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Summary of Systematic Review

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.

Indicators of Review Quality:

The review states a clearly focused question or aim Yes
Criteria for inclusion of studies are provided Yes
Search strategy is described in sufficient detail for replication Yes
Included studies are assessed for study quality Yes
Quality assessments are reproducible Yes
Characteristics of the included studies are provided Yes

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).

Question(s)/Aim(s) Addressed:
Does regular application of feeding interventions (sensorimotor, positioning, consistency of textures, oral appliance, feeding device) improve feeding efficiency (mastication, swallowing, decreased mealtime) and safety (decrease in aspirations) and result in enhanced weight gain in children with CP?

Population:
Children (under 18 years) with cerebral palsy

Intervention/Assessment:
Impairment-based feeding interventions or adaptive feeding interventions

Number of Studies Included:
21

Years Included:
1950 to July 2009

Conclusions:

Pediatric Dysphagia

  • Treatment

    • Positioning Techniques

      • “[T]here is level 2b evidence (limited) that positioning has a positive effect on feeding safety and efficiency by decreasing the risk of aspiration and diminishing mealtime. There were no [randomized controlled trials] RCTs found on the effects of positioning on feeding safety and efficiency, and thus, higher levels of evidence are lacking” (p. 71).

    • Diet Modification

      • “[T]here is 2b evidence (limited) demonstrating that providing children with CP with softer food consistencies enhance feeding safety and efficiency. Higher-quality studies (such as [randomized controlled trials] RCTs) investigating this question are currently lacking” (p. 72).

    • Equipment/Utensils

      • “[T]here is level 2b evidence (limited) indicating that feeding devices may not be useful in enhancing feeding efficiency. However, the same level of evidence indicates that adapted equipment may serve to enhance certain oral-motor behaviors and increase independence” (p. 73).

    • Prosthetic Treatments

      • “[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).

    • Oral-Motor Treatments

      • “[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).

Sponsoring Body:
Not stated.

Keywords:
Cerebral Palsy, Diet Modification, Positioning

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