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Pediatric Dysphagia Evidence Map
Treatment

Oral Motor Treatments

 


 

External Scientific Evidence

  

Evidence-Based Practice Guidelines

New York State Department of Health, Early Intervention Program; U.S. Department of Education
 
Clinical Practice Guideline: Report of the Recommendations. Motor Disorders, Assessment and Intervention for Young Children (Age 0-3 Years)
New York State Department of Health, Early Intervention Program. (2006).
Albany (NY): NYS Department of Health, Publication No. 4962, 322 pages
.
 
Added: July 2011
 
Description
This guideline provides recommendations regarding assessment and intervention for young children with developmental motor disorders and cerebral palsy, a static central nervous system disorder.  The target audiences for this guideline are parents and professionals. The recommendations are classified A, B, C, D1 or D2, based on the strength and quality of evidence. Level A recommendations are considered “strong evidence” based on high quality evidence from two or more efficacy studies. Level B recommendations are considered “moderate evidence" and based on evidence from at least one high quality efficacy study. Level C recommendations are "limited evidence" and based on evidence from at least one efficacy study with moderate quality or applicability to the topic.  Level D1 and D2 are consensus recommendations. Level D1 recommendations are consensus panel opinion based on information not meeting criteria for evidence in systematic reviews and Level D2 recommendations are based on information where a systematic review has not been done. 
 
Recommendations
Oral-motor intervention should be targeted to the specific phase or phases of swallowing which are impaired (Evidence Level D2). 
 
 
 
 
Royal College of Speech & Language Therapists; Department of Health (UK); National Institute for Clinical Excellence (NICE)
 
Royal College of Speech and Language Therapists Clinical Guidelines: 5.8 Disorders of Feeding, Eating, Drinking & Swallowing (Dysphagia)
Taylor-Goh, S., ed. (2005).
RCSLT Clinical Guidelines. Bicester, Speechmark Publishing Ltd.
 
Added: July 2011
 
Description
This guideline provides recommendations for the assessment and management of swallowing disorders in children and adults. This guideline is intended for speech-language pathologists. Populations included, but were not limited to, stroke, traumatic brain injury, autism spectrum disorder, cerebral palsy, Parkinson’s disease and head and neck cancer. Each recommendation is graded A (requires at least one randomized controlled trial), B (requires at least one well-conducted clinical study), or C (requires evidence from expert committee reports). 
 
Recommendations
  • “The Speech & Language Therapist will provide therapy to maintain and/or improve oromotor function, which will be within agreed optimal time frames. This may include range of motion, chewing and swallowing exercises, and thermal and tactile stimulation. This may be contraindicated for cardiac and certain degenerating conditions” (Level B Evidence) (p. 69).
  • Children receiving non-oral feeding should be given oral stimulation as appropriate to "normalise sensation and maintain and promote skills" (Expert Opinion) (p. 70).
  • The speech-language pathologist will consider and potentially modify "oral-motor skills to include organisation of non-nutritive suck in infants" (Level B Evidence) (p. 67).

» See full summary and quality ratings 

 
 
 
Evidence-Based Systematic Reviews
Integrative Literature Review Defining Evidence-Based Neurodevelopmental Supportive Care of the Preterm Infant
Lubbe, W., Van der Walt, C. S. J., et al. (2012).
Journal of Perinatal & Neonatal Nursing, 26(3), 251-259.
Added: April 2013

Description
This is a review of the literature investigating the evidence supporting the individual elements of a holistic supportive care for the preterm infant.

Conclusions
"Provision of nonnutritive sucking opportunities during gavage feeding contributes to feeding maturation in the preterm infant and is associated with physiologic stability" (p. 257).

» See full summary and quality ratings



Evidence-Based Intervention for Toddlers with Sensorimotor Feeding Disorders
Redle, E. E. (2012).
EBP Briefs, 7(4), 1-13.
Added: April 2013

Description
This is a systematic review of the peer-reviewed literature investigating oral sensorimotor interventions in toddlers with feeding delays.

Conclusions
The author concluded that direct comparisons of the two interventions (i.e., oral motor alone versus a combination of sensory and oral motor treatment) was difficult given that the treatments examined in the included empirical studies had both a sensory and motor component. Currently, better evidence is available for treatments combining oral motor and sensory interventions in this specific population. 

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Interventions for Oropharyngeal Dysphagia in Children with Neurological Impairment
Morgan, A. T., Dodrill, P., et al. (2012).
Cochrane Database of Systematic Reviews, 10, CD009456.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: April 2013

Description
This is a review of randomized controlled trials (RCTs) investigating direct and indirect dysphagia interventions for children with neurological impairment.

Conclusions
The included studies examined oral sensorimotor treatment or a lip strengthening program. The authors concluded, "This review demonstrates that there is currently not enough high-quality evidence from RCTs to provide conclusive results about the effectiveness of any particular type of therapy...no clear guidelines or recommendations for clinical practice with this population of children can be made until higher-quality evidence has been generated" (p. 16).

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Timing Introduction and Transition to Oral Feeding in Preterm Infants: Current Trends and Practice
Breton, S., & Steinwender, S. (2008).
Newborn & Infant Nursing Reviews, 8(3), 153-159.
Added: April 2013

Description
This is a review of the published literature investigating the best practices related to the timing of introduction to oral feeds and transition to full oral feeds with preterm infants. Findings from the review were classified as weak, fair, or good based on the following criteria:

  • "Good - Evidence includes consistent results from well-designed, well-conducted studies in representative populations that directly assess effects on health outcomes

  • Fair - Evidence is sufficient to determine effects on health outcomes, but the strength of evidence is limited by quality or consistency of the individual studies, generalizability to routine practice, or indirect nature of the evidence on health outcomes

  • Weak - Evidence is insufficient to assess the effects on health outcomes because of limited number or power of studies, important flaws in their design or conduct, gaps in the chain of evidence, or lack of information on important health outcomes" (p. 157).

Conclusions
There is good evidence that "NNS [non nutritive sucking] stimulation before initiation of oral feeding leads to increased feeding efficiency, earlier attainment of oral feeding, and enhanced maturation of feeding skills" (p. 156).

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Interventions for Drooling in Children with Cerebral Palsy
Walshe, M., Smith, M., et al. (2012).
Cochrane Database of Systematic Reviews, 2, CD008624.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: April 2013

Description
This is a systematic review of randomized controlled trials examining various interventions for drooling in children with cerebral palsy (CP).Treatments investigated in the review include: surgery, pharmacological interventions, botulin toxin, oro-motor/oro-sensory therapies, behavioral interventions, intra-oral appliances, and acupuncture.

Conclusions
No studies were found on surgery, physical/oro-motor-oro-sensory therapies, behavioral treatments, intra-oral appliances, or acupuncture. "There is insufficient evidence to evaluate the effectiveness and safety of interventions aimed at reducing or eliminating drooling in children with cerebral palsy or to provide the best available evidence to inform clinical practice" (p. 30).

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Does the End Justify the Means? A Critique of Oromotor Treatment in Children with Cerebral Palsy
Davies, F. (2003).
Asia Pacific Journal of Speech, Language & Hearing, 8(2), 146-52.
Added: September 2012

Description
This is a systematic review of the literature investigating the effects of oral motor treatment on the swallowing and feeding skills of children with cerebral palsy.

Conclusions

  • "The body of evidence regarding the benefits of oromotor treatment in children with cerebral palsy is affected by the diversity of the scant literature" (p. 151).

  • "...there is no evidence that oromotor treatment results in increased weight gain, or decrease in mealtime duration" (p. 152).

  • There is limited evidence for "improved pharyngeal clearing following oromotor treatment" (p. 152).

  • Oral motor treatment "can result in moderate improvement in oromotor skill level: however, it is not clear whether this results in functional improvement during mealtimes" (p. 150).

» See full summary and quality ratings



Non-Nutritive Sucking for Promoting Physiologic Stability and Nutrition in Preterm Infants
Pinelli, J., & Symington, A. (2005).
Cochrane Database Syst Rev(4), CD001071
.
 
This review meets the criteria for a high-quality evidence-based systematic review.
Added: March 2012
 
Description
This is a review of experimental and quasi-experimental designs addressing the use of non-nutritive sucking (NNS) in preterm infants. 
 
Conclusions 
  • “NNS decreased length of hospital stay in preterm infants, and appears to facilitate the transition to full oral/bottle feeds and bottle feeding performance in general” (p. 7).
  • NNS resulted in a reduction in defensive behaviors during tube feeding, a reduction in fussy time and active states before and after tube feeding, and improvement in transition to sleep state.
  • No consistent positive effects on behavioral state were noted related to NNS.
  • “Although a number of outcomes demonstrated no differences with or without NNS, there do not appear to be any short-term negative effects as a result of this intervention” (p. 8).
 
 
 
Feeding Interventions for Children with Cerebral Palsy: A Review of the Evidence
Snider, L., Majnemer, A., et al. (2011).
Physical & Occupational Therapy in Pediatrics, 31(1), 58-77.
 
This review meets the criteria for a high-quality evidence-based systematic review.
Added: July 2011 

Description
This is a systematic review of studies (all study designs included) investigating the impact of feeding interventions for children with cerebral palsy (CP). Levels of evidence are as follows: 1a (strong; well-designed meta-analysis or two or more “high-quality” randomized controlled trials [RCT]), 1b (moderate; one RCT of “high quality”), 2a (limited; at least one “fair quality” RCT), 2b (limited; at least one “poor quality” RCT), 3 (consensus; expert consensus or a number of pre-post studies with similar findings), 4 (conflict; two or more equally, well-designed studies with conflicting evidence), and 5 (no evidence; no well-designed studies-only case studies, cohort studies, or single-subject studies with no multiple baselines). 
 
Conclusions

“[T]here is conflicting evidence (level 4) that sensorimotor facilitation techniques are more effective than alternative treatment or absence thereof in enhancing feeding safety and efficiency. However, the [randomized controlled trials] RCTs may have been underpowered (small sample sizes), and the less rigorously designed studies indicated positive results” (p. 71).

» See full summary and quality ratings 

 
 
 
The Effects of Oral-Motor Exercises on Swallowing in Children: An Evidence-Based Systematic Review
Arvedson, J., Clark, H., et al. (2010).
Developmental Medicine and Child Neurology, 52(11), 1000-13.
 
 
This review meets the criteria for a high-quality evidence-based systematic review.
Added: July 2011
 
Description
This review investigates the impact of oral-motor exercises (OME) on swallowing for children with swallowing disorders.  Children included in this review had diagnoses of Down syndrome, cerebral palsy, multiple disabilities and orofacial dysfunction with tongue thrust. 
 
Conclusions
Due to the mixed results and heterogeneity of participants and interventions, no conclusions can be reached. 
 
 
 
 
 
Evidence-Based Systematic Review: Effects of Oral Motor Interventions on Feeding and Swallowing in Preterm Infants
Arvedson, J., Clark, H., et al. (2010).
American Journal of Speech-Language Pathology, 19(4), 321-40.
 
 
This review meets the criteria for a high-quality evidence-based systematic review.
Added: July 2011
 
Description
This is a review of experimental, quasi-experimental, or multiple-baseline single-subject design research investigating the effects of oral motor interventions (OMI) on outcomes of feeding and swallowing for preterm infants. 
 
Conclusions
  • “Non-nutritive sucking (NNS) has been the most extensively studied [oral-motor intervention], with strong positive findings for improvement in oral feeding and swallowing physiology variables and for reducing the time to transition to total oral feeding by some investigators” (p. 337).
  • “Pre-feeding stimulation has been explored in fewer studies, with equivocal results across the outcomes targeted in this review” (p. 337).
  • “Although less thoroughly investigated than NNS in isolation, the combined effect of NNS plus oral stimulation produced a similar pattern of findings to NNS alone” (p. 337).
  • “None of the OMIs provided consistent positive results on weight gain and growth in this population” (p. 337).

» See full summary and quality ratings 

 

 

Clinical Expertise/Expert Opinion

 
Consensus Guidelines  
NHS Quality Improvement Scotland
 
Best Practice Statement: Caring for the Child/Young Person with a Tracheostomy
NHS Quality Improvement Scotland. (2008).
Edinburgh (Scotland): NHS Quality Improvement Scotland, 68 pages
 
Added: July 2011
 
Description
This guideline provides recommendations for the management of children and adolescents with a tracheostomy. This guideline is intended for healthcare professionals involved in the multidisciplinary care of these children. 
 
Recommendations
“The speech and language therapist should implement an oro-motor programme for the child/young person who is non-orally fed in order to normalize sensation and maintain and promote skills. A child/young person who is non-orally fed can become orally hypersensitive resulting in possible future behavioural feeding difficulties” (p. 10). 
 
 
 
 
American Speech-Language-Hearing Association
 
Roles and Responsibilities of Speech-Language Pathologists in the Neonatal Intensive Care Unit: Guidelines
American Speech-Language-Hearing Association. (2005).
Retrieved from: http://www.asha.org/docs/html/GL2005-00060.html.
 
 
Added: July 2011
 
Description
This is a guideline providing recommendations on the roles and responsibilities of speech-language pathologists (SLPs) providing care in the Neonatal Intensive Care Unit (NICU). Recommendations are provided pertaining to assessment and management of communication, feeding, and swallowing of infants. 
 
Recommendations
  • Kangaroo mother care (KMC) (skin-to-skin contact between a mother and her newborn infant) and nonnutritive sucking (NNS) may be important factors in the achievement of readiness for oral feeding.
  • KMC was demonstrated to have a positive effect in one randomized controlled trial of over 400 infants; however, one review suggests that there is insufficient evidence to support the routine use of KMC in low birth weight infants.
  • Several studies have shown positive outcomes and cost-effectiveness associated with NNS. Findings from other studies support use of auditory, tactile, visual, and vestibular, oral and facial stimulation which appear to improve initial alertness.
 
 
 
American Speech-Language-Hearing Association
 
Preferred Practice Patterns for the Profession of Speech-Language Pathology
American Speech-Language-Hearing Association. (2004).
Retrieved from: http://www.asha.org/docs/html/PP2004-00191.html.
 
 
Added: July 2011
 
Description
This Preferred Practice Patterns for the Profession of Speech-Language Pathology document is a description of recommended practice for many areas of assessment and management in the scope of practice for SLPs. The guiding principles for each clinical service are discussed in terms of service provider, expected outcome, clinical indication, clinical processing, setting, equipment, safety precautions, and documentation. 
 
Recommendations

The results of the assessment dictate the focus of intervention. Intervention may involve alteration of lingual and labial resting postures, muscle retraining, and modification of solids, liquids, and saliva.

 
 
 
American Speech-Language-Hearing Association
 
Roles of Speech-Language Pathologists in Swallowing and Feeding Disorders: Technical Report
American Speech-Language-Hearing Association. (2001).
Retrieved from: http://www.asha.org/docs/html/TR2001-00150.html.
 
 
Added: July 2011
 
Description
This ASHA position statement provides information regarding the role of the SLP in evaluation and management of children and adults with feeding and swallowing disorders and discusses the scope and rationale for SLP services. 
 
Recommendations
“Neurophysiologic facilitation of orofacial muscles by stretching, brushing, vibrating, icing, and stroking areas of the face and mouth is reported effective in some children with cerebral palsy (Gallender, 1979, 1980; Sobsey & Orelove, 1984). However, once facilitation is withdrawn, regression has been noted" (p. 16). 
 
 
 
 

Client/Patient/Caregiver Perspectives

 
No information was found pertaining to client/patient/caregiver perspectives.
 
 
 




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