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Hahn Arkenberg RE, Mitchell SS, Craig BΑ, Brown B, Burdo-Hartman W, Lundine JP, Goffman L, Smith A, Malandraki GA. Neuromuscular adaptations of swallowing and speech in unilateral cerebral palsy: shared and distinctive traits. J Neurophysiol 2023; 130:1375-1391. [PMID: 37877193 PMCID: PMC11068406 DOI: 10.1152/jn.00502.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 10/02/2023] [Accepted: 10/19/2023] [Indexed: 10/26/2023] Open
Abstract
Our aims were to 1) examine the neuromuscular control of swallowing and speech in children with unilateral cerebral palsy (UCP) compared with typically developing children (TDC), 2) determine shared and separate neuromuscular underpinnings of the two functions, and 3) explore the relationship between this control and behavioral outcomes in UCP. Surface electromyography (sEMG) was used to record muscle activity from the submental and superior and inferior orbicularis oris muscles during standardized swallowing and speech tasks. The variables examined were normalized mean amplitude, time to peak amplitude, and bilateral synchrony. Swallowing and speech were evaluated using standard clinical measures. Sixteen children with UCP and 16 TDC participated (7-12 yr). Children with UCP demonstrated higher normalized mean amplitude and longer time to peak amplitude across tasks than TDC (P < 0.01; and P < 0.02) and decreased bilateral synchrony than TDC for swallows (P < 0.01). Both shared and distinctive neuromuscular patterns were observed between swallowing and speech. In UCP, higher upper lip amplitude during swallows was associated with shorter normalized mealtime durations, whereas higher submental bilateral synchrony was related to longer mealtime durations. Children with UCP demonstrate neuromuscular adaptations for swallowing and speech, which should be further evaluated for potential treatment targets. Furthermore, both shared and distinctive neuromuscular underpinnings between the two functions are documented.NEW & NOTEWORTHY Systematically studying the swallowing and speech of children with UCP is new and noteworthy. We found that they demonstrate neuromuscular adaptations for swallowing and speech compared with typically developing peers. We examined swallowing and speech using carefully designed tasks, similar in motor complexity, which allowed us to directly compare patterns. We found shared and distinctive neuromuscular patterns between swallowing and speech.
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Affiliation(s)
- Rachel E Hahn Arkenberg
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, United States
| | - Samantha S Mitchell
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, United States
| | - Bruce Α Craig
- Department of Statistics, Purdue University, West Lafayette, Indiana, United States
| | - Barbara Brown
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, United States
| | - Wendy Burdo-Hartman
- Nationwide Children's Hospital, Columbus, Ohio, United States
- Department of Pediatrics, College of Medicine, Ohio State University, Columbus, Ohio, United States
| | - Jennifer P Lundine
- Nationwide Children's Hospital, Columbus, Ohio, United States
- Department of Speech & Hearing Sciences, Ohio State University, Columbus, Ohio, United States
| | - Lisa Goffman
- Callier Center for Communication Disorders, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas Texas, United States
| | - Anne Smith
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, United States
| | - Georgia A Malandraki
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, United States
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, United States
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Ahmed Hassanin M, Aly MG, Atef H, Marques-Sule E, Ahmed GM. Task-oriented training for upper limb functions in patients with multiple sclerosis: Systematic review and meta-analysis. Mult Scler Relat Disord 2023; 73:104625. [DOI: 10.1016/j.msard.2023.104625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 03/10/2023] [Accepted: 03/18/2023] [Indexed: 03/30/2023]
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Eisman S, Husein N, Fehlings D, Andersen J, Oskoui M, Shevell M. Early Biomarkers in the Prediction of Later Functional Impairment in Term Children with Cerebral Palsy. Pediatr Neurol 2023; 140:59-64. [PMID: 36640520 DOI: 10.1016/j.pediatrneurol.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 11/09/2022] [Accepted: 12/11/2022] [Indexed: 12/25/2022]
Abstract
AIM To identify possible early biomarkers that could predict later functional capabilities in children at risk for cerebral palsy (CP). METHODS Data from 869 term children with CP were extracted from the Canadian Cerebral Palsy Registry. Univariate analyses were conducted to measure the association between readily available objective early biomarkers (neonatal encephalopathy [NE], cord or first hour of life pH, magnetic resonance imaging [MRI]) and functional outcomes such as mobility and feeding status. Multivariable regressions were then modeled to study whether adding predictors would affect the strength of the observed association. RESULTS Patients with NE have higher odds of having an assigned Gross Motor Function Classification Score level of IV to V (prevalence ratio [PR], 2.87; 95% confidence interval [CI], 2.07 to 3.97) and are more likely to require dependent tube feeding (PR, 2.09; 95% CI, 1.12 to 3.88); this was similarly seen in patients with MRI findings of deep gray matter injury, watershed injury, near-total brain injury, and/or cortical malformation (mobility status [PR, 5.13; 95% CI, 3.73 to 7.11] and feeding status [PR, 4.87; 95% CI, 2.57 to 9.75]). Patients with cord or first hour of life pH <7 were also more likely to predict dependent mobility status (PR, 2.86; 95% CI, 1.76 to 4.69), however, not significantly more likely to predict eventual dependent feeding status (PR, 1.47; 95% CI, 0.58 to 3.32). CONCLUSIONS This retrospective cohort study demonstrates that NE, MRI findings and cord or first hour of life pH can reliably predict later CP related functioning. These associations can be used to inform and clarify early prognosis discussions between caregivers and health professionals.
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Affiliation(s)
- Samantha Eisman
- Faculty of Medicine & Health Sciences, McGill University, Montreal, Quebec, Canada.
| | - Nafisa Husein
- Canadian Cerebral Palsy Registry, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Darcy Fehlings
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - John Andersen
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Oskoui
- Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada; Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Michael Shevell
- Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada; Department of Pediatrics, McGill University, Montreal, Quebec, Canada
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Min KC, Seo SM, Woo HS. Effect of oral motor facilitation technique on oral motor and feeding skills in children with cerebral palsy : a case study. BMC Pediatr 2022; 22:626. [PMID: 36324103 PMCID: PMC9632014 DOI: 10.1186/s12887-022-03674-8] [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: 05/24/2022] [Revised: 09/29/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Deficiencies in oral motor function and feeding skills are common in children with cerebral palsy (CP). Oral motor therapy is a useful method to improve oral motor function and feeding skills. Oral motor facilitation technique (OMFT) is a newly designed comprehensive oral motor therapy, including postural control, sensory adaptation, breathing control, sensorimotor facilitation, and direct feeding. Methods: This study was performed to identify the effect of OMFT on oral motor function and feeding skills in children with CP. A total of 21 children with CP (3–10 years, GMFCS III–V) participated in 16 weeks (16 sessions) of OMFT. The effects on oral motor function and feeding skills were assessed using the Oral Motor Assessment Scale (OMAS) before the treatment, 8 and 16 weeks after OMFT. Data were analyzed using the Friedman test and post-hoc analysis. Results: Significant improvement was found in oral motor function and feeding skills including mouth closure, lip closure on the utensil, lip closure during deglutition, control of the food during swallowing, mastication, straw suction, and control of liquid during deglutition after OMFT. Mouth closure was the most effective and mastication was the least effective item. Sixteen weeks is more effective than 8 weeks of OMFT. Conclusion: OMFT could be an effective and useful oral motor therapy protocol to improve oral motor function and feeding skills in children with CP.
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Affiliation(s)
- Kyoung-chul Min
- Department of Occupational Therapy, Seoul Metropolitan Children’s Hospital, Seocho-gu, Seoul Republic of Korea
| | - Sang-min Seo
- grid.443977.a0000 0004 0533 259XDepartment of Occupational Therapy, Semyung University, Seyoungro 65, Jecheon city, Chungchungbuk-do Republic of Korea
| | - Hee-soon Woo
- grid.410899.d0000 0004 0533 4755Department of Occupational Therapy, College of Medicine, Wonkwang University, 460 Iksandaero, Iksan city, Jeollabuk-do Republic of Korea
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Malandraki GA, Mitchell SS, Hahn Arkenberg RE, Brown B, Craig BΑ, Burdo-Hartman W, Lundine JP, Darling-White M, Goffman L. Swallowing and Motor Speech Skills in Unilateral Cerebral Palsy: Novel Findings From a Preliminary Cross-Sectional Study. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:3300-3315. [PMID: 35952392 PMCID: PMC9913219 DOI: 10.1044/2022_jslhr-22-00091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/25/2022] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Our purpose was to start examining clinical swallowing and motor speech skills of school-age children with unilateral cerebral palsy (UCP) compared to typically developing children (TDC), how these skills relate to each other, and whether they are predicted by clinical/demographic data (age, birth history, lesion type, etc.). METHOD Seventeen children with UCP and 17 TDC (7-12 years old) participated in this cross-sectional study. Feeding/swallowing skills were evaluated using the Dysphagia Disorder Survey (DDS) and a normalized measure of mealtime efficiency (normalized mealtime duration, i.e., nMD). Motor speech was assessed via speech intelligibility and speech rate measures using the Test of Children's Speech Plus. Analyses included nonparametric bootstrapping, correlation analysis, and multiple regression. RESULTS Children with UCP exhibited more severe (higher) DDS scores (p = .0096, Part 1; p = .0132, Part 2) and reduced speech rate than TDC (p = .0120). Furthermore, in children with UCP, total DDS scores were moderately negatively correlated with speech intelligibility (words: r = -.6162, p = .0086; sentences: r = -.60792, p = .0096). Expressive language scores were the only significant predictor of feeding and swallowing performance, and receptive language scores were the only significant predictor of motor speech skills. CONCLUSIONS Swallowing and motor speech skills can be affected in school-age children with UCP, with wide variability of performance also noted. Preliminary cross-system interactions between swallowing, speech, and language are observed and might support the complex relationships between these domains. Further understanding these relationships in this population could have prognostic and/or therapeutic value and warrants further study.
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Affiliation(s)
- Georgia A. Malandraki
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN
| | - Samantha S. Mitchell
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | | | - Barbara Brown
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Bruce Α. Craig
- Department of Statistics, Purdue University, West Lafayette, IN
| | - Wendy Burdo-Hartman
- Nationwide Children's Hospital, Columbus, OH
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus
| | - Jennifer P. Lundine
- Nationwide Children's Hospital, Columbus, OH
- Department of Speech and Hearing Sciences, The Ohio State University, Columbus
| | - Meghan Darling-White
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson
| | - Lisa Goffman
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson
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Jahan I, Sultana R, Muhit M, Akbar D, Karim T, Al Imam MH, Das MC, Smithers-Sheedy H, McIntyre S, Badawi N, Khandaker G. Nutrition Interventions for Children with Cerebral Palsy in Low- and Middle-Income Countries: A Scoping Review. Nutrients 2022; 14:nu14061211. [PMID: 35334869 PMCID: PMC8951851 DOI: 10.3390/nu14061211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Malnutrition is substantially higher among children with cerebral palsy (CP) in low- and middle-income countries (LMICs) when compared with the general population. Access to appropriate interventions is crucial for better management of malnutrition and nutritional outcomes of those children. We aimed to review the existing evidence on nutrition interventions for children with CP in LMICs. Methods: Online databases, i.e., PubMed and Scopus, and Google Scholar were searched up to 10 January 2022, to identify peer-reviewed publications/evidence on LMIC focused nutritional management guidelines/interventions. Following title screening and abstract review, full articles that met the inclusion/exclusion criteria were retained for data charting. Information about the study characteristics, nutrition interventions, and their effectiveness were extracted. Descriptive data were reported. Results: Eight articles published between 2008 and 2019 were included with data from a total of n = 252 children with CP (age range: 1 y 0 m–18 y 7 m, 42% female). Five studies followed experimental design; n = 6 were conducted in hospital/clinic/center-based settings. Four studies focused on parental/caregiver training; n = 2 studies had surgical interventions (i.e., gastrostomy) and n = 1 provided neurodevelopmental therapy feeding intervention. Dietary modification as an intervention (or component) was reported in n = 5 studies and had better effect on the nutritional outcomes of children with CP compared to interventions focused on feeding skills or other behavioral modifications. Surgical interventions improved nutritional outcomes in both studies; however, none documented any adverse consequences of the surgical interventions. Conclusion: There is a substantial knowledge gap on nutrition interventions for children with CP in LMICs. This hinders the development of best practice guidelines for the nutritional management of children with CP in those settings. Findings suggest interventions directly related to growth/feeding of children had a better outcome than behavioral interventions. This should be considered in planning of nutrition-focused intervention or comprehensive services for children with CP in LMICs.
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Affiliation(s)
- Israt Jahan
- CSF Global, Dhaka 1213, Bangladesh; (I.J.); (R.S.); (M.M.); (T.K.); (M.H.A.I.); (M.C.D.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1212, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD 4701, Australia
| | - Risad Sultana
- CSF Global, Dhaka 1213, Bangladesh; (I.J.); (R.S.); (M.M.); (T.K.); (M.H.A.I.); (M.C.D.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1212, Bangladesh
| | - Mohammad Muhit
- CSF Global, Dhaka 1213, Bangladesh; (I.J.); (R.S.); (M.M.); (T.K.); (M.H.A.I.); (M.C.D.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1212, Bangladesh
| | - Delwar Akbar
- School of Business and Law, Central Queensland University, Rockhampton, QLD 4701, Australia;
| | - Tasneem Karim
- CSF Global, Dhaka 1213, Bangladesh; (I.J.); (R.S.); (M.M.); (T.K.); (M.H.A.I.); (M.C.D.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1212, Bangladesh
- Specialty of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW 2145, Australia
- Cerebral Palsy Alliance, Sydney Medical School, The University of Sydney, Camperdown, NSW 2006, Australia; (H.S.-S.); (S.M.); (N.B.)
| | - Mahmudul Hassan Al Imam
- CSF Global, Dhaka 1213, Bangladesh; (I.J.); (R.S.); (M.M.); (T.K.); (M.H.A.I.); (M.C.D.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1212, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD 4701, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, QLD 4700, Australia
| | - Manik Chandra Das
- CSF Global, Dhaka 1213, Bangladesh; (I.J.); (R.S.); (M.M.); (T.K.); (M.H.A.I.); (M.C.D.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1212, Bangladesh
| | - Hayley Smithers-Sheedy
- Cerebral Palsy Alliance, Sydney Medical School, The University of Sydney, Camperdown, NSW 2006, Australia; (H.S.-S.); (S.M.); (N.B.)
| | - Sarah McIntyre
- Cerebral Palsy Alliance, Sydney Medical School, The University of Sydney, Camperdown, NSW 2006, Australia; (H.S.-S.); (S.M.); (N.B.)
| | - Nadia Badawi
- Cerebral Palsy Alliance, Sydney Medical School, The University of Sydney, Camperdown, NSW 2006, Australia; (H.S.-S.); (S.M.); (N.B.)
- Grace Centre for Newborn Intensive Care, The Children’s Hospital at Westmead, Sydney Children’s Hospital Network, Westmead, NSW 2145, Australia
| | - Gulam Khandaker
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD 4701, Australia
- Specialty of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW 2145, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, QLD 4700, Australia
- Correspondence: ; Tel.: +61-7-49206989
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Wilson E, Simione M, Polley L. Paediatric oral sensorimotor interventions for chewing dysfunction: A scoping review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:1316-1333. [PMID: 34423521 PMCID: PMC8585681 DOI: 10.1111/1460-6984.12662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Chewing dysfunction can have adverse effects on growth, development and quality of life. There is a lack of evidence-based consensus guidelines for sensorimotor intervention. To address this, we need to understand the current state of the science in clinical sensorimotor interventions for paediatric chewing dysfunction and systematically plan a research agenda and priorities for the field. AIMS The purpose of this scoping review was to examine the extent, range and nature of evidence for oral sensorimotor interventions for paediatric chewing dysfunction. METHODS & PROCEDURES This scoping review entailed five phases that included: identification of the research question; identification of relevant studies; study selection; data charting; and collation, summarization and report of the results. Treatment studies that were peer-reviewed and written in English were included. All studies involved a paediatric population and included an oral sensorimotor and/or chewing intervention. Information regarding study design, population, intervention, comparator, outcome measures and findings were extracted. MAIN CONTRIBUTION Of the 21 studies included in this scoping review, 53% were specific to children with cerebral palsy. All interventions were multi-component in nature and the treatment studies included a range of study designs, but few were controlled trials with comparators. A wide variety of outcomes measures were used within and across studies to determine treatment effectiveness. CONCLUSIONS & IMPLICATIONS The findings suggest that in a small number of studies, sensorimotor interventions provide preliminary evidence for effectiveness in specific populations. These and other treatment protocols must be trialled in additional clinical populations and settings to improve the evidence base for sensorimotor treatment of paediatric chewing dysfunction. This review also serves to help prioritize research agendas and further motivates the need for consensus-based clinical guidelines for paediatric chewing treatment. WHAT THIS PAPER ADDS What is already known on the subject Paediatric feeding disorders are highly prevalent and children often have chewing dysfunction that results in significant negative consequences. We lack evidence-based sensorimotor treatment approaches for chewing dysfunction, which directly impacts the care clinicians can provide children. What this study adds to existing knowledge This scoping review is the first step in examining the literature to understand the current state of the science for oral sensorimotor interventions for paediatric chewing dysfunction. Few randomized controlled studies were identified and a majority included children with cerebral palsy. Most of the interventions were multi-component and included a variety of treatment approaches. What are the potential or actual clinical implications of this work? The results of this scoping review can be used as an initial reference for clinicians selecting treatment approaches for chewing dysfunction. It also serves to help prioritize research agendas and further motivates the need for consensus-based clinical guidelines for paediatric chewing treatment.
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Affiliation(s)
- Erin Wilson
- Speech and Feeding Disorders Laboratory, MGH Institute of Health Professions, Boston, MA, USA
| | - Meg Simione
- Division of General Pediatrics, Mass General Hospital for Children, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Lydia Polley
- Department of Speech Pathology, Akron Children's Hospital, Akron, OH, USA
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Morgan C, Fetters L, Adde L, Badawi N, Bancale A, Boyd RN, Chorna O, Cioni G, Damiano DL, Darrah J, de Vries LS, Dusing S, Einspieler C, Eliasson AC, Ferriero D, Fehlings D, Forssberg H, Gordon AM, Greaves S, Guzzetta A, Hadders-Algra M, Harbourne R, Karlsson P, Krumlinde-Sundholm L, Latal B, Loughran-Fowlds A, Mak C, Maitre N, McIntyre S, Mei C, Morgan A, Kakooza-Mwesige A, Romeo DM, Sanchez K, Spittle A, Shepherd R, Thornton M, Valentine J, Ward R, Whittingham K, Zamany A, Novak I. Early Intervention for Children Aged 0 to 2 Years With or at High Risk of Cerebral Palsy: International Clinical Practice Guideline Based on Systematic Reviews. JAMA Pediatr 2021; 175:846-858. [PMID: 33999106 PMCID: PMC9677545 DOI: 10.1001/jamapediatrics.2021.0878] [Citation(s) in RCA: 142] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
IMPORTANCE Cerebral palsy (CP) is the most common childhood physical disability. Early intervention for children younger than 2 years with or at risk of CP is critical. Now that an evidence-based guideline for early accurate diagnosis of CP exists, there is a need to summarize effective, CP-specific early intervention and conduct new trials that harness plasticity to improve function and increase participation. Our recommendations apply primarily to children at high risk of CP or with a diagnosis of CP, aged 0 to 2 years. OBJECTIVE To systematically review the best available evidence about CP-specific early interventions across 9 domains promoting motor function, cognitive skills, communication, eating and drinking, vision, sleep, managing muscle tone, musculoskeletal health, and parental support. EVIDENCE REVIEW The literature was systematically searched for the best available evidence for intervention for children aged 0 to 2 years at high risk of or with CP. Databases included CINAHL, Cochrane, Embase, MEDLINE, PsycInfo, and Scopus. Systematic reviews and randomized clinical trials (RCTs) were appraised by A Measurement Tool to Assess Systematic Reviews (AMSTAR) or Cochrane Risk of Bias tools. Recommendations were formed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and reported according to the Appraisal of Guidelines, Research, and Evaluation (AGREE) II instrument. FINDINGS Sixteen systematic reviews and 27 RCTs met inclusion criteria. Quality varied. Three best-practice principles were supported for the 9 domains: (1) immediate referral for intervention after a diagnosis of high risk of CP, (2) building parental capacity for attachment, and (3) parental goal-setting at the commencement of intervention. Twenty-eight recommendations (24 for and 4 against) specific to the 9 domains are supported with key evidence: motor function (4 recommendations), cognitive skills (2), communication (7), eating and drinking (2), vision (4), sleep (7), tone (1), musculoskeletal health (2), and parent support (5). CONCLUSIONS AND RELEVANCE When a child meets the criteria of high risk of CP, intervention should start as soon as possible. Parents want an early diagnosis and treatment and support implementation as soon as possible. Early intervention builds on a critical developmental time for plasticity of developing systems. Referrals for intervention across the 9 domains should be specific as per recommendations in this guideline.
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Affiliation(s)
- Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Lars Adde
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic and Clinical Services, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
- Grace Centre for Newborn Care, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | | | - Roslyn N. Boyd
- The University of Queensland, St Lucia, Queensland, Australia
| | | | - Giovanni Cioni
- IRCCS Fondazione Stella Maris, Pisa, Italy
- University of Pisa, Pisa, Italy
| | | | - Johanna Darrah
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Linda S. de Vries
- University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | | | | | | | - Darcy Fehlings
- Holland Bloorview Kids Rehabilitation Hospital, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Hans Forssberg
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Andrea Guzzetta
- IRCCS Fondazione Stella Maris, Pisa, Italy
- University of Pisa, Pisa, Italy
| | - Mijna Hadders-Algra
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Petra Karlsson
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Beatrice Latal
- University Children’s Hospital Zurich, Zurich, Switzerland
| | - Alison Loughran-Fowlds
- Grace Centre for Newborn Care, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Catherine Mak
- The University of Queensland, St Lucia, Queensland, Australia
| | - Nathalie Maitre
- Nationwide Children’s Hospital, The Ohio State University, Columbus
| | - Sarah McIntyre
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Cristina Mei
- Orygen, Parkville, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Angela Morgan
- The Royal Children’s Hospital, Melbourne, Australia
- University of Melbourne, Parkville, Victoria, Australia
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | | | - Domenico M. Romeo
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli, Universitá Cattolica del Sacro Cuore, Rome, Italy
| | - Katherine Sanchez
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Alicia Spittle
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Physiotherapy, University of Melbourne, Parkville, Victoria, Australia
| | | | - Marelle Thornton
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jane Valentine
- Perth Children’s Hospital, Nedlands, Western Australia, Australia
| | | | - Koa Whittingham
- The University of Queensland, St Lucia, Queensland, Australia
| | - Alieh Zamany
- Eugene Child Development and Rehabilitation Center, Oregon Health and Science University, Eugene
| | - Iona Novak
- The University of Sydney, Sydney, Australia
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Acar G, Ejraei N, Turkdoğan D, Enver N, Öztürk G, Aktaş G. The Effects of Neurodevelopmental Therapy on Feeding and Swallowing Activities in Children with Cerebral Palsy. Dysphagia 2021; 37:800-811. [PMID: 34173063 DOI: 10.1007/s00455-021-10329-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/08/2021] [Indexed: 12/01/2022]
Abstract
This study investigated the effect of the structured Neurodevelopmental Therapy Method-Bobath (NDT-B) approach on the feeding and swallowing activity of patients with cerebral palsy (CP) and feeding difficulties. In addition to feeding and oral motor intervention strategies (OMIS), and nutrition-related caregiver training (NRCT), and the NDT-B, which was structured to increase trunk and postural control, was added to the therapy program. Forty patients with CP, with a mean age of 3.25 ± 0.927 years, were classified using the Gross Motor Function Classification System, Eating and Drinking Ability Classification System, and Mini-Manual Ability Classification System. The patients were randomly assigned into two groups as OMIS + NRCT (n = 20) and OMIS + NRCT + NDT-B (n = 20). The program was applied for 6 weeks, 2 days/week, for 45 min. The patients were evaluated using the Trunk Impairment Scale, Schedule for Oral Motor Assessment, and the Pediatric Quality of Life Inventory before and after 6 weeks. The trunk control of the OMIS + NRCT + NDT-B group was superior to the other group (P = 0.026). Although there was an improvement in the groups according to the subcategories of SOMA, the OMIS + NRCT + NDT-B group was superior in the trainer cup and puree subcategories of SOMA (P = 0.05). A significant correlation was observed between trunk control and oral motor functions in children with CP, and the eating function of children in the OMIS + NRCT + NDT-B group further improved. NDT-B-based neck and trunk stabilization exercises should be added to the treatment programs.Trial Registration NCT04403113.
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Affiliation(s)
- Gönül Acar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University, Basibuyuk, Basibuyuk Cd. No:9, Maltepe, Istanbul, 34854, Turkey
| | - Nasim Ejraei
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University, Basibuyuk, Basibuyuk Cd. No:9, Maltepe, Istanbul, 34854, Turkey.
| | - Dilşad Turkdoğan
- Department of Child Health and Diseases, Department of Pediatric Neurology, Marmara University Istanbul Pendik Training and Research Hospital, Istanbul, Turkey
| | - Necati Enver
- Department of Otolaryngology, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
| | - Gülten Öztürk
- Department of Child Health and Diseases, Department of Pediatric Neurology, Marmara University Istanbul Pendik Training and Research Hospital, Istanbul, Turkey
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10
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Motor Learning Feeding Interventions for Infants at Risk of Cerebral Palsy: A Systematic Review. Dysphagia 2019; 35:1-17. [DOI: 10.1007/s00455-019-10016-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/23/2019] [Indexed: 01/21/2023]
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11
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Sjögreen L, Gonzalez Lindh M, Brodén M, Krüssenberg C, Ristic I, Rubensson A, McAllister A. Oral Sensory-Motor Intervention for Children and Adolescents (3-18 Years) With Dysphagia or Impaired Saliva Control Secondary to Congenital or Early-Acquired Disabilities: A Review of the Literature, 2000 to 2016. Ann Otol Rhinol Laryngol 2018; 127:978-985. [PMID: 30296844 DOI: 10.1177/0003489418803963] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES: Dysphagia and impaired saliva control are common in children and adolescents with congenital and developmental disabilities. The aim of the present review was to investigate the evidence base for oral sensory-motor interventions in children and adolescents with dysphagia or impaired saliva control secondary to congenital or early-acquired disabilities and to make recommendations regarding methods for intervention. METHODS: A review of the literature from 2000 to 2016, including oral sensory-motor intervention studies for children and adolescents (3-18 years of age) with dysphagia or impaired saliva control secondary to congenital or early-acquired disabilities, was performed. The literature search included the PubMed, CINAHL, Medline, SpeechBITE, OVID, ERIC, Cochrane, and Google Scholar databases. Primary studies were evaluated on a 4-grade scale using the Grading of Recommendations Assessment, Development and Evaluation. RESULTS: Twenty primary studies of oral sensory-motor interventions for dysphagia and 6 studies for the treatment of impaired saliva control fulfilled the inclusion criteria. Of these, 3 were randomized, controlled trials. Five systematic reviews and 16 narrative reviews were also included. Limited and moderately strong recommendations were made on the basis of the grading results from the primary studies. The studies reported good results, but study design was often insufficient, and the study groups were small. The systematic reviews confirmed the lack of high scientific support for oral sensory-motor interventions in children and adolescents with congenital and developmental disabilities. CONCLUSIONS: There is an urgent need for high-quality studies that could serve as the basis for strong recommendations relating to oral sensory-motor interventions for children with dysphagia and impaired saliva control.
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Affiliation(s)
- Lotta Sjögreen
- 1 Mun-H-Center Orofacial Resource Centre for Rare Diseases, Public Dental Service, Gothenburg, Sweden
| | | | - Madeleine Brodén
- 3 Child and Adolescent Habilitation Services, Kronoberg County, Växjö, Sweden
| | | | | | - Agneta Rubensson
- 6 The Queen Silvia Children's Hospital, Regional Rehabilitation Centre, Gothenburg, Sweden
| | - Anita McAllister
- 7 Division of Speech and Language Pathology, CLINTEC, Karolinska Institutet, Functional Area Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
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12
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Henton PA. A Call to Reexamine Quality of Life Through Relationship-Based Feeding. Am J Occup Ther 2018; 72:7203347010p1-7203347010p7. [PMID: 29689186 DOI: 10.5014/ajot.2018.025650] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Feeding interventions that support family relationships enhance children's daily participation in meaningful occupations at home. A critical review of the literature yielded several premises that support the development of a relationship-based feeding framework. The proposed theoretical framework, based on the Biopsychosocial Model of Pediatric Feeding (Berlin, Davies, Lobato, & Silverman, 2009) and the Ecological Model of Occupation (Dunn, Brown, & Youngstrom, 2003), is presented to guide feeding interventions for children with significant feeding difficulties. A case example that illustrates the practical application of this framework is provided. Further development of relationship-based feeding theory and research is recommended to improve the occupational performance and quality-of-life outcomes for children and their families.
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Affiliation(s)
- Patricia A Henton
- Patricia A. Henton, OTD, OTR/L, ICA, is Assistant Professor, Doctor of Occupational Therapy Program, Huntington University, Fort Wayne, IN;
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13
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van den Engel-Hoek L, Harding C, van Gerven M, Cockerill H. Pediatric feeding and swallowing rehabilitation: An overview. J Pediatr Rehabil Med 2017; 10:95-105. [PMID: 28582882 DOI: 10.3233/prm-170435] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Children with neurological disabilities frequently have problems with feeding and swallowing. Such problems have a significant impact on the health and well-being of these children and their families. The primary aims in the rehabilitation of pediatric feeding and swallowing disorders are focused on supporting growth, nutrition and hydration, the development of feeding activities, and ensuring safe swallowing with the aim of preventing choking and aspiration pneumonia. Pediatric feeding and swallowing disorders can be divided into four groups: transient, developmental, chronic or progressive.This article provides an overview of the available literature about the rehabilitation of feeding and swallowing disorders in infants and children. Principles of motor control, motor learning and neuroplasticity are discussed for the four groups of children with feeding and swallowing disorders.
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Affiliation(s)
- Lenie van den Engel-Hoek
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Celia Harding
- City University, the Royal Free Hospital, London, UK
| | - Marjo van Gerven
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Helen Cockerill
- Evelina London Children's Hospital, Guy's and St. Thomas's NHS Foundation Trust, London, UK
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14
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Rabaey P. A review of feeding interventions for children with disabilities: Implications for institutionalised settings. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2017. [DOI: 10.12968/ijtr.2017.24.4.174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Paula Rabaey
- PhD Candidate Nova Southeastern University, Fort Lauderdale, FL; Assistant professor, Occupational Therapy Department, St Catherine University, St Paul, MN, USA
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15
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McCurtin A, Healy C. Why do clinicians choose the therapies and techniques they do? Exploring clinical decision-making via treatment selections in dysphagia practice. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 19:69-76. [PMID: 27063701 DOI: 10.3109/17549507.2016.1159333] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 02/24/2016] [Indexed: 06/05/2023]
Abstract
PURPOSE Speech-language pathologists (SLPs) are assumed to use evidence-based practice to inform treatment decisions. However, the reasoning underpinning treatment selections is not well known. Understanding why SLPs choose the treatments they do may be clarified by exploring the reasoning tied to specific treatments such as dysphagia interventions. METHOD An electronic survey methodology was utilised. Participants were accessed via the gatekeepers of two national dysphagia special interest groups representing adult and paediatric populations. Information was elicited on the dysphagia therapies and techniques used and on the reasoning for using/not using therapies. Data was analysed using descriptive and non-parametric statistics. RESULT The survey had a 74.8% response rate (n = 116). Consensus in both treatment selections and reasoning supporting treatment decisions was evident. Three favoured interventions (texture modification, thickening liquids, positioning changes) were identified. The reasoning supporting treatment choices centred primarily on client suitability and clinician knowledge. Knowledge reflected both absent knowledge (e.g. training) and accumulated knowledge (clinical experience). CONCLUSION Dysphagia practice appears highly-defined, being characterised by group consensus regarding both preferred treatments and the reasoning underpinning treatment selections. Treatment selections are based on two core criteria: client suitability and the SLPs experience/knowledge. Explicit scientific reasoning is less influential than practice-centric influences.
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Affiliation(s)
- Arlene McCurtin
- a University of Limerick - Clinical Therapies, Health Sciences Building University of Limerick Limerick , Limerick , Ireland
| | - Chiara Healy
- a University of Limerick - Clinical Therapies, Health Sciences Building University of Limerick Limerick , Limerick , Ireland
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16
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Abdelhadi RA, Rahe K, Lyman B. Pediatric Enteral Access Device Management. Nutr Clin Pract 2016; 31:748-761. [DOI: 10.1177/0884533616670640] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Ruba A. Abdelhadi
- Enteral Access Team, Children’s Mercy Kansas City, Kansas City, Missouri, USA
| | - Katina Rahe
- Enteral Access Team, Children’s Mercy Kansas City, Kansas City, Missouri, USA
| | - Beth Lyman
- Nutrition Support Team, Children’s Mercy Kansas City, Kansas City, Missouri, USA
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Taş SA, Çankaya T. An investigation of the relationship of drooling with nutrition and head control in individuals with quadriparetic cerebral palsy. J Phys Ther Sci 2015; 27:3487-92. [PMID: 26696723 PMCID: PMC4681930 DOI: 10.1589/jpts.27.3487] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 08/19/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of the present study was to investigate the relationship of drooling,
nutrition, and head control in individuals with quadriparetic cerebral palsy. [Subjects
and Methods] Fifty-six individuals between the ages 2 and 15 diagnosed with spastic
quadriparetic cerebral palsy and their families/caretakers were included in the study.
Drooling severity and frequency of individuals was evaluated by using the scale developed
by Thomas-Stonell and Greenberg (Drooling Severity and Frequency Scale). Individuals
having a drooling severity value of 1 were included in the not drooling group (group 2)
(n=27). Individuals having a drooling severity of 2, 3, 4, or 5 were included in the
drooling group (group 1) (n=29). The evaluations were applied to both groups. [Results]
There were significant differences between the two groups in terms of gestational age,
nutrition behavior, eating abilities, head control, gagging, nutritional status
(inadequate nutrition, normal nutrition, over weight-obese), and low weight. It was
established that as head control increased, drooling severity diminished, and as drooling
severity increased, BMI index decreased. Independence of eating ability was found to be
greater in the group having better drooling control. [Conclusion] In the present study, it
was determined that drooling control affected nutritional functions and that drooling
control was affected by head control.
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Affiliation(s)
- Seda Ayaz Taş
- Private 75th Year Special Education and Rehabilitation Centre, Turkey
| | - Tamer Çankaya
- School of Physical Therapy and Rehabilitation, Abant İzzet Baysal University: 14280 Bolu, Turkey
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18
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Rempel G. The Importance of Good Nutrition in Children with Cerebral Palsy. Phys Med Rehabil Clin N Am 2015; 26:39-56. [DOI: 10.1016/j.pmr.2014.09.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Arvedson JC. Feeding children with cerebral palsy and swallowing difficulties. Eur J Clin Nutr 2014; 67 Suppl 2:S9-12. [PMID: 24301008 DOI: 10.1038/ejcn.2013.224] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Children with cerebral palsy (CP) are at risk for aspiration with oral feeding with potential pulmonary consequences, and commonly have reduced nutrition/hydration status and prolonged stressful meal times. There is considerable variability in the nature and severity of swallowing problems in these children whose needs change over time. Children with generalized severe motor impairment (for example, spastic quadriplegia) are likely to experience greater swallowing deficits than those with diplegia, but oropharyngeal dysphagia is prevalent even in children with mild CP. This review is focused on dysphagia in children with CP: types of deficits, clinical and instrumental evaluation, management decision making and evidence of effectiveness of interventions.
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Affiliation(s)
- J C Arvedson
- Children's Hospital of Wisconsin, Milwaukee, WI, USA
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Ferluga ED, Sathe NA, Krishnaswami S, Mcpheeters ML. Surgical intervention for feeding and nutrition difficulties in cerebral palsy: a systematic review. Dev Med Child Neurol 2014; 56:31-43. [PMID: 23738903 DOI: 10.1111/dmcn.12170] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2013] [Indexed: 12/27/2022]
Abstract
AIM The aim of the study was to systematically review surgical intervention for feeding difficulties in cerebral palsy. METHOD We searched databases including MEDLINE from 1980 to July 2012. Two reviewers independently assessed studies and rated the overall quality and strength of the evidence. RESULTS Thirteen publications (11 unique studies) met the inclusion criteria and addressed gastrostomy outcomes or treatment of reflux via fundoplication. In nine studies, gastrostomy-fed children gained weight. Relative to typically developing populations, baseline weight z-scores ranged from -3.56 to -0.39 and follow-up z-scores ranged from -2.63 to -0.33. Other growth measures were mixed. Two studies assessed fundoplication: in one, both Nissen fundoplication and vertical gastric plication reduced reflux (by 57% and 43% respectively), while in one case series, reflux recurred within 12 months in 30% of children. The highest rates of adverse events across studies were site infection (59%), granulation tissue (42%), and recurrent reflux (30%). Death rates ranged from 7 to 29%; however, the underlying cause was probably not surgery. INTERPRETATION Evidence for the effectiveness of surgical interventions is insufficient to low. Studies of gastrostomy typically demonstrated significant weight gain. Results for other measures were mixed. Many children remained underweight, although, given a lack of appropriate reference standards, these results should be interpreted cautiously.
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Santos MTBR, Guaré RDO, Diniz MB, Ferreira MCD. Experiência de cárie e osmolaridade salivar em crianças com paralisia cerebral. REVISTA DE ODONTOLOGIA DA UNESP 2013. [DOI: 10.1590/s1807-25772013000600009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: Estudos têm demonstrado que quanto maior a severidade do dano neurológico em crianças com paralisia cerebral (PC), maior é o risco de doenças orais. OBJETIVO: Correlacionar a experiência de cárie com a osmolaridade salivar em crianças com PC. MATERIAL E MÉTODO: Participaram do estudo 99 crianças (9,2±2,3 anos) com PC, em tratamento reabilitacional. A saliva de repouso foi coletada no período matutino, utilizando rolos absorventes (Salivette®) por cinco minutos. A osmolaridade salivar foi medida por depressão do ponto de congelamento em osmômetro. As avaliações incluíram a experiência de cárie pelo índice de dentes cariados, perdidos e obturados (CPOD), e o motor oral durante o processo de alimentação da criança. Foram utilizados os testes Qui-quadrado, t de Student, Correlação de Spearman e razão de chances (OR), com nível de significância de 5%. RESULTADO: O grupo 1 (G1) foi composto por 41 crianças livres de cárie e o grupo 2 (G2), por 58 crianças com cárie (CPOD=3,5±2,7). Os grupos foram homogêneos para gênero (p=0,884) e idade (p=0,174). Entretanto, diferiram significantemente com relação à motricidade oral, apresentando G2 maiores porcentagens de crianças com motor oral subfuncional (p<0,001) e tetraparéticos (p=0,001). O G2 apresentou valores significantemente maiores (p<0,001) para osmolaridade (99,6±36,7mOsml) quando comparado ao G1 (76,7±15,9mOsml). Observou-se uma correlação significante entre osmolaridade e experiência de cárie (p<0,001). Apresentar osmolaridade superior a 76,7 (OR=5,18; 1,85 a 14,83) foi determinante individual de maior probabilidade de apresentar risco de cárie (CPOD>0). CONCLUSÃO: Maiores valores de osmolaridade salivar aumentam o risco de cárie em crianças com PC.
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Novak I, McIntyre S, Morgan C, Campbell L, Dark L, Morton N, Stumbles E, Wilson SA, Goldsmith S. A systematic review of interventions for children with cerebral palsy: state of the evidence. Dev Med Child Neurol 2013; 55:885-910. [PMID: 23962350 DOI: 10.1111/dmcn.12246] [Citation(s) in RCA: 787] [Impact Index Per Article: 71.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2013] [Indexed: 02/07/2023]
Abstract
AIM The aim of this study was to describe systematically the best available intervention evidence for children with cerebral palsy (CP). METHOD This study was a systematic review of systematic reviews. The following databases were searched: CINAHL, Cochrane Library, DARE, EMBASE, Google Scholar MEDLINE, OTSeeker, PEDro, PsycBITE, PsycINFO, and speechBITE. Two independent reviewers determined whether studies met the inclusion criteria. These were that (1) the study was a systematic review or the next best available; (2) it was a medical/allied health intervention; and (3) that more than 25% of participants were children with CP. Interventions were coded using the Oxford Levels of Evidence; GRADE; Evidence Alert Traffic Light; and the International Classification of Function, Disability and Health. RESULTS Overall, 166 articles met the inclusion criteria (74% systematic reviews) across 64 discrete interventions seeking 131 outcomes. Of the outcomes assessed, 16% (21 out of 131) were graded 'do it' (green go); 58% (76 out of 131) 'probably do it' (yellow measure); 20% (26 out of 131) 'probably do not do it' (yellow measure); and 6% (8 out of 131) 'do not do it' (red stop). Green interventions included anticonvulsants, bimanual training, botulinum toxin, bisphosphonates, casting, constraint-induced movement therapy, context-focused therapy, diazepam, fitness training, goal-directed training, hip surveillance, home programmes, occupational therapy after botulinum toxin, pressure care, and selective dorsal rhizotomy. Most (70%) evidence for intervention was lower level (yellow) while 6% was ineffective (red). INTERPRETATION Evidence supports 15 green light interventions. All yellow light interventions should be accompanied by a sensitive outcome measure to monitor progress and red light interventions should be discontinued since alternatives exist.
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Affiliation(s)
- Iona Novak
- Cerebral Palsy Alliance, Sydney, Australia; University of Notre Dame Australia, Sydney, Australia
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Benson JD, Parke CS, Gannon C, Muñoz D. A Retrospective Analysis of the Sequential Oral Sensory Feeding Approach in Children with Feeding Difficulties. JOURNAL OF OCCUPATIONAL THERAPY SCHOOLS AND EARLY INTERVENTION 2013. [DOI: 10.1080/19411243.2013.860758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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