomaly); Hirschsprung's disease (2.76%); anorectal malformation (1.16%); congenital vascular malformations of the liver; orofacial cleft, bifid uvula (4.63%), and submucous orofacial cleft; esophageal atresia (0.5-0.9%); pyloric stenosis (0.3%); diaphragmatic hernia; malrotation of small intestine or duodenum inversum; omphalocele, gastroschisis or anomalies of the median line, anomalies of the umbilical vein; biological, immunological, and infectious anomalies: neonatal cholestasis (3.9%); neonatal hepatic fibrosis; Helicobacter pylori infection (75.8% in institutionalized children with DS, between 29.2 and 19.5% in non-institutionalized); non-alcoholic fatty liver disease (NAFLD; 82% in obese and 45% in non-obese); biliary lithiasis (6.9% under 3 years); celiac disease (6.,6%); geographical tongue (4%); hepatitis B virus sensitivity; autoimmune hepatitis and cholangitis; Crohn's disease, inflammatory bowel disease (IBD); pancreatitis; vitamin D deficiency (45.2% in Italy); functional disorders: suction, swallowing and chewing disorders (13 of 19 children with DS under 4 years); gastroesophageal reflux (47% in children with sleep apnea); achalasia (0,5% in adults); obesity (51.6% of males and 40.0% of females in Ireland) and overweight (32.0% and 14.8%); constipation (19.0%). Based on their practice, the authors insist on the following points: malformations are sometimes detected late (chronic vomiting after the introduction of food pieces, resistant constipation despite appropriate measures); prescription of preventive doses of vitamin D is advised; jaundice in a baby with DS may be retentional; in the event of transient leukemoid reaction it is vital to monitor liver function; the patient with geographic tongue must be reassured; for celiac serology there is no consensus on the staring age and the frequency, we propose every year from the age of 2; we advise to test people with DS for H. pylori infection if they are attending specialized institutions; abdominal ultrasounds must be systematic during the first months of life; detection of NAFLD is recommended; people with DS must be vaccinated against hepatitis B; breastfeeding is possible with maternal support; it is important to start speech therapy very early; feeding difficulties are often overlooked by the family and educators; gastroesophageal reflux is often pathological; preventing obesity must start from birth using body mass index for the general population; it is necessary to do everything for their meals to be joyful.
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Marino M, Scala I, Scicolone O, Strisciuglio P, Bravaccio C. Distribution and age of onset of psychopathological risk in a cohort of children with Down syndrome in developmental age. Ital J Pediatr 2019; 45:92. [PMID: 31349869 PMCID: PMC6660693 DOI: 10.1186/s13052-019-0672-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/03/2019] [Indexed: 12/11/2022] Open
Abstract
Background Aim of the study is to intercept specific characteristics and psychiatric comorbidity in Down Syndrome (DS). The study describes the distribution and the age of specific aspects of behavioral phenotype in a sample of subjects with DS. Methods Psychopathological risk has been evaluated in a 97 DS patient cohort, aged 1 to 18 years, during regular follow-up neuropsychiatric visit and through administration of Child Behavior Checklist (CBCL); Childhood Autism Rating Scale (CARS-T) was assessed to verify the presence of autistic behaviors. Results The results show the presence of specific psychopathological risk factors in 90% of the sample. 7% of sample presents autistic features. The risk of psychopathology is independent of the degree of intellectual disability. Conclusion The high frequency of psychopathological risk factors indicates the need for accurate monitoring to intercept specific characteristics, such as in the case of comorbidity for autism. The search for specific psychopathological factors is a little explored aspect to date, as evidenced by the literature. Despite the studies available to date highlight the presence of psychopathological vulnerability in DS, so far there are only few reports that explore this issue systematically.
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Affiliation(s)
- M Marino
- Department of Medical and Translational Science, Federico II University Hospital, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - I Scala
- Department of Medical and Translational Science, Federico II University Hospital, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - O Scicolone
- Department of Medical and Translational Science, Federico II University Hospital, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - P Strisciuglio
- Department of Medical and Translational Science, Federico II University Hospital, Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - C Bravaccio
- Department of Medical and Translational Science, Federico II University Hospital, Via Sergio Pansini, 5, 80131, Naples, Italy
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Chenbhanich J, Wu A, Phupitakphol T, Atsawarungruangkit A, Treadwell T. Hospitalisation of adults with Down syndrome: lesson from a 10-year experience from a community hospital. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:266-276. [PMID: 30484927 DOI: 10.1111/jir.12572] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 08/16/2018] [Accepted: 11/07/2018] [Indexed: 05/26/2023]
Abstract
BACKGROUND Life expectancy of individuals with Down syndrome (DS) has improved significantly over the past decades. However, there are sparse data documenting the co-morbidities and hospitalisation of adult patients with DS in the literature. The aim of this study was to characterise the co-morbidities and pattern of hospitalisation in adult patients with DS during a 10-year period at the community hospital as well as to compare hospitalisation parameters with the general adult population during the same years. METHOD We reviewed the medical records of 81 hospitalisations from 37 patients with DS aged 21 to 68 years at Metrowest Medical Center during a 10-year period and compared with those of the general adult population during the same time. Co-morbidities were also described. RESULTS Adults with DS had a mean age at admission of 48.6 ± 8.8 years with the median length of stay of 3 days (interquartile range 4 days). Male patients were hospitalised longer than female patients (mean 5.0 vs. 2.8 days; P < 0.05), and patients who lived at home were admitted at earlier ages than those who came from residential healthcare facility (mean 41.5 vs. 52.2 years; P < 0.001). The most common cause of hospitalisation was pneumonia/aspiration syndrome (29.6%), and the most common co-morbidity was gastroesophageal reflux disease (GERD)/dysphagia (70.3%). Presence of GERD/dysphagia or seizure disorder was significantly associated with multiple admission and readmission within 1 month (P < 0.05). The mortality rate was 4.9%, and the rate of intensive care unit admission was 8.6%. CONCLUSIONS Our cohort did not show statistically significant different hospitalisation parameters such as inpatient mortality and average length of stay when compared with general adult population hospitalised at the same years. The care of adult patients with DS presents challenges in internal medicine due to its unique co-morbid profile and signifies the importance of multidisciplinary approach. In order to improve the care of this patient population, their co-morbidities, particularly GERD/dysphagia and seizure disorder, should be optimally managed and comprehensively addressed when patients are hospitalised.
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Affiliation(s)
- J Chenbhanich
- Department of Internal Medicine, Metrowest Medical Center, Framingham, MA, USA
| | - A Wu
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - T Phupitakphol
- Department of Internal Medicine, Metrowest Medical Center, Framingham, MA, USA
| | | | - T Treadwell
- Department of Internal Medicine, Metrowest Medical Center, Framingham, MA, USA
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston School of Medicine, Boston, MA, USA
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van Dijk M, Lipke-Steenbeek W. Measuring feeding difficulties in toddlers with Down syndrome. Appetite 2018; 126:61-65. [PMID: 29601917 DOI: 10.1016/j.appet.2018.03.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/22/2018] [Accepted: 03/22/2018] [Indexed: 11/29/2022]
Abstract
Early feeding problems occur frequently across the population, but have a higher incidence in children with Down syndrome (DS). Early identification can possibly be improved with the help of a valid screening instrument based on caregiver reports. In a previous study, we investigated the concurrent validity of the Dutch version of the Montreal Children's Hospital Feeding Scale (MCH-FS, SEP in Dutch) in a sample of typically developing toddlers, and we found a correlation between the score on the instrument and observed behavior during a regular meal. The current pilot study was a replication in a sample of children with DS (aged 1; 0-3; 0) and their primary caregivers (n = 32). The results showed that children in the sample did not score higher on the SEP than children in their respective norm groups. In addition, when caregivers reported more symptoms of feeding problems on the SEP, children showed more food refusal and negative affect during the observed meal. This suggests that the screening instrument is particularly associated with negative mealtime interactions. This is in contrast with earlier results, which mainly indicated a relation with eating skills.
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Affiliation(s)
- Marijn van Dijk
- Heymans Institute for Psychological Research, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands.
| | - Wilma Lipke-Steenbeek
- Department of Health and Social Work, Windesheim University of Applied Sciences, Campus 2, 8017 CA, Zwolle, The Netherlands.
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Meyer C, Theodoros D, Hickson L. Management of swallowing and communication difficulties in Down syndrome: A survey of speech-language pathologists. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 19:87-98. [PMID: 27598658 DOI: 10.1080/17549507.2016.1221454] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 07/20/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE To explore speech pathology services for people with Down syndrome across the lifespan. METHOD Speech-language pathologists (SLPs) working in Australia were invited to complete an online survey, which enquired about the speech pathology services they had provided to client/s with Down syndrome in the past 12 months. The data were analysed using descriptive statistics. RESULT A total of 390 SLPs completed the survey; 62% reported seeing a client with Down syndrome in the past 12 months. Most commonly, SLPs provided assessment and individual intervention for communication with varying levels of family involvement. The areas of dysphagia and/or communication addressed by SLPs, or in need of more services differed according to the age of the person with Down syndrome. SLPs reported a number of reasons why services were restricted. CONCLUSION There is a need to re-assess the way that SLPs currently provide services to people with Down syndrome. More research is needed to develop and evaluate treatment approaches that can be used to better address the needs of this population.
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Affiliation(s)
- Carly Meyer
- a School of Health and Rehabilitation Sciences , University of Queensland , Brisbane , Australia
| | - Deborah Theodoros
- a School of Health and Rehabilitation Sciences , University of Queensland , Brisbane , Australia
| | - Louise Hickson
- a School of Health and Rehabilitation Sciences , University of Queensland , Brisbane , Australia
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Alqahtani NM, Alsayed HD, Levon JA, Brown DT. Prosthodontic Rehabilitation for a Patient with Down Syndrome: A Clinical Report. J Prosthodont 2017; 27:681-687. [PMID: 28118512 DOI: 10.1111/jopr.12595] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2016] [Indexed: 11/26/2022] Open
Abstract
Patients with Down syndrome can present with a variety of oral manifestations such as hypodontia, periodontal disease, premature tooth loss, reduced salivary flow, crowding of teeth in both arches, and decreased occlusal vertical dimension. The intellectual ability of people with Down syndrome varies widely. They present with a mild-to-moderate intellectual disability that restricts their ability to communicate and adjust to their environment, which can add complexity in the overall dental treatment. There is little information in the literature regarding the prosthodontic rehabilitation for patients with Down syndrome in combination with dental implant placement. An implant-assisted removable partial dental prosthesis can be a cost-effective treatment alternative for carefully chosen patients with Down syndrome. This article presents the treatment of a 44-year-old male patient with Down syndrome and a moderate intellectual disability who presented with congenital and acquired tooth loss with significant occlusal discrepancies. The treatment included a prosthodontic approach that used a single dental implant, which will be described and illustrated in this article.
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Affiliation(s)
- Nasser M Alqahtani
- Department of Prosthetic Dental Sciences, King Khalid University College of Dentistry, Abha, Saudi Arabia
| | - Hussain D Alsayed
- Department of Prosthetic Dental Sciences, King Saud University College of Dentistry, Riyadh, Saudi Arabia.,Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, IN
| | - John A Levon
- Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, IN
| | - David T Brown
- Department of Comprehensive Care and General Dentistry, Indiana University School of Dentistry, Indianapolis, IN
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McElyea SD, Starbuck JM, Tumbleson-Brink DM, Harrington E, Blazek JD, Ghoneima A, Kula K, Roper RJ. Influence of prenatal EGCG treatment and Dyrk1a dosage reduction on craniofacial features associated with Down syndrome. Hum Mol Genet 2016; 25:4856-4869. [PMID: 28172997 PMCID: PMC6049609 DOI: 10.1093/hmg/ddw309] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/17/2016] [Accepted: 09/01/2016] [Indexed: 12/26/2022] Open
Abstract
Trisomy 21 (Ts21) affects craniofacial precursors in individuals with Down syndrome (DS). The resultant craniofacial features in all individuals with Ts21 may significantly affect breathing, eating and speaking. Using mouse models of DS, we have traced the origin of DS-associated craniofacial abnormalities to deficiencies in neural crest cell (NCC) craniofacial precursors early in development. Hypothetically, three copies of Dyrk1a (dual-specificity tyrosine-(Y)-phosphorylation regulated kinase 1A), a trisomic gene found in most humans with DS and mouse models of DS, may significantly affect craniofacial structure. We hypothesized that we could improve DS-related craniofacial abnormalities in mouse models using a Dyrk1a inhibitor or by normalizing Dyrk1a gene dosage. In vitro and in vivo treatment with Epigallocatechin-3-gallate (EGCG), a Dyrk1a inhibitor, modulated trisomic NCC deficiencies at embryonic time points. Furthermore, prenatal EGCG treatment normalized some craniofacial phenotypes, including cranial vault in adult Ts65Dn mice. Normalization of Dyrk1a copy number in an otherwise trisomic Ts65Dn mice normalized many dimensions of the cranial vault, but did not correct all craniofacial anatomy. These data underscore the complexity of the gene–phenotype relationship in trisomy and suggest that changes in Dyrk1a expression play an important role in morphogenesis and growth of the cranial vault. These results suggest that a temporally specific prenatal therapy may be an effective way to ameliorate some craniofacial anatomical changes associated with DS.
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Affiliation(s)
- Samantha D McElyea
- Department of Biology, Indiana University-Purdue University Indianapolis, 723 W. Michigan Street, SL306, Indianapolis, IN, USA
| | - John M Starbuck
- Department of Orthodontics and Facial Genetics, Indiana University School of Dentistry, 1121 W. Michigan Street, DS 250B, Indianapolis, IN, USA
- Department of Anthropology, University of Central Florida, 4000 Central Florida Blvd., Howard Phillips Hall, Room 309F, Orlando, FL, USA
| | - Danika M Tumbleson-Brink
- Department of Biology, Indiana University-Purdue University Indianapolis, 723 W. Michigan Street, SL306, Indianapolis, IN, USA
| | - Emily Harrington
- Department of Biology, Indiana University-Purdue University Indianapolis, 723 W. Michigan Street, SL306, Indianapolis, IN, USA
| | - Joshua D Blazek
- Department of Biology, Indiana University-Purdue University Indianapolis, 723 W. Michigan Street, SL306, Indianapolis, IN, USA
| | - Ahmed Ghoneima
- Department of Orthodontics and Facial Genetics, Indiana University School of Dentistry, 1121 W. Michigan Street, DS 250B, Indianapolis, IN, USA
| | - Katherine Kula
- Department of Orthodontics and Facial Genetics, Indiana University School of Dentistry, 1121 W. Michigan Street, DS 250B, Indianapolis, IN, USA
| | - Randall J Roper
- Department of Biology, Indiana University-Purdue University Indianapolis, 723 W. Michigan Street, SL306, Indianapolis, IN, USA
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Implant therapy for a patient with Down syndrome and oral habits: A clinical report. J Prosthet Dent 2016; 116:320-4. [DOI: 10.1016/j.prosdent.2016.01.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/15/2016] [Accepted: 01/19/2016] [Indexed: 11/24/2022]
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Glass TJ, Connor NP. Digastric Muscle Phenotypes of the Ts65Dn Mouse Model of Down Syndrome. PLoS One 2016; 11:e0158008. [PMID: 27336944 PMCID: PMC4919106 DOI: 10.1371/journal.pone.0158008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/08/2016] [Indexed: 12/18/2022] Open
Abstract
Down syndrome is frequently associated with complex difficulties in oromotor development, feeding, and swallowing. However, the muscle phenotypes underlying these deficits are unclear. We tested the hypotheses that the Ts65Dn mouse model of DS has significantly altered myosin heavy chain (MyHC) isoform profiles of the muscles involved in feeding and swallowing, as well as reductions in the speed of these movements during behavioral assays. SDS-PAGE, immunofluorescence, and qRT-PCR were used to assess MyHC isoform expression in pertinent muscles, and functional feeding and swallowing performance were quantified through videofluoroscopy and mastication assays. We found that both the anterior digastric (ADG) and posterior digastric (PDG) muscles in 11-day old and 5–6 week old Ts65Dn groups showed significantly lower MyHC 2b protein levels than in age-matched euploid control groups. In videofluoroscopic and videotape assays used to quantify swallowing and mastication performance, 5–6 week old Ts65Dn and euploid controls showed similar swallow rates, inter-swallow intervals, and mastication rates. In analysis of adults, 10–11 week old Ts65Dn mice revealed significantly less MyHC 2b mRNA expression in the posterior digastric, but not the anterior digastric muscle as compared with euploid controls. Analysis of MyHC 2b protein levels across an adult age range (10–53 weeks of age) revealed lower levels of MyHC 2b protein in the PDG of Ts65Dn than in euploids, but similar levels of MyHC 2b in the ADG. Cumulatively, these results indicate biochemical differences in some, but not all, muscles involved in swallowing and jaw movement in Ts65Dn mice that manifest early in post-natal development, and persist into adulthood. These findings suggest potential utility of this model for future investigations of the mechanisms of oromotor difficulties associated with Down syndrome.
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Affiliation(s)
- Tiffany J. Glass
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, United States of America
- * E-mail:
| | - Nadine P. Connor
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, United States of America
- Department of Communication Sciences and Disorders, University of Wisconsin, Madison, Wisconsin, United States of America
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Dietary Intakes and Nutritional Issues in Neurologically Impaired Children. Nutrients 2015; 7:9400-15. [PMID: 26580646 PMCID: PMC4663597 DOI: 10.3390/nu7115469] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 10/28/2015] [Accepted: 11/03/2015] [Indexed: 12/16/2022] Open
Abstract
Neurologically impaired (NI) children are at increased risk of malnutrition due to several nutritional and non-nutritional factors. Among the nutritional factors, insufficient dietary intake as a consequence of feeding difficulties is one of the main issues. Feeding problems are frequently secondary to oropharyngeal dysphagia, which usually correlates with the severity of motor impairment and presents in around 90% of preschool children with cerebral palsy (CP) during the first year of life. Other nutritional factors are represented by excessive nutrient losses, often subsequent to gastroesophageal reflux and altered energy metabolism. Among the non-nutritional factors, the type and severity of neurological impairment, ambulatory status, the degree of cognitive impairment, and use of entiepileptic medication altogether concur to determination of nutritional status. With the present review, the current literature is discussed and a practical approach for nutritional assessment in NI children is proposed. Early identification and intervention of nutritional issues of NI children with a multidisciplinary approach is crucial to improve the overall health and quality of life of these complex children.
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Hennequin M, Mazille MN, Cousson PY, Nicolas E. Increasing the number of inter-arch contacts improves mastication in adults with Down syndrome: a prospective controlled trial. Physiol Behav 2015; 145:14-21. [PMID: 25824190 DOI: 10.1016/j.physbeh.2015.03.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/25/2015] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
Abstract
Feeding difficulties due to their condition have been widely described for babies, children and adults with Down syndrome (DS). A previous study demonstrated that, compared with wearing a placebo appliance, wearing an occlusal appliance increased inter-arch dental contacts, improved the oral health status of adults with DS and normalised their mandibular rest position. This longitudinal prospective controlled trial aimed to evaluate whether increasing inter-arch contacts in adults with DS would lead to improved masticatory efficiency. Fourteen subjects with DS (mean age±SD: 28.5±9.3years) and twelve controls without DS (24.6±1.0years) were video recorded while chewing samples of carrot and peanuts with and without an oral appliance that was designed to equalise the number of posterior functional units (PFUs) in both groups. Three parameters were collected during mastication for 15cycles and until swallowing: food refusals, food bolus granulometry (D50) and kinematic parameters of the chewing process (number of cycles, chewing duration and cycle frequency within the chewing sequence). In the DS group, increasing the number of PFUs led to a decrease in bolus particle size, to fewer masticatory cycles needed to produce a bolus ready for swallowing and to a decrease in the occurrence of food refusal, while mean chewing frequency did not vary. In the control group, bolus granulometry and chewing time increased with appliance wear while mean chewing frequency decreased. These changes clearly indicate a functional improvement in subjects with DS. This study also demonstrated a causal relationship between the number of functional pairs of posterior teeth and improved mastication. Any evaluation of feeding behaviour in persons with DS should consider inter-arch dental contacts as an explicative variable for feeding problems and their nutritional and respiratory consequences.
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Affiliation(s)
- Martine Hennequin
- Clermont University, University of Auvergne, CROC EA4847, BP 10448, F-63000 Clermont-Ferrand, France; CHU de Clermont-Ferrand, Service d'Odontologie, F-63000 Clermont-Ferrand, France.
| | - Marie-Noëlle Mazille
- Clermont University, University of Auvergne, CROC EA4847, BP 10448, F-63000 Clermont-Ferrand, France; CHU de Clermont-Ferrand, Service d'Odontologie, F-63000 Clermont-Ferrand, France
| | - Pierre-Yves Cousson
- Clermont University, University of Auvergne, CROC EA4847, BP 10448, F-63000 Clermont-Ferrand, France; CHU de Clermont-Ferrand, Service d'Odontologie, F-63000 Clermont-Ferrand, France
| | - Emmanuel Nicolas
- Clermont University, University of Auvergne, CROC EA4847, BP 10448, F-63000 Clermont-Ferrand, France; CHU de Clermont-Ferrand, Service d'Odontologie, F-63000 Clermont-Ferrand, France
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Tongue Pressure During Swallowing in Adults with Down Syndrome and Its Relationship with Palatal Morphology. Dysphagia 2014; 29:509-18. [DOI: 10.1007/s00455-014-9538-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 04/18/2014] [Indexed: 10/25/2022]
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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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Billingsley CN, Allen JR, Baumann DD, Deitz SL, Blazek JD, Newbauer A, Darrah A, Long BC, Young B, Clement M, Doerge RW, Roper RJ. Non-trisomic homeobox gene expression during craniofacial development in the Ts65Dn mouse model of Down syndrome. Am J Med Genet A 2013; 161A:1866-74. [PMID: 23843306 DOI: 10.1002/ajmg.a.36006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 04/08/2013] [Indexed: 01/25/2023]
Abstract
Trisomy 21 in humans causes cognitive impairment, craniofacial dysmorphology, and heart defects collectively referred to as Down syndrome. Yet, the pathophysiology of these phenotypes is not well understood. Craniofacial alterations may lead to complications in breathing, eating, and communication. Ts65Dn mice exhibit craniofacial alterations that model Down syndrome including a small mandible. We show that Ts65Dn embryos at 13.5 days gestation (E13.5) have a smaller mandibular precursor but a normal sized tongue as compared to euploid embryos, suggesting a relative instead of actual macroglossia originates during development. Neurological tissues were also altered in E13.5 trisomic embryos. Our array analysis found 155 differentially expressed non-trisomic genes in the trisomic E13.5 mandible, including 20 genes containing a homeobox DNA binding domain. Additionally, Sox9, important in skeletal formation and cell proliferation, was upregulated in Ts65Dn mandible precursors. Our results suggest trisomy causes altered expression of non-trisomic genes in development leading to structural changes associated with DS. Identification of genetic pathways disrupted by trisomy is an important step in proposing rational therapies at relevant time points to ameliorate craniofacial abnormalities in DS and other congenital disorders.
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Affiliation(s)
- Cherie N Billingsley
- Department of Biology and Indiana University Center for Regenerative Biology and Medicine, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
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Dey A, Bhowmik K, Chatterjee A, Chakrabarty PB, Sinha S, Mukhopadhyay K. Down Syndrome Related Muscle Hypotonia: Association with COL6A3 Functional SNP rs2270669. Front Genet 2013; 4:57. [PMID: 23626599 PMCID: PMC3631610 DOI: 10.3389/fgene.2013.00057] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 04/02/2013] [Indexed: 12/03/2022] Open
Abstract
Down syndrome (DS), the principal cause for intellectual disability, is also associated with hormonal, immunological, and gastrointestinal abnormalities. Muscle hypotonia (MH) and congenital heart diseases (CHD) are also frequently observed. Collagen molecules are essential components for maintaining muscle integrity and are formed by the assembly of three chains, alpha 1–3. The type VI collagen is crucial for cardiac as well as skeletal muscles. The COL α1 (VI) and α2 (VI) chains are encoded by genes located at the 21st chromosome and are expected to have higher dosage in individuals with DS. The α 3 (VI) chain is encoded by the COL6A3 located at the chromosome 2. We hypothesized that apart from COL6A1 and COL6A2, COL6A3 may also have some role in the MH of subjects with DS. To find out the relevance of COL6A3 in DS associated MH and CHD, we genotyped two SNPs in COL6A3, rs2270669 and rs2270668, in individuals with DS. Subjects with DS were recruited based on the Diagnostic and Statistical Manual for Mental Disorders-IV and having trisomy of the 21st chromosome. Parents of individuals with DS and ethnically matched controls were enrolled for comparison. Informed written consent was obtained for participation. Peripheral blood was used for isolation of genomic DNA. Target genetic loci were studied by DNA sequence analysis. Data obtained was subjected to population – as well as family-based statistical analysis. rs2270668 was found to be non-polymorphic in the studied population. rs2270669 showed significant association of the “C” allele and “CC” genotype with DS probands having MH (P = 0.02). Computational analysis showed that rs2270669 may induce structural and functional alterations in the COL α3 (VI). Interaction of COLα3 (VI) with different proteins, crucial for muscle integrity, was also noticed by computational methods. This pioneering study on COL6A3 with DS related MH thus indicates that rs2270669 “C” could be considered as a risk factor for DS related MH.
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Affiliation(s)
- Arpita Dey
- Manovikas Biomedical Research and Diagnostic Centre Kolkata, West Bengal, India
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O’Neill AC, Richter GT. Pharyngeal Dysphagia in Children with Down Syndrome. Otolaryngol Head Neck Surg 2013; 149:146-50. [DOI: 10.1177/0194599813483445] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Pharyngeal dysphagia (PD) in children with Down syndrome (DS) has not been examined. This study aims to describe the incidence, duration, and precipitating factors of PD in a large cohort of children with DS. Study Design Case series with chart review. Setting Tertiary care children’s hospital. Methods The International Classification of Diseases, Ninth Revision ( ICD-9) code for DS was used to identify all children treated at a single institution from 1992 to 2012. Patient charts were reviewed for signs, symptoms, and documentation of PD. Videofluoroscopic swallow studies (VFSS) established the final diagnosis of PD in affected patients. Otolaryngologic interventions and their impact on PD were also explored. Results A total of 228 patients with the ICD-9 code for DS were found. Twenty-seven patients (11.8%) were excluded due to record deficiencies. Thus, of the 201 children with DS who were available for complete review, 116 (57.7%) had and established diagnosis of PD by VFSS. The mean age at first diagnosis of PD was 1.69 years. At the time of the study, the cohort mean age was 7.45 years, with only 20 patients demonstrating resolution of PD. Patients with a tracheotomy or significant neurologic delays were more likely to have worsening or prolonged PD. Laryngeal clefts were identified in 3 patients, whereas 78 (67%) underwent surgery for upper airway obstruction that did not consistently improve PD. Conclusion This study suggests that PD is common, persistent, and should be routinely explored in children with DS. Intervention for upper airway obstruction had a limited role for PD in this study cohort.
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Affiliation(s)
- Ashley C. O’Neill
- Department of Audiology and Speech Pathology, University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Little Rock, Arkansas, USA
| | - Gresham T. Richter
- Department of Otolaryngology–Head and Neck Surgery, University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Little Rock, Arkansas, USA
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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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Morgan AT, Dodrill P, Ward EC. Interventions for oropharyngeal dysphagia in children with neurological impairment. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2011. [DOI: 10.1002/14651858.cd009456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Tsilingaridis G, Yucel-Lindberg T, Modéer T. T-helper-related cytokines in gingival crevicular fluid from adolescents with Down syndrome. Clin Oral Investig 2011; 16:267-73. [PMID: 21221679 DOI: 10.1007/s00784-010-0495-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 12/06/2010] [Indexed: 02/01/2023]
Abstract
Subjects with Down syndrome have a high prevalence of periodontal disease. The aim was to investigate the level of Th1-, Th2- and Th17-related cytokines in the gingival crevicular fluid (GCF) of subjects with Down syndrome. Subjects with Down syndrome (n = 24) and controls (n = 29) with a mean age of 16.4 years were clinically examined with respect to periodontal probing depth (PD) and gingival inflammation in terms of bleeding on probing (BOP%). The controls were matched to subjects with Down syndrome regarding age and gingival inflammation (BOP%). All subjects answered a questionnaire regarding oral hygiene, medical history and socioeconomic background. GCF was collected and the concentration of the cytokines, IFN-γ, TNF-α, IL-1β, IL-4, IL-6, IL-10, IL-12 and IL-17 were determined using Bio-Plex cytokine multiplex assays. The volume of GCF (microliters) was significantly higher in subjects with Down syndrome (P < 0.001) compared with controls. The mean concentrations (picogrammes per millilitre) of IL-1β (P < 0.001), IL-4 (P = 0.002), IL-6 (P = 0.005), IL-10 (P = 0.001), IL-12 (P = 0.003), IFN-γ (P = 0.002), and TNF-α (P = 0.002) in GCF, respectively, were significantly higher in subjects with Down syndrome compared with controls. The regression line of the relationship between IFN-γ and IL-4 in GCF differed significantly (P = 0.006) in subjects with Down syndrome compared to controls. Subjects with Down syndrome demonstrated higher concentration of Th1-, Th2- and Th17-related cytokines with an altered relationship between Th1 cytokine, IFN-γ and Th2 cytokine, IL-4, in volume GCF compared to controls.
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Affiliation(s)
- Georgios Tsilingaridis
- Division of Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
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Chávez CJ, Ortega P, Leal J, D'Escrivan A, González R, Miranda LE. [Vitamin A deficiency and nutritional status in patients with Down's syndrome]. An Pediatr (Barc) 2010; 72:185-90. [PMID: 20153273 DOI: 10.1016/j.anpedi.2009.10.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Revised: 09/29/2009] [Accepted: 10/20/2009] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Vitamin A deficiency (VAD) is a worldwide public health problem. Epidemiological studies of VAD prevalence have been conducted in individuals with chromosome load and genetic potential compared with the general population; however, there are few studies in patients with Down's syndrome (DS). The objective of this study was to determine the prevalence of VAD and analyse nutritional status in patients with DS. METHODS A prospective and cross-sectional study was performed, with 50 karyotypically normal (KN) individuals (10.4+/-3.7 years old) and 38 randomly selected patients with DS (8.2+/-4.1 years old). Serum retinol was determined by HPLC using the Bieri method, with an international reference standard to define VAD (serum retinol <20 microg/dL). The data were analysed using the SAS/STAT statistical program. RESULTS The prevalence of VAD was 18.4% in individuals with DS and 4% in KN individuals (OR: 5.42; 95% CI=0.93-40.64; p=0.02). Children with DS between two and six years old shown a significativily lower serum retinol (p=<0.05).The patients with DS also showed a significant decrease in height and weight compared to KN (p=<0.001). CONCLUSIONS The prevalence of VAD detected in patients with DS could be considered a public health problem. Also, the chromosome 21 trisomy represent a risk factor associated with VAD.
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Affiliation(s)
- C J Chávez
- Instituto de Investigaciones Biológicas, Universidad del Zulia, Maracaibo, Venezuela.
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