Oral Motor Assessment Scale Research Articles

The Development of Sucking Patterns in Preterm, Small-for-Gestational Age Infants

To determine whether the development of sucking patterns in small-for-gestational age (SGA) preterm infants differs from appropriate-for-gestational age (AGA) preterm infants. We assessed sucking patterns in 15 SGA and 34 AGA preterms (gestational age<or=36 weeks) longitudinally from 34 to 50 weeks postmenstrual age (PMA) using the Neonatal Oral-Motor Assessment Scale (NOMAS). At each measurement, we scored sucking as normal, dysfunctional, or disorganized. We examined the development of their sucking patterns in relation to clinical characteristics. SGA preterms developed a normal sucking pattern later than did AGA preterms (median, 50 versus 44 weeks PMA, P=.002). At term-equivalent age, none of the SGA and 38% of the AGA preterms showed normal sucking (P<.05); at 48 to 50 weeks PMA this was 54% and 81%, respectively (P=.064). Abnormal sucking including "incoordination" and dysfunctional sucking were more prevalent in SGA preterms than in AGA preterms (median, 11% versus 0% per infant, P<.05). A higher gestational age and z-score for birth weight were predictive of normal sucking at 50 weeks PMA. SGA preterms developed a normal sucking pattern later than AGA preterms. Many AGA preterms also developed a normal mature sucking pattern only after they had reached term age.

Development of Sucking Patterns in Pre-Term Infants with Bronchopulmonary Dysplasia

Background: Pre-term infants with bronchopulmonary dysplasia (BPD) are at risk of acquiring brain abnormalities. Combined with ongoing breathing difficulties, this may influence the development of their sucking patterns. Objective: To determine the longitudinal development of sucking patterns from birth until 10 weeks’ post-term age in pre-term infants with and without BPD. Methods: The sucking patterns of 16 pre-term infants with BPD and 15 pre-term infants without BPD were prospectively assessed with the Neonatal Oral-Motor Assessment Scale. The infants were matched for gestational age (<30 weeks). We recorded approximately 12 feeding episodes per infant, from 34 until 50 weeks’ post-menstrual age. We diagnosed the infants’ sucking patterns as normal, dysfunctional, or disorganized. Then, we examined the development of the sucking patterns in relation to relevant clinical characteristics. Results: Thirty (21%) of 142 feeding episodes of the pre-term infants with BPD and 36 (23%) of 156 of those without BPD were diagnosed as normal (non-significant). Of the abnormal patterns, 3 were diagnosed as dysfunctional and 229 as disorganized. Before term-equivalent age, definitely abnormal sucking patterns were more prevalent in the pre-term infants with BPD than in those without BPD: 69 (49%) and 47 (30%) episodes, respectively (χ² = 10.7, p < 0.01). In particular, the abnormal patterns including the item ‘incoordination’, defined as the inability to coordinate sucking and swallowing with breathing, were more prevalent: 36 and 15%, respectively (χ² = 6.37, p < 0.05). There was no difference between the two groups regarding the age at which they acquired normal sucking patterns. Relevant clinical characteristics did not influence the development of the sucking patterns. Conclusions: The developmental characteristicof sucking patterns in infants with BPD was that these infants were unable to coordinate swallowing with breathing. This was the case especially prior to term-equivalent age; after term-equivalent age, the development of sucking closely resembled that of pre-term infants without BPD.

Prediction for developmental delay on Neonatal Oral Motor Assessment Scale in preterm infants without brain lesion

Preterm infants often have difficulty in achieving a coordinated sucking pattern. To analyze the correlation between preterm infants with disorganized sucking and future development, weekly studies were performed of 27 preterm infants from initiation of bottle feeding until a normal sucking pattern was recognized. A total of 27 preterm infants without brain lesion participated in the present study. Neonatal Oral Motor Assessment Scale (NOMAS) was utilized to evaluate the sucking pattern. Infants who were initially assessed as having disorganized sucking on NOMAS and regained a normal sucking pattern by 37 weeks old were assigned to group I; infants with a persistent disorganized sucking pattern after 37 weeks were assigned to group II. The mental (MDI) and psychomotor (PDI) developmental indices of Bayley Scales of Infant Development, second edition were used for follow-up tests to demonstrate neurodevelopment at 6 months and 12 months of corrected age. At 6 months follow up, subjects in group I had a significantly higher PDI score than group II infants (P= 0.04). At 12 months follow up, group I subjects had a significantly higher score on MDI (P= 0.03) and PDI (P= 0.04). There was also a higher rate for development delay in group II at 6 months (P= 0.05). NOMAS-based assessment for neonatal feeding performance could be a helpful tool to predict neurodevelopmental outcome at 6 and 12 months. Close follow up and early intervention may be necessary for infants who present with a disorganized sucking pattern after 37 weeks post-conceptional age.

Sucking patterns in fullterm infants between birth and 10 weeks of age

ObjectiveCoordinating sucking, swallowing and breathing to achieve effective sucking is a complex process and even though sucking is essential for nutrition, little is known about sucking patterns after birth. Our objective was to study sucking patterns in healthy fullterm infants and to describe the age-specific variations. MethodWe studied the sucking patterns of 30 healthy, fullterm infants longitudinally from 2 or 3 days after birth to 10 weeks of age. During this time we recorded five to seven feeding episodes that we assessed off-line with the Neonatal Oral-Motor Assessment Scale (NOMAS). ResultsWe found a normal sucking pattern on the second or third day after birth in 27 out of 30 infants. During the following weeks we found abnormal sucking patterns in 23 out of 171 feeding episodes (14%) and normal patterns in 148 episodes (86%). Altogether, between 38 and 50 weeks’ postmenstrual age (10 weeks after birth), 10 infants displayed a deviating, arrhythmical sucking pattern. Dysfunctional sucking patterns and problems of coordinating sucking, swallowing and breathing did not occur. Birth weight, gestational age, type of labour and gender did not influence sucking patterns. Arrhythmical sucking was seen more often in bottle-fed infants. ConclusionOur study demonstrated that practically all healthy fullterm infants started off with a normal sucking pattern soon after birth. One-third of the infants displayed one or more deviating episodes up to the age of 10 weeks. Apart from bottle-feeding, no other factors were found that influenced sucking patterns.

Assessment scale of the oral motor performance of children and adolescents with neurological damages

Among the conditions that classify individuals as special needs patients are those resulting from neurological sequelae, particularly cerebral palsy (CP), which is a disorder of high prevalence. Innumerable alterations can be found in individuals with CP but the inability to control striated muscles, due to damages suffered by the central nervous system, should be emphasized. Changes in tonus, speed and strength of oral muscles, reduction of mandibular mobility amplitude and difficulty to passively seal the lips are characteristics observed in such individuals. Categorization of the individual's mastication pattern is important in order to establish diagnosis and treatment protocols and prognosis. The aim of this study was to develop an Oral Motor Assessment Scale (OMAS) and evaluate its performance in terms of construct validity and reliability in a cohort of 53 children and individuals with CP. Two dentists examined the same patients on two different occasions. Good interexaminer (kappa > 0.85) and intra-examiner (kappa > 0.90) agreement was obtained for the majority of the OMAS items. This study shows that the OMAS is an accurate and valid method of assessment of oral motor skills in children and adolescents with neurological damages.

Sprechmotorische Fähigkeiten stotternder Kinder

Die sprechmotorischen Fähigkeiten stotternder Erwachsener wurden in der Vergangenheit häufig untersucht. Im Gegensatz dazu sind die Studien an Kindern begrenzt und lieferten bislang uneinheitliche Ergebnisse. In dieser Studie wurden die sprechmotorischen Fähigkeiten von 40 6-11-jährigen Kindern (20 Stotterer, 20 Nicht-Stotterer) anhand einer umfassenden Beurteilung der Diadochokinese [1]überprüft. Die Analysen zeigen, dass stotternde Kinder signifikant schlechtere sprechmotorische Fähigkeiten aufweisen. Innerhalb der Gruppe stotternder Kinder konnten Subgruppen mit unterschiedlich schwerwiegenden sprechmotorischen Koordinationsschwächen voneinander abgegrenzt werden. Ein Zusammenhang mit dem Stotterschweregrad bestand nur für mäßig bis schwer Stotternde; diese Kinder zeigen in der Regel eine schwere sprechmotorische Beeinträchtigung. Ein Vergleich temporal-akustischer Parameter (Stimmeinsatzzeit, Vokaldauer, Verschlusszeit) ergab hingegen keine Gruppenunterschiede, jedoch eine höhere inter- sowie intraindividuelle Variabilität bei den stotternden Kindern. Dies deutet auf eine instabile sprechmotorische Kontrolle, die zur Entstehung von Unflüssigkeiten beiträgt. Das verwendete Diagnostikinstrument (Oral Motor Assessment Scale) erscheint aufgrund der Zeiteffizienz, den vorhandenen Normdaten und der differenzierten Bewertung für einen Einsatz in der Stotterdiagnostik geeignet.

The reliability of the Neonatal Oral‐Motor Assessment Scale

Sucking problems in preterm infants can be specified by means of visual observation. The Neonatal Oral-Motor Assessment Scale (NOMAS) is the visual observation method most commonly used to assess the non-nutritive sucking (NNS) and nutritive sucking (NS) skills of infants up to approximately 8 weeks postterm. During the first 2 min of a regular feeding the infant's sucking skill is assessed, either immediately or on video. Although NOMAS has been used since 1993, little is known about the method's reliability. The aim of our study was to determine the test-retest and inter-rater reliability of NOMAS. The 75 infants included in this study were born at 26-36 weeks postmenstrual age (PMA). Four observers participated in the study. They were trained and certified to administer NOMAS in the Netherlands by M.M. Palmer between 2000 and 2002. We found the test-retest agreement of NOMAS to be 'fair' to 'almost perfect' (Cohen's kappa [kappa] between 0.33 and 0.94), whereas the inter-rater agreement with respect to the diagnosis was 'moderate' to 'substantial' (Cohen's kappa, between 0.40 and 0.65). As a diagnostic tool, however, the current version of NOMAS cannot be used for both full-term and preterm infants. For a measuring instrument such as NOMAS, one should aim at reliability coefficients for inter-rater and test-retest agreement of at least 0.8. A Cohen's kappa of 0.6 or less we find unacceptable. Nonetheless, by observing sucking and swallowing according to a protocol much useful information can be gathered about the development of an infant's sucking skills. For instance, whether the infant is able to co-ordinate sucking and swallowing, whether the infant can maintain sucking, swallowing and breathing during the continuous phase and whether the infant is able to suck rhythmically with equally long bursts. In addition, NOMAS offers useful aids for intervention. NOMAS should be re-adjusted in order to improve inter-rater agreement, and at the same time current insights into the development of sucking and swallowing should be incorporated in the method.

Psychometric characteristics of the Neonatal Oral‐Motor Assessment Scale in healthy preterm infants

We examined the reliability, validity, and responsiveness of the Neonatal Oral-Motor Assessment Scale (NOMAS) in healthy preterm infants. Feeding records of 147 infants (71 males, 76 females; gestational age [GA] <or= 36 wks), taken from the day bottle-feeding was initiated to the day the infants were discharged, were used to examine the psychometric properties of the normal and disorganized categories of the NOMAS. The infants, with or without experience of breastfeeding, were all fed by bottle, with either formula and/or breast milk. GA ranged from 24 to 35.9 weeks (mean 29.7 wks, SD 2.7) and birthweight ranged from 470 g to 2570 g (mean 1251.1g, SD 425.9). Postmenstrual age (PMA) at the starting point of bottle-feeding ranged from 29.4 to 40.1 weeks (mean 33.8 wks, SD 1.7). We found that the NOMAS had satisfactory internal consistency (Cronbach's alpha >0.70) in the normal category for 32 to 35 weeks'PMA. Moderate correlations were found between scores on the NOMAS and feeding performance for all age groups except for PMA of >or= 36 weeks (absolute Spearman's r(s)=0.51-0.69), indicating acceptable convergent validity. The NOMAS demonstrated moderate responsiveness to changes in oral-motor skills in every 2-week period, ranging from 32 to 36 weeks'PMA (standard response mean greater than 0.5). This study demonstrated that the normal and disorganized categories of the NOMAS are useful, with acceptable psychometric properties, in assessing oral-motor function in preterm infants aged 32 to 35 weeks'PMA. Future research on infants with abnormal oral-motor skills is needed to further validate psychometric properties of the dysfunction category of the NOMAS.

The Nature of Feeding in Infants with Unrepaired Cleft Lip and/or Palate Compared with Healthy Noncleft Infants

Feeding difficulties are reported widely in infants with cleft lip and/ or palate. There is, however, a paucity of objective information about the feeding patterns of these infants. This study compared patterns of feeding in infants with unrepaired cleft lip and palate with healthy noncleft infants of a similar age. North Thames Regional Cleft Centre. The noncleft cohort was recruited from West Middlesex University Hospital, a general hospital with similar demographics. Fifty newborn infants with nonsyndromic complete unilateral cleft lip and palate or a cleft of the soft and at least two thirds of the hard palate who were referred to the North Thames Regional Cleft Centre participated. Parents of 20 randomly selected, noncleft infants agreed to participate. Feeding patterns were rated using the Neonatal Oral Motor Assessment Scale. Additional objective information was collected using the Great Ormond Street Measurement of Infant Feeding (Masarei et al., 2001; Masarei, 2003). Infants with nonsyndromic complete unilateral cleft lip and palate or a cleft of the soft and at least two thirds of the hard palate had less efficient sucking patterns than their noncleft peers had. They used shorter sucks (mean difference, 0.30 second; p < .0005), a faster rate of sucking (mean difference, 34.20 sucks/second; p < .0005), higher suck-swallow ratios (mean difference, 1.87 sucks/swallow; p < .0005), and a greater proportion of intraoral positive pressure generation (mean difference, 45.97% positive pressure; p < .0005). This study demonstrated that the sucking patterns of infants with nonsyndromic complete unilateral cleft lip and palate or a cleft of the soft and at least two thirds of the hard palate differ from those of their noncleft peers.

Factors Related to Sucking Ability in Healthy Newborns

To identify maternal, infant, and environmental factors related to newborn sucking ability. Prospective, descriptive, exploratory study using a convenience sample. Normal newborn nursery in an urban tertiary-care medical center. Two hundred three healthy newborns admitted to the normal newborn nursery after delivery. The newborns were between 30 minutes and 11 hours of age, and between 34 and 42 weeks gestation. This study examined 15 variables related to newborn sucking ability: infant state, age, gestational age, Apgar scores, birth weight, labor medications, type of delivery, elapsed time since last feeding, infant sex, perinatal complications, infant vital signs, birth resuscitation, clothing, room temperature, and length of labor. Sucking ability was measured by the Neonatal Oral Motor Assessment Scale (NOMAS). The variables of gestational age, weight, and state were positively correlated with sucking ability (NOMAS scores). Newborn's age postdelivery and minutes to the quiet alert state were inversely correlated with sucking ability. Newborn weight and gestational age are related to sucking ability. Younger newborns had better sucking ability than did older newborns.

The quality of sucking in infants with colic

Feeding problems have been reported in infants with colic. The purpose of this study was to examine the nutritive sucking pattern of infants identified as having colic. Twenty-nine infants (16 with colic and 13 controls) between the ages of 1 to 3 months, being bottle-fed by their mothers, were observed by a blind examiner. We hypothesized that infants with colic would show greater disorganization in nutritive sucking and show greater variability in sucking rate than infants without colic, as assessed by the revised Neonatal Oral Motor Assessment Scale (NOMAS). Infants with colic were found to present a disorganized sucking pattern; namely, a lack of rhythmical movement and a difference in amount of sucks per burst than infants without colic. Methods of intervention are suggested.

Feeding efficiency of premature neonates.

The purpose of this study was (a) to investigate the validity of the revised Neonatal Oral Motor Assessment Scale (NOMAS) in discriminating between efficient and inefficient feeders in a sample of high-risk premature neonates and (b) to identify significantly different oral motor behaviors in the two groups. The revised NOMAS rates normal and abnormal characteristics of nutritive and nonnutritive sucking. The 26 subjects were classified by the amount of liquid they consumed during the first 5 min of feeding. The findings demonstrated that both nutritive and nonnutritive sucking scores were higher in the efficient feeders than in the inefficient feeders and that the revised NOMAS scores accurately classified the two groups. Characteristics that were significantly associated with inefficient feeding were lack of rhythm, disorganization in jaw and tongue movements, and pauses of more than 6 sec. Often, these responses appeared to be related to respiratory patterns.

Oral motor discoordination among children who stutter

A large body of literature describes subtle oral motor differences among people who stutter, which are not typical of other speakers. The purpose of this report was to propose that oral motor discoordination (OMD) can be assessed and treated, and that such treatment may be useful prior to targeting perceived stuttering behaviors. Oral motor coordination (correct voicing, smooth coarticulation, proper sequencing, and age appropriate rate of production of syllables) was assessed using an Oral Motor Assessment Scale. An oral motor training program was described that improved OMD 78% after 14 hours of training in nine children. Stuttering was improved 62% by the training, although it was not specifically targeted. This report proposes that improvement in OMD and reduction of stuttering may be reciprocal (i.e., treatment of one may produce improvement in the other as a byproduct). It may be that OMD is among the physiologic features that can cause post-treatment fluency to be “tenuous.” Its inclusion in treatment programs may improve maintenance and naturalness of fluency.

A Pilot Study of Oral-Motor Dysfunction in “At-Risk” Infants

The purposes of this pilot study were to devise a neonatal oral-motor assessment scale (NOMAS), and to correlate oral-motor function with feeding histories, perinatal-neonatal complications, neurologic status, and polygraphic recording of sucking. The methods used to study the at-risk infants were polygraphic amplification and recording of intra-oral pressure waves; scoring of sucking behavior with the NOMAS occurred concurrently with instrumental measurement. Both non-nutritive (NNS) and nutritive sucking (NS) modes were tested. Oral-motor performance tended to be disorganized or dysfunctional in infants with intraventricular hemorrhage (IVH) and asphyxia neonatorum. Those infants with brain insults (IVH, hydrancephaly) showed slower sucking rates in NNS, and the degree of slowing of the rate when switched to NS was less in these higher-risk infants. The polygraphic data did not, however, distinguish those same infants who had abnormal NOMAS scores. Oral-motor dysfunction was identified only from 40 week...