Cup Drinking Research Articles

Incorporating social validity into practice: Treatment progression across pediatric feeding skill domains

AbstractA small but growing body of research in pediatric feeding disorders asserts the importance of comprehensively measuring social significance of goals, procedures, and effects of intervention, and incorporating social validity into practice to inform treatment. This report sought to extend this literature by detailing procedures to measure and improve social validity during a clinical case of a 3.5‐year‐old during a home‐based intensive feeding program. A multiple baseline design demonstrated effectiveness of nonremoval and re‐presentation added to a treatment package. Repeated choice via direct child preference assessments informed demand fading and gradual progression across six feeding skill domains (medication, cup drinking, independence, texture, volume, variety) and arrangements of response effort (preference, skill) with layers of reinforcer parameters (quality, magnitude, rate, immediacy). Indices of happiness definitions were modified, and extinction bursts examined. Fostering a collaborative approach, caregivers provided detailed input on social validity measures pretreatment, at discharge, and long‐term follow‐up (6‐month, 1‐year), inclusive of both qualitative and quantitative responses, written and verbal communication, and permanent product data. Further implications for practitioners included detailing the process for caregiver training and generalization to family meals with siblings and community settings, and providing adaptable full‐text guidelines for free access/choice contexts.

The 100ml-Timed Water Swallow Test: Pilot Data from Children with No Dysphagia.

Dysphagia screening tests are useful in identifying possible dysphagia for further evaluation and in supporting feeding recommendations. This study aimed to investigate swallowing parameters in children, while widening the pool of data available, using the '100ml-Timed Water Swallow Test' (100ml-TWST). Sixty Singaporean children aged 4 to 18years old completed the 100ml-TWST via a cup and a straw. Task completion, presence of cough, choke or throat clear, post-swallow voice quality, total time taken and number of swallows were observed. Subsequently, analysis of time per swallow (T/S), volume per swallow (V/S) and volume per time or swallowing capacity (V/T) were performed. Higher tendencies for coughing and task incompletion were observed in younger participants. A shorter time taken, fewer number of swallows, greater V/S and greater swallowing capacity were observed for adolescent or male participants, or via the mode of cup drinking. These could be due to oropharyngeal structural changes and swallow maturation with age, an increased capacity of oropharyngeal structures for swallowing in adolescent males, and more controlled or paced drinking from a straw. A plateau in time taken, number of swallows and swallowing capacity in adolescence were also observed, possibly indicating an emerging maturation of swallow functions during that period. Interestingly, speed of bolus movement was largely unaffected by age, gender and mode of drinking. Pilot data for children with no dysphagia have been established, while gaining insight into the swallowing parameters and maturation process in the paediatric population.

Effect of Nursing Interventions on Feeding Difficulties of Children with Cerebral Palsy

Context: Cerebral Palsy (CP) is a static non-progressive brain disorder defined as a group of motor disorders resulting from brain damage before, during, or after birth. Children with CP frequently have feeding problems, growth disorders, feeding complications, communication disorders, mental obstruction, seizure disorders, auditory problems, and visual deficiency, which may significantly impact their health.
 Aim: The study aimed to evaluate the effect of nursing interventions on feeding difficulties of children with cerebral palsy.
 Methods: A quasi-experimental (pre/post-test) research design was utilized in this study that was conducted at the Neurologic Specialized Clinic at Children's Hospital affiliated to Ain Shams University Hospitals. A convenient sample of forty-five children with CP having feeding difficulties and their mothers was selected from the previously mentioned setting. Data were collected by using three tools, a structured interview questionnaire and a Children Observation Assessment Record to assess the child's ability and feeding difficulties of the studied children before and after the intervention.
 Results: The study reveals a mother's mean age of 31.33±4.46 and a child's mean age of 6.28±2.91. The children's assessment reveals that 84.4% of cerebral palsy children were hypotonic. Pre and post-test comparisons of children's BMI revealed a statistically significant difference at p=0.018, and feeding difficulties revealed a statistically significant difference in spoon feeding p= 0.007, biting p=0.002, chewing p=0.003, cup drinking p= 0.005, swallowing p=0.001, and drooling during eating p=0.009.
 Conclusion: The study concluded that the supportive nursing intervention program was successful in improving the feeding difficulties as regards spoon feeding, biting, chewing, cup drinking, swallowing, and drooling during eating after the intervention compared to the children's pre-intervention level. The study recommended applying supportive nursing interventions for children with CP having feeding difficulties as a main supportive nursing intervention to overcome feeding difficulties.

Baby Intensive Early Active Treatment (babiEAT): A Pilot Randomised Controlled Trial of Feeding Therapy for Infants with Cerebral Palsy and Oropharyngeal Dysphagia.

Cerebral palsy (CP), results in impairment of muscle function including the face, mouth, and throat, leading to oropharyngeal dysphagia (OPD), which affects 85% of children with CP. OPD increases risk of deficiencies in growth, neurological development, and aspiration pneumonia, a leading cause of death in CP. This pilot randomised controlled trial aimed to (i) assess feasibility and acceptability of a novel neuroplasticity and motor-learning feeding intervention program, Baby Intensive Early Active Treatment (babiEAT), and standard care, and (ii) explore preliminary efficacy of babiEAT on health and caregiver feeding-related quality of life (QoL). A total of 14 infants with both CP and OPD were randomly allocated to 12 weeks of babiEAT or standard care. Results indicate that babiEAT and standard care are equally feasible, and acceptable. Parents in the babiEAT group thought recommendations were significantly more effective than standard care parents, were more likely to recommend the program to a friend and reported higher QoL. babiEAT infants showed significantly greater efficiency in fluid intake, fewer compensatory strategies with cup drinking, consumption of more advanced food textures, and shorter mealtimes without impacting intake, aspiration risk, or weight. This small pilot study shows promise for babiEAT in infants with CP and OPD. Further research is needed to determine strength of its effects.

Effect of Oral Apraxia on Dysphagia in Patients with Subacute Stroke.

Aim of this study was to investigate the effect of post-stroke oral apraxia on dysphagia in patients with subacute stroke. We retrospectively analyzed the clinical data of 130 supratentorial stroke patients from January 2015 to February 2021 who underwent a formal limb and oral apraxia test and videofluoroscopic swallowing study (VFSS), and we compared the patients in two groups: the apraxia and non-apraxia (oral apraxia score > 45 and ≤ 45 points, respectively). All the patients participated in the standardized testing battery. The test variables were videofluoroscopic dysphagia scale (VDS), oral transit time (OTT), pharyngeal delay time (PDT), pharyngeal transit time, and penetration-aspiration scale (PAS); we conducted multivariable regression analysis with those parameters to confirm the significance of oral apraxia as a clinical determinant of post-stroke dysphagia. The mean oral apraxia scores were 38.4 and 47.6 points in the apraxia and non-apraxia groups, respectively (p < 0.001). The apraxia group had a higher proportion of delayed OTT for the 2-mL-thick liquid than the non-apraxia group (17.6% and 4.2%, respectively; p = 0.011). Oral apraxia was a significant determinant of VDS (p < 0.001), delayed OTT of 2-mL-thick liquids (p = 0.028), delayed PDT of cup drinking for thin liquid (p = 0.044), and PAS scores (p = 0.003). The presence of oral apraxia was significantly associated with dysphagia, especially with the VFSS parameters of the oral phase (thick liquid), pharyngeal phase (cup drinking for thin liquid) of swallowing, and increased risk of aspiration in subacute stroke patients. Thus, a formal assessment of oral apraxia is needed for stroke patients with dysphagia.

A feasibility pilot study of the effects of neurostimulation on swallowing function in Parkinson's Disease [version 2; peer review: 1 approved, 3 approved with reservations, 1 not approved

IntroductionDysphagia often occurs during Parkinson’s disease (PD) and can have severe consequences. Recently, neuromodulatory techniques have been used to treat neurogenic dysphagia. Here we aimed to compare the neurophysiological and swallowing effects of three different types of neurostimulation, 5 Hertz (Hz) repetitive transcranial magnetic stimulation (rTMS), 1 Hz rTMS and pharyngeal electrical stimulation (PES) in patients with PD.Method12 PD patients with dysphagia were randomised to receive either 5 Hz rTMS, 1 Hz rTMS, or PES. In a cross-over design, patients were assigned to one intervention and received both real and sham stimulation. Patients received a baseline videofluoroscopic (VFS) assessment of their swallowing, enabling penetration aspiration scores (PAS) to be calculated for: thin fluids, paste, solids and cup drinking. Swallowing timing measurements were also performed on thin fluid swallows only. They then had baseline recordings of motor evoked potentials (MEPs) from both pharyngeal and (as a control) abductor pollicis brevis (APB) cortical areas using single-pulse TMS. Subsequently, the intervention was administered and post interventional TMS recordings were taken at 0 and 30 minutes followed by a repeat VFS within 60 minutes of intervention.ResultsAll interventions were well tolerated. Due to lower than expected recruitment, statistical analysis of the data was not undertaken. However, with respect to PAS swallowing timings and MEP amplitudes, there was small but visible difference in the outcomes between active and sham.ConclusionPES, 5 Hz rTMS and 1 Hz rTMS are tolerable interventions in PD related dysphagia. Due to small patient numbers no definitive conclusions could be drawn from the data with respect to individual interventions improving swallowing function and comparative effectiveness between interventions. Larger future studies are needed to further explore the efficacy of these neuromodulatory treatments in Parkinson’s Disease associated dysphagia.

Breathing-swallow dysfunction in COPD: How silent aspiration may be contributing to exacerbations.

Breathing-swallow dysfunction in COPD: How silent aspiration may be contributing to exacerbations.

A feasibility pilot study of the effects of neurostimulation on dysphagia recovery in Parkinson’s Disease

Introduction: Dysphagia often occurs during Parkinson’s disease (PD) and can have severe consequences. Recently, neuromodulatory techniques have been used to treat neurogenic dysphagia. Here we aimed to compare the neurophysiological and swallowing effects of three different types of neurostimulation, 5 Hertz (Hz) repetitive transcranial magnetic stimulation (rTMS), 1 Hz rTMS and pharyngeal electrical stimulation (PES). Method: 12 PD patients with dysphagia were randomised to receive either 5 Hz rTMS, 1 Hz rTMS, or PES. In a cross-over design, patients were assigned to one intervention and received both real and sham stimulation. Patients received a baseline videofluoroscopic (VFS) assessment of their swallowing, enabling penetration aspiration scores (PAs) to be calculated for: thin fluids, paste, solids and cup drinking. Swallowing timing measurements were also performed on thin fluid swallows only. They then had baseline recordings of motor evoked potentials (MEPs) from both pharyngeal and (as a control) abductor pollicis brevis (APB) cortical areas using single-pulse TMS. Subsequently, the intervention was administered and post interventional TMS recordings were taken at 0 and 30 minutes followed by a repeat VFS within 60 minutes of intervention. Results: All interventions were well tolerated. Due to lower than expected recruitment, statistical analysis of the data was not undertaken. However, with respect to PAs swallowing timings and MEP amplitudes, there was visual separation in a positive direction between active and sham groups for all interventions. Conclusion: PES, 5 Hz rTMS and 1 Hz rTMS are tolerable interventions in PD related dysphagia. Due to small patient numbers no definitive conclusions could be drawn from the data with respect to individual interventions improving swallowing function and comparative effectiveness between interventions. Larger future studies are needed to further explore the efficacy of these neuromodulatory treatments in Parkinson’s Disease associated dysphagia.

Aspiration and severe exacerbations in COPD: a prospective study.

RationaleSwallow may be compromised in COPD leading to aspiration and adverse respiratory consequences. However, prevalence and consequences of detectable aspiration in stable COPD are not known.ObjectivesWe tested the hypothesis that a significant number of patients with stable COPD will have detectable aspiration during swallow (prandial aspiration) and that they would experience more frequent severe acute exacerbations of COPD (AECOPD) over the subsequent 12 months.MethodsPatients (n=151) with verified and stable COPD of all severities were recruited at a tertiary care hospital. Videofluoroscopy was conducted to evaluate aspiration using Rosenbek's scale for penetration–aspiration during 100-mL cup drinking. AECOPD was documented as moderate (antibiotics and/or corticosteroid treatment) or severe (emergency department admission or hospitalisation) over the ensuing 12 months.Measurements and main resultsAspiration was observed in 30 out of 151 patients (19.9%, 18 males, 12 females; mean age 72.4 years). Patients with aspiration had more overall AECOPD events (3.03 versus 2 per patient; p=0.022) and severe AECOPD episodes (0.87 versus 0.39; p=0.032). Severe AECOPD occurred in more patients with aspiration (50% of patients versus 18.2%; OR 4.5, CI 1.9–10.5; p=0.001) and with silent aspiration (36.7% versus 18.2%; OR 2.6, CI 1.1–6.2; p=0.045). Aspiration was related to a shorter exacerbation-free period during the 12-month follow-up period (p=0.038).ConclusionsPrandial aspiration is detectable in a subset of patients with COPD and was predictive of subsequent severe AECOPD. Studies to examine if the association is causal are essential to direct strategies aimed at prevention of aspiration and AECOPD.

Pleasantness, emotions and perceptions induced by coffee beverage experience depend on the consumption motivation (hedonic or utilitarian)

Motivations to consume a given food or drink differ across consumers. For instance, coffee drinking can be motivated by sensory enjoyment (hedonic motivation) or by stimulation (functional motivation). Today it remains unknown how hedonic vs. utilitarian motivations impact consumer–product interaction. The objective of the present research was to study the impact of both motivations on consumer responses (i.e. pleasantness, emotions, and importance and satisfaction for each of the five senses) during the entire experience of a coffee beverage. Sixty participants drinking coffee beverage either for sensory enjoyment (SENS, n=30) or to be stimulated (STIM, n=30) were recruited. Four moments of the product experience were considered: water heating, jar handling, cup preparation and cup drinking. Self-ratings were repeatedly performed by the participants after each moment. SENS participants depicted higher positive emotions than STIM participants and even if similar levels of pleasantness were reached after cup drinking by both groups, levels of pleasantness at water heating and jar handling moments differed. The importance and satisfaction for the different senses also changed according to the participant motivation to drink the coffee beverage. Marketing implications are discussed in terms of communication materials development to more strongly engage consumers with the product.

Spoon-to-cup fading as treatment for cup drinking in a child with intestinal failure.

We treated a child with intestinal failure who consumed solids on a spoon but not liquids from a cup. We used spoon-to-cup fading, which consisted of taping a spoon to a cup and then gradually moving the bowl of the spoon closer to the edge of the cup. Spoon-to-cup fading was effective for increasing consumption of liquids from a cup.

Clinical implications of design characteristics, flow rates, and suction pressure attributes in commercially available training cups

Transitioning from a bottle to open cup drinking can be a lengthy process in typical development. Children are often introduced to training cups during this period. Due to a lack of standardization in commercially available training cups, differences in design and performance characteristics may potentially create medical complications in developmentally delayed individuals. Our purpose is to report commercially available training cup design characteristics, residual fluid, flow rates, and suction pressures and discuss the potential clinical implications. A testing apparatus was developed to determine suction pressure and flow rate. Nine commercially available training cups were tested by two independent research teams. Experimental data were filtered and then fit with a linear approximation determined by a least squares method. Commercially available cups exhibited extensive variability in design parameters, suction pressure, rate of flow, and residual fluid. The extensive variability of design and function within current commercially available cups has clinical implications for children with development delays such as the ingestion of air and aspiration. Studying the variability of existing training cup performance identifies characteristics that impact cup function which can influence future cup design.

Assessment of feeding performance in patients with cerebral palsy

Patients with cerebral palsy (CP) frequently manifest oral-ingestive problems ranging from mild to severe. Drooling, rejection of solid foods, choking, coughing and spillage during eating may contribute to these problems. The aim of this study was to assess functional feeding skills of patients with CP, aged 4-25 years. They were assessed with the Modified Functional Feeding Assessment Scale (FFAm). Mothers had expressed concern regarding drooling and reluctance in accepting solid foods. None of the mothers thought that there was a major problem with adequate ingestion. However, the study revealed that patients had disabilities in spoon feeding, biting, chewing, cup drinking, straw drinking, swallowing and clearing.

Physiologic model of oropharyngeal swallowing revisited

Objectives: Historical studies of oropharyngeal swallowing have used small boluses, unnatural means of bolus presentation, and temporal measures to differentiate normal vs abnormal function. This study set out to test the known physiologic model of oropharyngeal swallowing in 80 healthy volunteers in 4 age groups: group 1 (21–40 years; n = 20), group 2 (41–60 years; n = 20), group 3 (61–80 years; n = 20), group 4 (81+ years; n = 20) using larger bolus volumes during cup drinking. Methods: Simultaneous videofluorographic and respiratory airflow recordings were obtained during liquid swallowing. Factor analysis and multiple regression were used to support or refute the known model. Results: Analysis revealed a 3-factor model with nonage dependent variation in the sequence of timed physiologic components. The onset of the obligatory cessation in breathing was highly variable and could not be used to signal abnormality. The onset of hyoid excursion was highly predictive of the total pharyngeal swallow duration ( P < 0.01), yet was delayed by definition in the previous model without evidence of laryngeal penetration or aspiration. Expected differences in temporal pharyngeal events were not found when these normative data were compared to age-matched patients treated for head and neck cancer. Conclusions: These findings speak to the inadequacy of using temporal measurement as the sole means of swallowing assessment. Rather, valid and reliable tools are demanded that allow quantification of the functionality of the components of swallowing as they relate to patient outcomes. A validated measurement model under empirical test will be presented.

Syringe Feeding in Long-Term Care

Syringe Feeding in Long-Term Care

Oral motor, communication, and nutritional status of children during intrathecal baclofen therapy: A descriptive pilot study

Bjornson KF, McLaughlin JF, Loeser JD, Nowak-Cooperman KM, Russel M, Bader KA, Desmond SA. Oral motor, communication, and nutritional status of children during intrathecal baclofen therapy: a descriptive pilot study. Arch Phys Med Rehabil 2003;84:500-6. Objective: To describe the oral motor, communication, and nutritional status of children receiving intrathecal baclofen (ITB) therapy for spasticity of cerebral origin. Design: Observational cross-sectional design. Setting: Tertiary-care regional children[apos]s hospital. Participants: Thirty children with spasticity of cerebral origin receiving ITB therapy. Interventions: Not applicable. Main Outcome Measure: One interviewer administered a structured in-person interview tool designed for this pilot study, data from which were collapsed into 4 change categories: communication and speech, feeding and nutrition, oral motor function, and gastrointestinal function. Functional severity was ranked with the Gross Motor Function Classification System (GMFCS). Results: Speech: 10 improved (5 in GMFCS level V) and 2 worsened. Use of assistive technology to communicate: 6 improved (5 in GMFCS level V). Appetite: 10 improved (6 in GMFCS level V) and 4 worsened. Self-feeding: 9 improved (2 in GMFCS level III, 4 in level IV, 3 in level V) and 2 worsened. Saliva control: 10 improved (1 in GMFCS level III, 1 in level IV, 8 in level V) and 8 worsened. Cup drinking: 12 improved (5 in GMFCS level V) and 2 worsened. Indicates thirst: 9 improved (4 in GMFCS level IV, 5 in level V) and none worsened. Stool frequency: 8 improved (8 in GMFCS level V) and 14 worsened. Conclusions: Some aspects of speech, communication, and saliva control seemed to have improved, with bowel movement frequency decreased in some children receiving ITB. Fewer changes in feeding and nutritional status were reported. On the basis of this pilot study, prospective management guidelines are proposed that relate objective outcome measures of oral motor function, communication, and nutrition to changes in spasticity with ITB.

Oral-motor skills following sensorimotor therapy in two groups of moderately dysphagic children with cerebral palsy: aspiration vs nonaspiration.

The purpose of this study was to determine the effect of oral sensorimotor treatment on oral-motor skills and measures of growth in moderately eating impaired children with cerebral palsy who were stratified by state of aspiration/nonaspiration. Twenty-seven children aged 2.5-10.0 years participated in this study (aspiration: n = 7, nonaspiration: n = 20). Weight and skinfold measures were taken. Children were observed at lunch time and six domains of feeding were examined: spoon feeding, biting, chewing, cup drinking, straw drinking, swallowing, and drooling. Children underwent 10 weeks of control and 10 weeks of sensorimotor treatment, 5-7 minutes/day, 5 days/week. Treatment compliance for the entire group was 67%. Children who aspirated had significantly poorer oral-motor skills in spoon feeding, biting, chewing, and swallowing than children who did not aspirate. There was significant improvement in eating: spoon feeding (fewer abnormal behaviors, p < 0.03), chewing (more normal behaviors, p < 0.003), and swallowing (more normal behaviors, p < 0.008). There were no significant changes in drinking skills. Children as a group maintained their pretreatment weight-age percentile but did not show any catch-up growth. Children showed adequate energy reserves as measured by skinfold thicknesses. Improvement in oral-motor skills may help these children to ingest food more competently (i.e., less spillage). However, their weight remains at the lowest level of age norms.

Oral-motor skills following sensorimotor intervention in the moderately eating-impaired child with cerebral palsy.

The purpose of this study was to determine the efficacy of oral sensorimotor treatment in moderately eating-impaired children with cerebral palsy and to examine the effects of treatment on measures of growth. Six domains of feeding were examined in 35 children 4.3-13.3 years of age. Weight and skinfold measures were taken. Children were observed at lunch time, and spoon-feeding, biting, chewing, cup drinking, straw drinking, swallowing, and drooling were examined. Children underwent 20 weeks of sensorimotor treatment, 5-7 min/day, 5 days/week. Limited improvement was observed in the following eating domains: spoon-feeding, biting, and chewing, but not in drinking. Children as a group maintained the pretreatment weight-age percentile. To meet the increasing growth demands of the teenage years, oral-motor therapy may need to be combined with oral caloric supplementation.

Effects of adaptive seating devices on the eating and drinking of children with multiple handicaps.

The purpose of this study was to explore the effects of adaptive seating on oral-motor functioning as it relates to eating and drinking in 11 children with multiple handicaps between the ages of 1 and 4 years. An assessment instrument with a behavioral base was used for the seven direct observations of each child's motor behavior. During the first and last visit the parent or guardian filled out a pre- and post-equipment questionnaire. Evaluations were conducted every 6 weeks beginning 3 months before and ending 6 months after the receipt of the seating devices. An analysis of variance was used to analyze rating scale score data. A nonparametric sign test was used for the analysis of yes/no data. Other data were analyzed for frequencies and central tendencies. Sitting posture and head alignment during eating and drinking improved significantly. A significant increase in the frequency with which liquid and food was retained in the mouth was noted. A significant number of children progressed from bottle to cup drinking and from eating blended to chopped or cut-up food. The present research extends beyond case study and retrospective study reports to support the efficacy of the use of adaptive seating devices by children with multiple handicaps.