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Pediatric Dysphagia Evidence Map
Treatment

Prosthetic 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. Down Syndrome, 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. 4959, 292 pages
.
 
Added: July 2011
 
Description
This guideline provides recommendations pertaining to the assessment and intervention of young children with Down syndrome. The intended audiences for this guideline include families and professionals. Of particular importance to speech-language pathologists and audiologists are recommendations regarding assessment and management of communication, cognition, social relationships, oral-motor feeding, and hearing. 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
Interventions for oral motor and feeding problems may include palatal plate therapy (Level B). 
 
 
 
 
 
Evidence-Based Systematic Reviews
Long-Term Effects of Presurgical Infant Orthopedics in Patients with Cleft Lip and Palate: A Systematic Review
Uzel, A., & Alparslan, Z. N. (2011).
Cleft Palate-Craniofacial Journal, 48(5), 587-95.

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 and controlled clinical trials investigating the efficiency of presurgical infant orthopedics (PSIO) on long-term outcomes in children with cleft lip and palate.

Conclusions
"PSIO with passive and active appliances had no positive effects on feeding or consequent nutritional status in patients with UCLP [unilateral cleft lip and palate]" (p. 592).

» See full summary and quality ratings



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).

» See full summary and quality ratings



Feeding Interventions for Growth and Development in Infants with Cleft Lip, Cleft Palate or Cleft Lip and Palate
Bessell, A., Hooper, L. et al. (2011).
Cochrane Database of Systematic Reviews (2)
.
 
This review meets the criteria for a high-quality evidence-based systematic review.
Added: July 2011
 
Description
This is a review of randomized controlled trials investigating the effects of feeding interventions on growth, development and parent satisfaction for infants with cleft lip and palate. 
 
Conclusions
No evidence was found to support the use of maxillary plates for infants with a unilateral cleft palate. 
 
 
 
 
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 evidence of level 1b (moderate) that the use of oral appliance is more effective than no or alternative interventions enhancing oral sensorimotor skills. Studies of a lesser level of evidence (level 5) suggest positive effects on eating efficiency and safety and more generalized postural control” (p. 73).
 
 
 

Clinical Expertise/Expert Opinion

 
Consensus Guidelines  
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
“Some areas that are being investigated include use of intra-oral appliances (e.g., Gisel, Schwartz, & Haberfellner, 1999; Gisel, Schwartz, Petryk, Clarke, & Haberfellner, 2000). This type of intervention is shown to result in significant improvement in functional feeding skills in children with moderate dysphagia (Haberfellner, Schwartz, & Gisel, 2001)” (p. 16). 
 
  
 
 

Client/Patient/Caregiver Perspectives

 
Feeding Interventions for Growth and Development in Infants with Cleft Lip, Cleft Palate or Cleft Lip and Palate
Bessell, A., Hooper, L. et al. (2011).
Cochrane Database of Systematic Reviews (2)
.
Added: July 2011
 
Description
This is a review of randomized controlled trials investigating the effects of feeding interventions on growth, development and parent satisfaction for infants with cleft lip and palate. 
 
Conclusions
  • Five studies were included which examined various feeding interventions. However, no findings related to parental satisfaction included.
  • Further research is warranted.

» See full summary and quality ratings 

 
 
The Effects of Lactation Education and a Prosthetic Obturator Appliance on Feeding Efficiency in Infants with Cleft Lip and Palate
Turner, L., Jacobsen, C., et al. (2001).
Cleft Palate-Craniofacial Journal, 38(5), 519-24
 
Added: July 2011
 
Description
This is a prospective study of eight breastmilk bottle-fed newborn infants with cleft lip and/or palate.  This study reports on the effects of lactation education and a prosthetic obturator appliance on feeding efficiency.  In addition, mothers' satsifaction with feeding and swallowing outcomes linked to the intervention were reported. 
 
Conclusions
The majority of mothers surveyed reported high satisfaction in response to questions that addressed success in feeding their baby, that the baby ate in a normal fashion, that the baby received adequate amounts of milk with each feeding, and that the baby was gaining weight appropriately post-intervention. 
 




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