Assessment of mastication in healthy children and children with cerebral palsy: a validity and consistency study

Oropharyngeal Dysphagia in Children with Eosinophilic Esophagitis

Dysphagia is the most troublesome symptom of eosinophilic esophagitis (EoE). This study aimed to investigate oropharyngeal dysphagia in children with EoE and possible related factors. Children with a definite diagnosis of EoE were included in the study. Medical and feeding histories were recorded. A disease control level was determined for each child. An oral structure examination, the Turkish version of the Mastication and Observation Evaluation (T-MOE), the Pediatric version of the Eating Assessment Tool-10 (PEDI-EAT-10) and the 3-oz water swallow test were applied in screening for oropharyngeal dysphagia. Fifty-two children participated in the study. Oropharyngeal dysphagia took the form of abnormal swallowing (PEDI-EAT-10 score ≥ 4) and increased aspiration risk (PEDI- EAT-10 score ≥ 13) in 51.9% and 25.0% of the children, respectively. Seven children failed the 3-oz water swallow test. Abnormal swallowing and aspiration risk were significantly higher in children with prolonged mealtimes, impaired chewing function, and uncontrolled disease (p < 0.05). Chewing function was the most important risk factor for abnormal swallowing and increased aspiration (R² = 0.36, R² = 0.52, p < 0.001, respectively). Oropharyngeal dysphagia is common in children with EoE and associated with increased aspiration risk in a subpopulation. Uncontrolled disease, prolonged mealtimes, and impaired chewing function may provide clues for oropharyngeal dysphagia in EoE.

Evaluation of masticatory behavior and taste sensitivity after pacifier removal in preschool children: a 1-year follow-up

OBJECTIVE

The aim was to investigate the influence of pacifier removal on the development of masticatory function and taste sensitivity in preschool children.

METHODS

Sixty children (mean age 48.2 months) were divided into two groups: pacifier group (n = 28) and a control group (n = 32), which were evaluated and followed up for a period of 12 months (at baseline, 6 months, and 1 year). Masticatory and swallowing functions were assessed using the Mastication Observation and Evaluation (MOE) protocol and Orofacial Myofunctional Rating (MBGR), respectively. Detection thresholds for sucrose and urea were measured by the staircase method. The two-way ANOVA mixed model was used for time*group interaction analysis.

RESULTS

MOE scores improved significantly over time in both groups, although a significant difference between groups persisted after 1 year. On the other hand, swallowing scores were significantly different at baseline, but within 1 year, the scores were no longer different between groups. Chewing time and the number of cycles were not different between groups and both decreased after 1 year. Sucrose sensitivity was significantly greater in the control group at baseline and changed over time (p < 0.05), being no longer different between groups after 6 months. Bitter sensitivity did not differ over time nor between groups.

CONCLUSIONS

Detection threshold for sucrose differed significantly between children with and without pacifier habit at a mean age of 42 months. Total masticatory function did not self-correct after sucking habit removal within a 1-year period.

CLINICAL RELEVANCE

Children with pacifier habit showed important changes in masticatory function that did not self-correct 1 year after cessation of the habit, highlighting the need for prevention and habit interruption as early as possible.

L, González G. S. Instrumentos de evaluación de la deglución pediátrica: un reporte por fonoaudiólogos en Colombia y Chile

La prevalencia de usuarios pediátricos que presentan alteraciones en la deglución/ alimentación ha aumentado significativamente, por lo que realizar un proceso de evaluación sistemático, a usuarios ambulatorios y/u hospitalizados, con el uso de instrumentos estandarizados, puede evitar complicaciones asociadas. El objetivo de esta investigación fue identificar cuáles son las pruebas que conocen y usan los fonoaudiólogos en dos países de habla hispana: Colombia y Chile, para la valoración de la deglución en población pediátrica. Se trata de un estudio observacional de corte transversal, en el que participaron 36 fonoaudiólogos de ambos países, los que contestaron una encuesta de 23 ítems, previamente validada por juicio de expertos. El 55,6% (n=20) señaló que conocía pruebas de screening, el 63,89% (n=23) conocía pruebas de evaluación clínica (no instrumentales o subjetivas), el 100% conocía pruebas instrumentales (objetivas) y sólo el 11% (n=4) conocían pruebas de calidad de vida. Se evidenció de forma general dificultad en la clasificación de las pruebas y un mayor uso de pruebas no estandarizadas, lo que sugiere una necesidad disciplinar en cuanto a la formación sobre instrumentos de medición y evaluación, que permitan la identificación, selección y comprensión analítica de dichos instrumentos.

Parent-delivered interventions used at home to improve eating, drinking and swallowing in children with neurodisability: the FEEDS mixed-methods study

BACKGROUND

Eating, drinking and swallowing difficulties are common in young children with neurodisability. These difficulties may lead to inadequate calorie intake, which affects a child's nutrition, growth and general physical health.

OBJECTIVE

To examine which interventions are available that can be delivered at home by parents to improve eating, drinking and swallowing in young children with neurodisability and are suitable for investigation in pragmatic trials.

DESIGN

This was a mixed-methods study that included focus groups, surveys, an update of published systematic reviews of interventions, a systematic review of measurement properties of existing tools, evidence mapping, evidence synthesis, a Delphi survey and stakeholder workshops.

SETTING

The study was carried out in NHS hospitals, community services, family homes and schools.

PARTICIPANTS

Parents of children who had neurodisability and eating, drinking and swallowing difficulties. Professionals from health and education. Young people with eating, drinking and swallowing difficulties or young people who had previously experienced eating, drinking and swallowing difficulties.

DATA SOURCES

Literature reviews; national surveys of parents and professionals; focus groups with parents, young people and professionals; and stakeholder consultation workshops.

REVIEW METHODS

An update of published systematic reviews of interventions (searched July-August 2017), a mapping review (searched October 2017) and a systematic review of measurement properties using COnsensus-based Standards for the Selection of health status Measurement INstruments (COSMIN) methodology (searched May 2018).

RESULTS

Significant limitations of the available research evidence regarding interventions and tools to measure outcomes were identified. A total of 947 people participated: 400 parents, 475 health professionals, 62 education professionals and 10 young people. The survey showed the wide range of interventions recommended by NHS health professionals, with parents and professionals reporting variability in the provision of these interventions. Parents and professionals considered 19 interventions as relevant because they modified eating, drinking and swallowing difficulties. Parents and professionals considered 10 outcomes as important to measure (including Nutrition, Growth and Health/safety); young people agreed that these were important outcomes. Stakeholder consultation workshops identified that project conclusions and recommendations made sense, were meaningful and were valued by parents and professionals. Parents and health professionals were positive about a proposed Focus on Early Eating, Drinking and Swallowing (FEEDS) toolkit of interventions that, through shared decision-making, could be recommended by health professionals and delivered by families.

LIMITATIONS

The national surveys included large numbers of parents and professionals but, as expected, these were not representative of the UK population of parents of children with eating, drinking and swallowing difficulties. Owing to the limitations of research evidence, pragmatic decisions were made about interventions that might be included in future research and outcomes that might be measured. For instance, the reviews of research found only weak or poor evidence to support the effectiveness of interventions. The review of outcome measures found only limited low-level evidence about their psychometric properties.

CONCLUSIONS

Opportunities and challenges for conducting clinical trials of the effectiveness of the FEEDS toolkit of interventions are described. Parents and professionals thought that implementation of the toolkit as part of usual NHS practice was appropriate. However, this would first require the toolkit to be operationalised through development as a complex intervention, taking account of constituent interventions, delivery strategies, implementation and manualisation. Subsequently, an evaluation of its clinical effectiveness and cost-effectiveness could be undertaken using appropriate research methods.

FUTURE WORK

Initial steps include FEEDS toolkit development and evaluation of its use in clinical practice, and identification of the most robust methods to measure valued outcomes, such as Nutrition and Growth.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN10454425.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 22. See the NIHR Journals Library website for further project information.

Turkish Version of the Mastication Observation and Evaluation (MOE) Instrument: A Reliability and Validity Study in Children

The Mastication Observation and Evaluation (MOE) instrument is an objective assessment of the chewing process in children. This study aimed to translate the MOE into Turkish and to test its reliability and validity in children with cerebral palsy (CP). A total of 53 children with CP and 27 typical children were included in the study. The MOE was translated from Dutch into Turkish by using the forward, backward, forward translation method. The internal consistency, intra- and inter-observer reliability, criterion, and discriminant validity of the Turkish version of the MOE (T-MOE) were investigated. Internal consistency was excellent with a Cronbach's alpha value of 0.98. The Intraclass correlation coefficient ranged from 0.89 to 0.97 for intra-rater reliability and from 0.86 to 0.94 for inter-rater reliability. The median score from Karaduman Chewing Performance Scale (KCPS) was 7 (min = 1, max = 8). All of the items in the T-MOE and the total T-MOE score had a negative and strong correlation with the KCPS score. Typical children without chewing disorders had greater T-MOE scores than the children with CP suffering from chewing disorders (p < 0.01). The T-MOE is a reliable and valid instrument for evaluating the observed oral motor behaviors of chewing function in children. It can be used in clinical practice and research.Clinical trial number: NCT03811353.

A new masticatory performance assessment method for infants: A feasibility study

This study evaluated the feasibility of assessing masticatory performance in infants and toddlers. Four groups of healthy children (n = 97, 42 girls and 55 boys) participated in the study: two study groups (SG) followed at 6, 8, and 10 months old (MO) or at 12, 15, and 18 MO, and two control groups (CG) of respectively 10 and 18 MO children. Masticatory performance was determined from children's ability to comminute a model gel during videotaped lab measurements. The gel was inserted in a mesh feeder and offered to the child for a 60s oral processing duration, then gel particles were collected from the feeder and photographed. Resulting gel breakdown was assessed from the characterization of the area and number of formed particles. Children strategy to orally process the gel (sucking vs. biting/chewing) was evaluated from video recordings. Children's compliance (acceptance of the feeder in the mouth for the expected duration) was average (51%) overall. It decreased from 1 year of age and was higher in SG than in CG. The number and area of gel particles formed under oral processing increased significantly with age, demonstrating an increase in children masticatory performance as they grew up. Median particles area was positively associated with sucking behavior and negatively associated with biting/chewing. The association with teeth emergence was not significant. In conclusion, the proposed method is relevant for quantifying the development of early masticatory performance in children who accept to hold the feeder in their mouth. PRACTICAL APPLICATIONS: In this article, a method to easily quantify masticatory performance in young children aged 6-18 MO was evaluated. The method is based on a feeder and could be used for collecting boluses, as an alternative to the chew-and-spit method when it is unfeasible. Children's compliance to the method and the impact of previous study participation on compliance to the protocol are detailed, giving thus a rationale for an optimal application of this method in future experiments. Finally, the determination of masticatory performance as a function of age thanks to this method could contribute to the understanding of food oral processing and food texture acceptance in childhood in future studies.

Spatial Characteristics of Jaw Movements During Chewing in Children with Cerebral Palsy: A Pilot Study

This study compared jaw motion between children with cerebral palsy (CP) and their typically-developing (TD) peers during chewing. The jaw movements of 11 children with spastic CP (GMFCS levels II-V) all of whom were exclusively oral feeders with no reported clinical issues with feeding [mean age = 7.49 (2.30) years; 7 males, 4 females] and 11 age- and sex-matched TD peers [mean age = 7.54 (2.35) years] were recorded using optical motion capture. Participants chewed five trials of three different consistencies, including puree, mechanical soft, and solid. For each chewing sequence, the path distance (total amount of distance traveled by the jaw), average jaw speed, and working space (total 3-dimensional size of the jaw movements during chewing) were calculated. The CP group had greater path distances for mechanical soft and solids (p < 0.001) and larger working spaces (p < 0.001) than the TD group. Consistency differences were also found with path distances increasing for both groups with increased bolus consistency (p < 0.001). Puree was chewed most slowly for both groups (p = 0.05) and was associated with smaller working space than the other consistencies for both groups (p < 0.001). The TD group demonstrated slower speeds for mechanical soft as compared to solids (p = 0.05), a finding which was not observed in the CP group. The results suggest children with CP showed jaw movement differences during chewing despite being exclusive oral eaters with no reports of clinical feeding or deglutition disorders. Food consistency also influenced jaw movements in both children with CP and their TD peers.

Validation of Clinical Observations of Mastication in Persons with ALS

Amyotrophic lateral sclerosis (ALS) is a progressive neurological disease that can result in difficulties with mastication leading to malnutrition, choking or aspiration, and reduced quality of life. When evaluating mastication, clinicians primarily observe spatial and temporal aspects of jaw motion. The reliability and validity of clinical observations for detecting jaw movement abnormalities is unknown. The purpose of this study is to determine the reliability and validity of clinician-based ratings of chewing performance in neuro-typical controls and persons with varying degrees of chewing impairments due to ALS. Adults chewed a solid food consistency while full-face video were recorded along with jaw kinematic data using a 3D optical motion capture system. Five experienced speech-language pathologists watched the videos and rated the spatial and temporal aspects of chewing performance. The jaw kinematic data served as the gold-standard for validating the clinicians' ratings. Results showed that the clinician-based rating of temporal aspects of chewing performance had strong inter-rater reliability and correlated well with comparable kinematic measures. In contrast, the reliability of rating the spatial and spatiotemporal aspects of chewing (i.e., range of motion of the jaw, consistency of the chewing pattern) was mixed. Specifically, ratings of range of motion were at best only moderately reliable. Ratings of chewing movement consistency were reliable but only weakly correlated with comparable measures of jaw kinematics. These findings suggest that clinician ratings of temporal aspects of chewing are appropriate for clinical use, whereas ratings of the spatial and spatiotemporal aspects of chewing may not be reliable or valid.

Validity and reliability of the Mastication Observation and Evaluation (MOE) instrument

The Mastication Observation and Evaluation (MOE) instrument was developed to allow objective assessment of a child's mastication process. It contains 14 items and was developed over three Delphi rounds. The present study concerns the further development of the MOE using the COSMIN (Consensus based Standard for the Selection of Measurement Instruments) and investigated the instrument's internal consistency, inter-observer reliability, construct validity and floor and ceiling effects. Consumption of three bites of bread and biscuit was evaluated using the MOE. Data of 59 healthy children (6-48 mths) and 38 children (bread) and 37 children (biscuit) with cerebral palsy (24-72 mths) were used. Four items were excluded before analysis due to zero variance. Principal Components Analysis showed one factor with 8 items. Internal consistency was >0.70 (Chronbach's alpha) for both food consistencies and for both groups of children. Inter-observer reliability varied from 0.51 to 0.98 (weighted Gwet's agreement coefficient). The total MOE scores for both groups showed normal distribution for the population. There were no floor or ceiling effects. The revised MOE now contains 8 items that (a) have a consistent concept for mastication and can be scored on a 4-point scale with sufficient reliability and (b) are sensitive to stages of chewing development in young children. The removed items are retained as part of a criterion referenced list within the MOE.