Oral Motor Therapy Research Articles

Treatment Approaches to Speech Sound Disorders: A Scoping Review

Objective: The objective was to highlight and review different therapeutic approaches to cater to speech sound disorders in Pakistan. Methodology: To find the different therapeutic approaches, a literature search for related articles/ publications was conducted using the Keywords “speech sound disorders, phonological disorders, articulation disorder and a combination of words using search engines like Google & and databases like PubMed and other websites. Around 130 publications, reports, and articles were downloaded, of which 25 were used for literature review. Results: There are many treatments used to cater for speech sound disorders including contextual utilisation, phonological contrast, complexity, core vocabulary, cycles phonological pattern, distinctive feature therapy, metaphor therapy, naturalist speech intelligibility, non-speech oral-motor therapy, speech sound perception training and bilingual or cross-lingual approach. However, novel trends like the use of hybrid treatment, speech motor learning- phonetic placement approach, blocked practice versus serial practice schedule & interventions using biofeedback need to be utilized. Conclusion: Treatment approaches in use include contextual utilisation, phonological contrast, complexity, core vocabulary, cycles phonological pattern, distinctive feature therapy, metaphor therapy, naturalist speech intelligibility, non-speech oral-motor therapy, speech sound perception training and bilingual or cross-lingual approach, however, novel treatments need to be utilised. Keywords: Articulation disorders, Phonological disorders, Phonological Representations

Oral-motor therapy

Eating and swallowing disorders are prevalent among children with neuromotor disabilities, significantly impacting their overall quality of life. The COVID-19 pandemic exacerbated the challenges by restricting access to health care, underscoring the necessity for innovative solutions with caregiver involvement. This study investigated the effectiveness of a distance learning educational model in oral-motor therapy for primary caregivers of children with neuromotor impairments in Mérida, Mexico. The quasi-experimental pretest-posttest design included thirty primary caregivers of children aged 2 to 12 with feeding and swallowing disorders from seven institutions. Twenty-three participants completed the program. The program encompassed theoretical sessions on various aspects of oral motor therapy and practical sessions focusing on hands-on training. Results revealed substantial enhancements in theoretical knowledge and practical competencies among caregivers, with competence levels exceeding 80% in all evaluated activities. Despite these positive outcomes, the study acknowledges limitations such as a small sample size and the absence of a control group. Addressing these constraints through future research endeavors will bolster the evidence supporting the effectiveness of this innovative caregiver-centric approach. Ultimately, integrating caregivers into the care team is imperative for improving the quality of life for children with neuromotor disabilities and effectively managing eating and swallowing disorders.

Improving feeding skills and transition to breastfeeding in early preterm infants: a randomized controlled trial of oromotor intervention.

Oromotor therapy exercises used for preterm infants in the NICU might promote oral-motor skills and shorten discharge day. This study investigates the impact of an oral-motor therapy program on the successful transition to breastfeeding (BF) and the enhancement of feeding skills in preterm infants below 30 weeks of gestational age who experience feeding intolerance. The intervention group received oral-motor therapy programme for one month, while the control group did not. The feeding skills were evaluated by Early Feeding Skills Assessment Tool (EFS) and Preterm Oral Feeding Readiness Scales (POFRAS). There was a significant difference in EFS and POFRAS scores, transition to bottle feeding at discharge and transition to BF after discharge between babies given oral-motor therapy programme and controls (p < 0.05). While the transition time to full enteral feeds did not vary significantly between the groups, noteworthy outcomes were observed in the intervention group, including differences in feeding type at discharge, the nature of feeds at discharge, and the success of transitioning to breastfeeding after discharge. We conclude that the oromotor therapy exercises in NICU improves the quality of sucking, contributes to better oromotor skills and promotes transition to enteral feeding and BF in preterm babies. ClinicalTrials.gov, identifier (NCT05845684).

Oral motor weakness: a possible clinical marker for sleep-related difficulties in Down syndrome children — a preliminary study

BackgroundThere is an increasing incidence of sleep difficulties in Down syndrome children. Identifying the clinical symptoms that are correlated with sleep difficulties for early diagnosis and treatment is critical.AimTo investigate whether oral motor weakness could be considered as an underlying factor for sleep-related difficulties in Down syndrome patients not previously treated with oral motor therapy to prioritize them for definitive objective testing.Material and methodsThe study included 45 Down syndrome children with and without congenital heart disease or hypothyroidism aged 2.5 years to 7 years without a history of prior oral motor therapy, adenotonsillar hypertrophy, and with an average body mass index. The parents were asked to fill in a questionnaire on sleep difficulties involving seven sections. The children were also subjected to 4 oral motor tasks.ResultsSymptoms of sleep-related difficulties were reported in 66.70 to 100% of the DS children. The highest percentage had severe oral motor weaknesses. There is no significant correlation between scores of sleep difficulties and scores of oral motor skills except for a significant negative correlation between scores of restless sleep and frequent awakening with score of Chewy Tubes.ConclusionThe current study did not prove a significant correlation between oral motor skills and the symptoms of sleep difficulties.

Prolonged Oral Motor Stimulation Treatment was Effective for Breastfeeding Achievement in Full Term Infants With Feeding Problems

Objectives: Feeding problems can occur in early-term infants born at 37 weeks. Early-term and full-term infants may benefit from oral motor therapy to attain successful breastfeeding. The present study aims to determine the impact of the 5-minute premature infant oral motor intervention (PIOMI) and the 15-minute oral stimulation program (15-minute oral stimulation program) on 37 to 41 weeks infants in attaining successful breastfeeding. Methods: This clinical trial was conducted on early-term and full-term infants in the neonatal intensive care units (NICUs) of two hospitals in Mashhad City, Iran. They were randomly divided into two intervention groups (5-minute PIOMI or 15-minute oral stimulation program) and one control group (17 infants in each group). These three groups were then compared to each other after the intervention by pediatricians and speech and language specialists regarding their breastfeeding. All statistical analysis was performed using R software, version 4.0.2, and the significance level was set at 0.05. Results: Infants in both intervention groups attained different levels of breastfeeding compared to pre-intervention. This outcome could be due to our interventions or natural growth and development (P&lt;0.05). However, the longer the infants’ oral motor therapy time was, the more likely they were to breastfeed successfully. The 15-minute oral stimulation program group had a significantly higher number of male infants attaining breastfeeding after treatment than the control and PIOMI groups (P=0.03). Discussion: The PIOMI has been confirmed as an effective early intervention for small preterm infants as young as 29 weeks, and the short 5-minute therapy time is accepted in the preterm infant population. The program affects the brain’s plasticity and improves neurosensory and motor skill development for feeding. The current study indicates that PIOMI remains effective versus the control group in the full-term babies. However, the longer 15-minute oral stimulation program, is more effective in full-term infants. This finding shows that full-term infants can endure and benefit from longer than 5 minutes per day of oral motor therapy.

Effect of Premature Infant Oral Motor Intervention on Oral Feeding and Weight Gain: A Systematic Review and Meta-Analysis.

Sucking and swallowing coordination did not achieve until 32-34 weeks of gestation in premature infants. Oral motor stimulations improve oral motor musculature and neurobehavioral synergism which improves the rate of oral feeding readiness and weight gain and ultimately reduces the duration of hospitalization. Premature Infant Oral Motor Interventions (PIOMI) is a specific oral motor therapy effective in improving the clinical outcomes among premature infants. Earlier no review had been conducted specifically to assess the effectiveness of PIOMI on oral feeding progression, weight gain, and Length of hospital Stay (LOS) among premature infants. So, the present review had been planned. Review was conducted by searching databases like PubMed/Medline, Embase, Ovid, Clinical Key and Academia, Google and Google Scholar (from PIOMI inception to October 2020). Published articles on RCTs and clinical trials were included. Six studies, with a total of 301 premature infants, were included in Meta Analysis (MA). PIOMI was found effective in early attainment of feeding progression (Mean Difference (MD) = -4.63 days at 95% Confidence Interval (CI) = -4.97 to - 4.29, p < 0.001) and shifting from gavage to independent oral feeding (MD = -2.54 days at 95% CI = -3.13 to - 1.95, p < 0.001), shows weight gain at discharge (MD = 51.61 grams at 95% CI = 19.84 to 83.38, p = 0.001), and reduces LOS (MD = -2.81 days at 95% CI = -3.51 to - 2.10, p < 0.001). Review shows shows the effectiveness of PIOMI in improving oral feeding progression and early attainment of gavage to independent oral feedings, and it also showed weight gain at discharge and reduced LOS.

Effect of oral motor facilitation technique on oral motor and feeding skills in children with cerebral palsy : a case study

Background:Deficiencies in oral motor function and feeding skills are common in children with cerebral palsy (CP). Oral motor therapy is a useful method to improve oral motor function and feeding skills. Oral motor facilitation technique (OMFT) is a newly designed comprehensive oral motor therapy, including postural control, sensory adaptation, breathing control, sensorimotor facilitation, and direct feeding.Methods:This study was performed to identify the effect of OMFT on oral motor function and feeding skills in children with CP. A total of 21 children with CP (3–10 years, GMFCS III–V) participated in 16 weeks (16 sessions) of OMFT. The effects on oral motor function and feeding skills were assessed using the Oral Motor Assessment Scale (OMAS) before the treatment, 8 and 16 weeks after OMFT. Data were analyzed using the Friedman test and post-hoc analysis.Results:Significant improvement was found in oral motor function and feeding skills including mouth closure, lip closure on the utensil, lip closure during deglutition, control of the food during swallowing, mastication, straw suction, and control of liquid during deglutition after OMFT. Mouth closure was the most effective and mastication was the least effective item. Sixteen weeks is more effective than 8 weeks of OMFT.Conclusion:OMFT could be an effective and useful oral motor therapy protocol to improve oral motor function and feeding skills in children with CP.

Effect of intradermal needling combined with oral motor therapy for salivation in children with cerebral palsy: a randomized controlled trial

To compare the effect of combination of intradermal needling with oral motor therapy and simple oral motor therapy on salivation in children with cerebral palsy. A total of 60 children with salivation in cerebral palsy were randomized into an observation group and a control group, 30 cases in each group. The observation group was treated with intradermal needling (kept for 24 hours each time at Jiache [ST 6], Dicang [ST 4], tongue three needles, etc. ) and oral motor therapy, while the control group was only given oral motor therapy. The intradermal needling was performed 3 times a week, and oral motor therapy was performed 5 times a week, 4 weeks as a course, totally 3 courses of treatment were required. The classification of teacher drooling scale (TDS), drooling severity and Kubota water swallow test, dysphagia disorders survey (DDS) score were compared before treatment and after 4, 8 and 12 weeks of treatment in both groups, and the clinical efficacy was evaluated. After 8 weeks of treatment in the observation group and after 12 weeks of treatment in the two groups, the classification of TDS and drooling severity were improved (P<0.05), and the observation group was better than the control group after 12 weeks of treatment (P<0.05). After 8 and 12 weeks of treatment, the DDS scores of oral period in the observation group were lower than those before treatment (P<0.05). The total effective rate in the observation group was 83.3% (25/30), which was higher than 53.3% (16/30) in the control group (P<0.05). The combination of intradermal needling with oral motor therapy can improve salivation symptoms and swallowing function in children with cerebral palsy, the effect is better than oral motor therapy alone, and the effect is earlier.

CHARGE Syndrome and Comorbid Feeding Difficulties: A Summary of Outcomes following Behavior Analytic Treatment.

CHARGE syndrome is a genetic disorder caused by mutation of the CHD7 gene. Children with CHARGE syndrome often experience vision and hearing impairments, delayed growth and development, heart abnormalities, and artesia/stenosis of the chonae. Although not part of the diagnostic criteria, many individuals with CHARGE syndrome experience feeding and gastrointestinal difficulties. Interventions most commonly recommended and utilized to address feeding difficulties for children with CHARGE syndrome include tube feedings (medical approach) and oral-motor therapy. Despite the effectiveness of a behavior analytic approach to address feeding difficulties for a variety of pediatric populations, this approach is not routinely considered as a viable treatment option to address feeding difficulties for children with CHARGE syndrome. Outcome data of four children with CHARGE syndrome who participated in an intensive behavioral-based feeding program were reviewed. Variables reviewed included percentage of admission goals achieved, treatment strategies utilized, and changes in growth status, feeding tube dependence, texture and variety of foods consumed, and occurrence of inappropriate mealtime behavior. Outcomes evaluated in this review support the effectiveness of a behavior analytic approach for addressing feeding difficulties for children with CHARGE syndrome.

The Effect of Oral Motor Therapy on Feeding Difficulties and Eating Behaviors in Younger ASD Children

Background: A variety of feeding difficulties like aversion of food, food selectivity, complete food refusal are the most common problems reported by the Parents of ASD children. Every parent of ASD children struggles to manage their child’s feeding routine as well as undesirable mealtime behaviours, which can cause parental concern and poor family dynamics.&#x0D; Aim: 1) The aim of this study is to analyze the effect of dedicated oral motor work in children with ASD who presented with feeding difficulty. 2) To determine parental concerns related to feeding behavior shown by their child and assess whether an additional home program in parallel with oral motor work by an Occupational Therapist would provide any benefits.&#x0D; Methods: This is a pre and post study where a total number of 18 ASD children at the age of 2-4 year old were participated and selected through BPFAS, out of which 15 copies were considered to be concerned with the oral motor and feeding difficulties of the child. Therefore, 15 participants who were facing feeding difficulties with their children were recruited. Concerned Participants were further assessed by Occupational therapist with the help of ‘The com deall Oro-motor assessment scale for toddlers’.&#x0D; Results: According to The Com Deall Oral-motor assessment scale, some changes observed in the oral motor skills and When parental concern is considered via home plan including mealtime strategies with oral motor activities, the post intervention result showed decrease in Total problem score as well as in Total frequency score.&#x0D; Conclusion: The study concluded that continuous structured direct oral motor work as well as addressing parental concerns via home programs is helpful for the ASD children and gives better understanding of feeding difficulties to their parents. Also, some changes have been seen in oral motor skills through continuous practice of oral motor activities by the therapist.

Intensive Multidisciplinary Intervention for Young Children with Feeding Tube Dependence and Chronic Food Refusal: An Electronic Health Record Review

To assess characteristics and outcomes of young children receiving intensive multidisciplinary intervention for chronic food refusal and feeding tube dependence. We conducted a retrospective study of consecutive patients (birth to age 21years) admitted to an intensive multidisciplinary intervention program over a 5-year period (June 2014-June 2019). Inclusion criteria required dependence on enteral feeding, inadequate oral intake, and medical stability to permit tube weaning. Treatment combined behavioral intervention and parent training with nutrition therapy, oral-motor therapy, and medical oversight. Data extraction followed a systematic protocol; outcomes included anthropometric measures, changes in oral intake, and percentage of patients fully weaned from tube feeding. Of 229 patients admitted during the 5-year period, 83 met the entry criteria; 81 completed intervention (98%) and provided outcome data (46 males, 35 females; age range, 10-230months). All patients had complex medical, behavioral, and/or developmental histories with longstanding feeding problems (median duration, 33months). At discharge, oral intake improved by 70.5%, and 27 patients (33%) completely weaned from tube feeding. Weight gain (mean, 0.39±1kg) was observed. Treatment gains continued following discharge, with 58 patients (72%) weaned from tube feeding at follow-up. Our findings support the effectiveness of our intensive multidisciplinary intervention model in promoting oral intake and reducing dependence on tube feeding in young children with chronic food refusal. Further research on the generalizability of this intensive multidisciplinary intervention approach to other specialized treatment settings and/or feeding/eating disorder subtypes is warranted.

Language Development: Early Detection of Speaking Disorders and The Process of Treating

The old paradigm which states that speech disorders in children are normal so that when they become a disorder, it will have an impact on the process of language development of children to adulthood. The number of cases of speech disorders found in children caused by the delay in early detection by parents. This is due to the lack of information regarding children's speech disorders. The purpose of writing this article is 1) to find out the stages of children's language development, (2) to find out the causes of speech and language disorders in children and (3) to find out the symptoms and the process of handling speech and language disorders in children. The article writing methodology uses a systematic literature review approach to 39 articles. The results of the writing obtained four stages of children's language development, namely the babbling stage (the babbling stage), the holophrastic stage (the one-word one-phrase stage), the two-word one-phrase stage (telegraphic) and the differentiation stage. Every child has a different range of stages. Factors that cause children's speech disorders that can be caused by medical factors, physiological factors and environmental factors. Children's speech disorders can be in the form of delays in language development, aphasia, speech organ disorders, hearing problems, autism, emotional and behavioral disorders. Treatment of speech disorders can be done with speech therapy, oral motor therapy and melodic intonation therapy. The implications of writing this article can be used as a reference by parents and health practitioners to carry out early detection and the process of handling speech disorders.

Randomized Controlled Trial of a Prefeeding Oral Motor Therapy and Its Effect on Feeding Improvement in a Thai NICU

ObjectiveTo evaluate the effect of the Premature Infant Oral Motor Intervention (PIOMI) on preterm newborns’ feeding efficiency and rates of improvement across Days 1, 3, and 5 of oral feeding in a Thai NICU. DesignRandomized controlled trial. SettingA 20-bed special neonatal ward and 8-bed NICU in urban Thailand. ParticipantsStable newborns (N = 30) born between 26 and 34 weeks postmenstrual age (PMA) without comorbidities. MethodsAfter they reached 32 to 34 weeks PMA, participants were randomly assigned to groups. The experimental group (n = 15) received the PIOMI once daily for 7 consecutive days, and the control group (n = 15) received routine care only. After oral feedings were initiated, the mean volume (MV) of oral intake of two consecutive oral feedings was calculated on Days 1, 3, and 5 to assess feeding efficiency and compare the groups. ResultsThe MV of oral intake (percentage of prescribed feeding) was significantly greater in the experimental group versus the control group on all days of measurement. The MV consumed on Day 1 of oral feeding was 44.9% ± 7.33% in the experimental group versus 29.7% ± 9.55% in the control group (P < .001), 53.9% ± 8.01% versus 30.4% ± 11.07% on Day 3 (P < .001), and 61.7% ± 7.44% versus 34.8% ± 8.76 on Day 5 (P < .001). The rate of improvement was also accelerated in the intervention group. ConclusionThe improved feeding efficiency that we found in our participants is consistent with results from other published studies and supports the use of the PIOMI as an effective oral motor therapy for newborns ages 32 to 34 weeks PMA.

Oral motor treatment: Effects of therapeutic feeding on articulatory skills

The prevalence of feeding problems is over 20% in typically developing children and over 70% in children with developmental disabilities. Oral motor therapy targeting feeding disorders may have secondary/indirect positive effects on co-morbid articulation disorders in young children. The purpose of this study was to examine such indirect effects. Seven young children with feeding problems were assessed via a known standardized articulation test upon admission for feeding therapy. They received a 4-week oral motor treatment protocol toward the development of age-appropriate feeding and swallowing, consisting of the application of tongue pressure and therapeutic spoon placement. At the conclusion of the oral motor feeding therapy, the participants’ articulatory skills were tested again. Results indicated a significant difference in the pre- and post-treatment scores on the articulation test as well as on parents’ reports on their child’s speech intelligibility.

Respiratory morbidity in children with cerebral palsy: an overview

Respiratory problems have a significant impact on morbidity and mortality in patients with cerebral palsy (CP). In particular, recurrent aspiration, impaired airway clearance, spinal and thoracic deformity, impaired lung function, poor nutritional status, and recurrent respiratory infections negatively affect respiratory status. Bronchopulmonary dysplasia may contribute to pulmonary problems, but asthma is not more common in CP than in the general population. We discuss treatment options for each of these factors. Multiple coexisting and interacting factors that influence the respiratory status of patients with CP should be recognized and effectively addressed to reduce respiratory morbidity and mortality. WHAT THIS PAPER ADDS: Respiratory problems are a significant cause of morbidity in patients with cerebral palsy (CP). Respiratory status in patients with CP is influenced by recurrent aspiration and impaired airway clearance. Spinal and thoracic deformity, impaired lung function, poor nutrition, and respiratory infections also negatively affect respiratory status. These factors should all be addressed to reduce respiratory problems in patients with CP.

The motor learning approach and strategies in the treatment of children’s articulation disorders

The article presents a theoretical analysis of the concept based on a motor learning approach as well as the possibilities for the application of this approach in speech and language therapy in the treatment of children’s articulation disorders. Motor learning principles have been emphasised as essential elements in speech and language therapy. They explain the importance of speech and language therapy services which are flexible and focused on individual cases. &#x0D; An analysis of theoretical sources focuses on the strategies of speech and language therapy based on the motor learning approach. These therapies differ between non-speech or speech levels. The aims of the application of these strategies and their theoretical presumptions of efficacy reveals the need for changes in the practice of speech and language therapists. An analysis of theoretical sources reveals that speech-based strategies of therapy are more efficient in learning correct sound pronunciation and promoting the intelligible speech of children. The application of non-speech oral motor therapy is purposeful in teaching non-speech movements of the articulatory system. When coping with children’s articulation disorders, it is necessary to differentiate strategies of motor learning with regard to the origin and level of a particular disorder.

Controversies in the Management of Pediatric Sialorrhea

Sialorrhea or drooling is the unintentional loss of saliva from the mouth. Considered pathological if it persists after the age of 4 years, sialorrhea is more common in patients with neurological conditions. It is typically caused by an inability to swallow saliva frequently or efficiently, rather than by an excessive production of saliva. This comprehensive review will discuss current management options used in the treatment of sialorrhea. These include rehabilitative options such as oral-motor and behavior therapy; medical treatments such as anti-cholinergics and botulinum toxin; and surgical interventions intended to either decrease salivary secretion or divert salivary flow. The plethora of possibilities is a testament to the lack of a single, universally accepted effective treatment. Controversies will be highlighted based on data in the literature as well as the author’s rich experience at a saliva management referral center.

Effects of oral motor therapy in children with cerebral palsy

Aim:Oral motor dysfunction is a common issue in children with cerebral palsy (CP). Drooling, difficulties with sucking, swallowing, and chewing are some of the problems often seen. In this study, we aimed to research the effect of oral motor therapy on pediatric CP patients with feeding problems.Materials and Methods:Included in this single centered, randomized, prospective study were 81 children aged 12-42 months who had been diagnosed with CP, had oral motor dysfunction and were observed at the Pediatric Neurology outpatient clinic of the Children's Health and Diseases Department, Istanbul Medical Faculty, Istanbul University. Patients were randomized into two groups: The training group and the control group. One patient from the training group dropped out of the study because of not participating regularly. Following initial evaluation of all patients by a blinded physiotherapist and pedagogue, patients in the training group participated in 1 h oral motor training sessions with a different physiotherapist once a week for 6 months. All patients kept on routine physiotherapy by their own physiotherapists. Oral motor assessment form, functional feeding assessment (FFA) subscale of the multidisciplinary feeding profile (MFP) and the Bayley scales of infant development (BSID-II) were used to evaluate oral motor function, swallowing, chewing, the gag reflex, the asymmetrical tonic neck reflex, tongue, jaw, and mouth function, severity of drooling, aspiration, choking, independent feeding and tolerated food texture during the initial examination and 6 months later.Results:When the initial and post-therapy FFA and BSID-II scores received by patients in the training and the study group were compared, the training group showed a statistically significant improvement (P < 0.05).Conclusion:Oral motor therapy has a beneficial effect on feeding problems in children with CP.

Interventions for oropharyngeal dysphagia in children with neurological impairment

Oropharyngeal dysphagia encompasses problems with the oral preparatory phase of swallowing (chewing and preparing the food), oral phase (moving the food or fluid posteriorly through the oral cavity with the tongue into the back of the throat) and pharyngeal phase (swallowing the food or fluid and moving it through the pharynx to the oesophagus). Populations of children with neurological impairment who commonly experience dysphagia include, but are not limited to, those with acquired brain impairment (for example, cerebral palsy, traumatic brain injury, stroke), genetic syndromes (for example, Down syndrome, Rett syndrome) and degenerative conditions (for example, myotonic dystrophy). To examine the effectiveness of interventions for oropharyngeal dysphagia in children with neurological impairment. We searched the following electronic databases in October 2011: CENTRAL 2011(3), MEDLINE (1948 to September Week 4 2011), EMBASE (1980 to 2011 Week 40) , CINAHL (1937 to current) , ERIC (1966 to current), PsycINFO (1806 to October Week 1 2011), Science Citation Index (1970 to 7 October 2011), Social Science Citation Index (1970 to 7 October 2011), Cochrane Database of Systematic Reviews, 2011(3), DARE 2011(3), Current Controlled Trials (ISRCTN Register) (15 October 2011), ClinicalTrials.gov (15 October 2011) and WHO ICTRP (15 October 2011). We searched for dissertations and theses using Networked Digital Library of Theses and Dissertations, Australasian Digital Theses Program and DART-Europe E-theses Portal (11 October 2011). Finally, additional references were also obtained from reference lists from articles. The review included randomised controlled trials and quasi-randomised controlled trials for children with oropharyngeal dysphagia and neurological impairment. All three review authors (AM, PD and EW) independently screened titles and abstracts for inclusion and discussed results. In cases of uncertainty over whether an abstract met inclusion criterion, review authors obtained the full-text article and independently evaluated each paper for inclusion. The data were categorised for comparisons depending on the nature of the control group (for example, oral sensorimotor treatment versus no treatment). Effectiveness of the oropharyngeal dysphagia intervention was assessed by considering primary outcomes of physiological functions of the oropharyngeal mechanism for swallowing (for example, lip seal maintenance), the presence of chest infection and pneumonia, and diet consistency a child is able to consume. Secondary outcomes were changes in growth, child's level of participation in the mealtime routine and the level of parent or carer stress associated with feeding. Three studies met the inclusion criteria for the review. Two studies were based on oral sensorimotor interventions for participants with cerebral palsy compared to standard care and a third study trialled lip strengthening exercises for children with myotonic dystrophy type 1 compared to no treatment (Sjogreen 2010). A meta-analysis combining results across the three studies was not possible because one of the studies had participants with a different condition, and the remaining two, although using oral sensorimotor treatments, used vastly different approaches with different intensities and durations. The decision not to combine these was in line with our protocol. In this review, we present the results from individual studies for four outcomes: physiological functions of the oropharyngeal mechanism for swallowing, the presence of chest infection and pneumonia, diet consistency, and changes in growth. However, it is not possible to reach definitive conclusions on the effectiveness of particular interventions for oropharyngeal dysphagia based on these studies. One study had a high risk of attrition bias owing to missing data, had statistically significant differences (in weight) across experimental and control groups at baseline, and did not describe other aspects of the trial sufficiently to enable assessment of other potential risks of bias. Another study was at high risk of detection bias as some outcomes were assessed by parents who knew whether their child was in the intervention or control group. The third study overall seemed to be at low risk of bias, but like the other two studies, suffered from a small sample size. The review demonstrates that there is currently insufficient high-quality evidence from randomised controlled trials or quasi-randomised controlled trials to provide conclusive results about the effectiveness of any particular type of oral-motor therapy for children with neurological impairment. There is an urgent need for larger-scale (appropriately statistically powered), randomised trials to evaluate the efficacy of interventions for oropharyngeal dysphagia.

Impact of nonnutritive oral motor stimulation and infant massage therapy on oral feeding skills of preterm infants

We have shown that the provision of a nonnutritive oral motor therapy (NNOMT) or infant massage therapy (iMT) provided singly and in combination vs. no intervention shortens the number of days from start to independent oral feeding in very low birth weight infants. This study hypothesizes that infants who benefited from NNOMT and/or iMT will demonstrate enhanced maturation of their oral feeding skills (OFS) when compared to control counterparts. OFS levels were monitored using a recently developed scale that takes into account their nutritive sucking skills and endurance at time of assessment. It is a simple method that requires only the additional reading of the volume taken 5 minutes into the start of a feeding and information routinely recorded in patients' medical chart. Four OFS levels were identified, characterized by infant's proficiency (% volume taken during the first 5 min/volume prescribed) and rate of transfer monitored over the entire feeding session (ml/min); OFS level 1 being the most immature and 4 the most mature. In parallel with the benefits provided by NNOMT and/or iMT, we demonstrate the direct positive impact these interventions have on accelerating the maturation of infants' oral feeding skills.