Schedule For Oral Motor Assessment Research Articles

Investigation of the relationship between oral motor feeding development and gross motor development between preterm and term infants at 10- to 12-month postnatal age

BackgroundImmature central nervous system, extended stay in the neonatal intensive care unit, and sensory experience deficiency may contribute to oral and gross motor delay in preterm infants. Current study aimed to investigate oral and motor development in preterm infants.MethodsTwenty-nine preterm infants and 28 term infants were evaluated within the scope of the study. Oral motor feeding development was assessed with the Schedule for Oral Motor Assessment, and motor development was evaluated with the Alberta Infant Motor Scale. All analyses were performed using SPSS 22. The study was approved by the Gazi University Clinical Researches Ethics Committee (no: 25901600–23).ResultsThere was a correlation between the Schedule for Oral Motor Assessment categories (solid, semisolid, cracker, puree, bottle, and cup) and the Alberta Infant Motor Scale score (p < 0.05). There was a significant difference between groups in the Schedule for Oral Motor Assessment’s solid, semisolid, cracker, and puree categories and total score (p < 0.05). There was a significant difference between groups regarding the Alberta Infant Motor Scale score (p < 0.05).ConclusionPreterm infants come behind their term peers in motor and oral motor feeding performance. These two areas of development can influence each other. For this reason, oral motor feeding problems should be emphasized as well as motor problems in physiotherapy rehabilitation evaluations.

The effect of tummy time and oral massage on infants' oral motor skills as an effort to receive complementary food

Introduction: Complementary foods (complementary foods) are additional nutrition for babies after the age of 6 months because breastfeeding alone cannot meet the daily needs of calories and nutrients. But it is not uncommon to find children unable to eat because of oral motor skills. This study aimed to determine the effect of oral massage stimulation and tummy time on oral motor skills which were seen from the baby's response to the first food. Methods: The design of this research was using True Experimental analysis with a post-test-control group design, the population of babies aged 4-5 months was 210 respondents with probability sampling technique with purposive random sampling for 3 months in the independent practice of Gresik East Java Indonesia midwives. The research instrument was a checklist from The Schedule for Oral Motor Assessment (SOMA). Data analysis with Kruskal-Wallis test, and Mann-Whitney test. Results: The results showed that in the group of babies who received oral massage treatment almost all (77.1%) had good oral motor skills, and in the group of babies who got tummy time stimulation most (65.7%) had good oral motor skills and in the control group almost half (34%) had good oral motor skills. The value of p = 0,0001 &lt;=0,05 means that differences in infant oral motor skills in the tummy time stimulation group, oral massage group, and control group. Oral massage has a good impact on the baby's oral motor skills. Conclusion: There are other stimulations that have a good impact on the child's motor development.

The relation between clinically diagnosed and parent-reported feeding difficulties in children with and without clefts

A cleft lip and/or palate (CL/P) is one of the most common craniofacial malformations, occurring worldwide in about one in 600–1000 newborn infants. CL/P is known to influence the feeding process negatively, causing feeding difficulties in 25–73% of all children with CL/P. Because there is a risk for serious complications in these children regarding feeding difficulties, there is often a need for intensive medical counseling and treatment. At this moment, adequate diagnosis and measurement remain a challenge and often lead to a delayed referral for professional help. Since parents play a big part in reporting feeding difficulties, it is important to help objectify parents’ experiences, as well as the use of a frontline screening instrument for routine check-ups during medical appointments. The aim of this study is to investigate the relationship between parent perspective and standardized observation by medical professionals on feeding difficulties in 60 children with and without clefts at the age of 17 months. We focus on the information from parents and health professionals by comparing the Observation List Spoon Feeding and the Schedule for Oral Motor Assessment with the validated Dutch translation of the Montreal Children’s Hospital Feeding Scale. Conclusion: There is a need for timely and adequate diagnosis and referral when it comes to feeding difficulties in children with CL/P. This study underscores the importance of combining both parental observations and measurements of oral motor skills by healthcare professionals to enable this.What is Known:• Early identification of feeding difficulties can prevent adversely affected growth and development.• Clefts increase the probability of feeding difficulties; however, the diagnostic trajectory is unclear.• The Observation List Spoon Feeding (OSF) and Schedule for Oral Motor Assessment (SOMA) are validated to measure oral motor skills. The Montreal Children’s Hospital Feeding Scale Dutch version (MCH-FSD) has been validated for the parental perception of infant feeding difficulties.What is New:• Parents of children with CL/P experience relatively few feeding problems in their child on average.• Oral motor skills for spoon feeding are associated with oral motor skills for solid foods in children with CL/P.• The extent of the cleft is associated with experiencing more feeding difficulties in children with CL/P.

Exploring swallowing, feeding and communication characteristics of toddlers with severe acute malnutrition.

Severe acute malnutrition (SAM) is associated with cognitive and motor deficits. Little is known about the swallowing, feeding and communication characteristics of hospitalised toddlers with SAM, limiting the abilities of speech-language therapists to provide effective early intervention. To explore the background, swallowing, feeding and communication characteristics of toddlers with SAM during in-patient nutritional rehabilitation. An exploratory, prospective, collective case-study was conducted with three hospitalised toddlers who were 12-18 months old and independently diagnosed with SAM, at least 1 week after transitioning to oral feeding. Detailed case histories were compiled through medical file perusal and parent interviews. Cross-sectional clinical bedside assessments were completed with the Rossetti Infant-Toddler Language Scale and Schedule for Oral-Motor Assessment. All three participants had a history of feeding difficulties before admission. Despite intact pharyngeal swallows, heterogeneous oral-sensorimotor dysfunction and disruptive feeding behaviours were identified. Risk for oropharyngeal dysphagia indicates the need to modify dietary consistencies to prevent prolonging recovery or SAM relapse. Participants had mild-to-moderate language delays, particularly in interaction-attachment, play and language comprehension, with an atypical moderate receptive and mild expressive language delay profile. None of the participants were referred for speech-language therapy. This exploratory research showed the oral-sensorimotor skills, swallowing and communication characteristics of children with SAM. Speech-language therapists could address oral-sensorimotor functioning, feeding difficulties and communication interaction delays before discharge to community-based management for SAM. Further investigation with a larger sample size is recommended.Contribution:Novel description of the oral-sensorimotor skills for feeding and the communication development of three severely malnourished toddlers with HIV and tuberculosis co-infection was presented. The complexity of the three cases is highlighted.

The Effects of Neurodevelopmental Therapy on Feeding and Swallowing Activities in Children with Cerebral Palsy.

This study investigated the effect of the structured Neurodevelopmental Therapy Method-Bobath (NDT-B) approach on the feeding and swallowing activity of patients with cerebral palsy (CP) and feeding difficulties. In addition to feeding and oral motor intervention strategies (OMIS), and nutrition-related caregiver training (NRCT), and the NDT-B, which was structured to increase trunk and postural control, was added to the therapy program. Forty patients with CP, with a mean age of 3.25 ± 0.927years, were classified using the Gross Motor Function Classification System, Eating and Drinking Ability Classification System, and Mini-Manual Ability Classification System. The patients were randomly assigned into two groups as OMIS + NRCT (n = 20) and OMIS + NRCT + NDT-B (n = 20). The program was applied for 6weeks, 2days/week, for 45min. The patients were evaluated using the Trunk Impairment Scale, Schedule for Oral Motor Assessment, and the Pediatric Quality of Life Inventory before and after 6weeks. The trunk control of the OMIS + NRCT + NDT-B group was superior to the other group (P = 0.026). Although there was an improvement in the groups according to the subcategories of SOMA, the OMIS + NRCT + NDT-B group was superior in the trainer cup and puree subcategories of SOMA (P = 0.05). A significant correlation was observed between trunk control and oral motor functions in children with CP, and the eating function of children in the OMIS + NRCT + NDT-B group further improved. NDT-B-based neck and trunk stabilization exercises should be added to the treatment programs.Trial Registration NCT04403113.

Characteristics of Dysphagia in Infants with Microcephaly Caused by Congenital Zika Virus Infection, Brazil, 2015.

We summarize the characteristics of dysphagia in 9 infants in Brazil with microcephaly caused by congenital Zika virus infection. The Schedule for Oral Motor Assessment, fiberoptic endoscopic evaluation of swallowing, and the videofluoroscopic swallowing study were used as noninstrumental and instrumental assessments. All infants had a degree of neurologic damage and showed abnormalities in the oral phase. Of the 9 infants, 8 lacked oral and upper respiratory tract sensitivity, leading to delays in initiation of the pharyngeal phase of swallowing. Those delays, combined with marked oral dysfunction, increased the risk for aspiration of food, particularly liquid foods. Dysphagia resulting from congenital Zika virus syndrome microcephaly can develop in infants >3 months of age and is severe.

Neuropredictors of oromotor feeding impairment in 12 month-old children

BackgroundFeeding impairment is prevalent in children with neurodevelopmental issues. Neuroimaging and neurobehavioural outcomes at term are predictive of later neuromotor impairment, but it is unknown whether they predict feeding impairment. AimsTo determine whether neurobehavior and brain magnetic resonance imaging (MRI) at term predict oromotor feeding at 12 months in preterm and term-born children. Study designProspective cohort study. Subjects248 infants (97 born <30weeks and 151 born at term) recruited at birth. Outcome measuresNeurobehavioral assessments (General Movements (GMA), Hammersmith Neonatal Neurological Examination (HNNE), Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS)); and brain MRI were administered at term-equivalent age. Oromotor feeding was assessed at 12months corrected age using the Schedule for Oral Motor Assessment. Results49/227 children had oromotor feeding impairment. Neurobehavior associated with later feeding impairment was: suboptimal NNNS stress (odds ratio [OR] 2.68; 95% confidence interval [CI] 1.20–6.01), non-optimal reflexes (OR 3.33; 95% CI 1.37–8.11) and arousal scales (OR 2.54; 95% CI 1.03–6.27); suboptimal HNNE total (OR 4.69; 95% CI 2.20–10.00), reflexes (OR 2.62; 95% CI 1.06–6.49), and tone scores (OR 3.87; 95% CI 1.45–10.35); and abnormal GMA (OR 2.60; 95% CI 1.21–5.57). Smaller biparietal diameter also predicted feeding impairment (OR 0.88; 95% CI 0.79–0.97). There was little evidence that relationships differed between birth groups. ConclusionsNeurobehavior and biparietal diameter at term are associated with oromotor feeding at 12months. These results may identify children at greatest risk of oromotor feeding impairment.

Oromotor Feeding in Children Born Before 30 Weeks' Gestation and Term-Born Peers at 12 Months' Corrected Age

To evaluate oromotor feeding at 12 months' corrected age in children born before 30 weeks' gestational age compared with term-born peers by the use of observational assessment and to examine predictors of oromotor feeding difficulties in children born before 30 weeks. Oromotor feeding was assessed at 12 months' corrected age with the Schedule for Oral Motor Assessment in 90 children born before 30 weeks and 137 term-born children. Feeding outcomes were compared between groups. Sex, gestational age at birth, birth weight, social risk, history of tube feeding, surgery, and respiratory support were analyzed as potential risk factors. At 12 months' corrected age, 38% of children born before 30 weeks had oromotor feeding difficulties-with greater odds of difficulties than term-born participants (OR 2.21; 95% CI 1.55-3.16). Difficulties were observed with specific food textures (purees, solids, crackers) and areas of oromotor skill (lip and jaw movement, food loss, swallowing). Neonatal surgery (n = 4/89) appeared to be the only predictor of oromotor feeding issues (OR 11.66; 95% CI 1.56-87.23; P = .02). Children born before 30 weeks presented with greater odds of oromotor feeding problems at 12 months' corrected age than their term-born peers. Neonatal surgery was associated with increased odds of feeding difficulties in children born before 30 weeks. Surveillance and support of oromotor feeding skills for very preterm children is indicated, particularly during their transition to solid foods.

Validity and reproducibility of measures of oropharyngeal dysphagia in preschool children with cerebral palsy.

The aim of the study was to determine the best measure to discriminate between those with oropharyngeal dysphagia (OPD) and those without OPD, among young children with cerebral palsy (CP). We carried out a cross-sectional population-based study involving 130 children with CP aged between 18 months and 36 months (mean 27.4mo; 81 males, 49 females) classified according to the Gross Motor Function Classification Scale (GMFCS) as level I (n=57), II (n=15), III (n=23), IV (n=12), or V (n=23). Forty children with CP (mean 28.5mo; 21 males,19 females, eight for each GMFCS level) were included in the reproducibility sub-study, and 40 children with typical development (mean 26.2mo; 18 males, 22 females) were included in the validity sub-study. OPD was assessed using the Dysphagia Disorders Survey (DDS), Pre-Speech Assessment Scale (PSAS), and Schedule for Oral Motor Assessment (SOMA). We analysed reproducibility using inter- and intrarater agreement (percentage) and reliability (kappa values and intraclass correlation coefficients). Construct validity was assessed as concordance between measures (SOMA, DDS, and PSAS). In the absence of a criterion standard measure for OPD, prevalence was estimated using latent class variable analysis. Data from the children with typical development were used to propose modified OPD cut-points for discriminative validity. All measures had strong agreement (>85%) for inter- and intrarater reliability. The SOMA had the best specificity (100.0%), but lacked sensitivity (53.0%), whereas the DDS and PSAS had high sensitivity (each 100.0%) but lacked specificity (47.1% and 70.6% respectively). OPD prevalence when calculated using the web-based estimation was 65.4%, which was similar to the estimate from the modified cut-points. Using the sample of children with typical development and modified cut-points, OPD prevalence was lower than estimates with standard scoring. We propose using these modified cut-points when administering the DDS, PSAS or SOMA in young children with CP.

Oropharyngeal Dysphagia and Gross Motor Skills in Children With Cerebral Palsy

To determine the prevalence of oropharyngeal dysphagia (OPD) and its subtypes (oral phase, pharyngeal phase, saliva control), and their relationship to gross motor functional skills in preschool children with cerebral palsy (CP). It was hypothesized that OPD would be present across all gross motor severity levels, and children with more severe gross motor function would have increased prevalence and severity of OPD. Children with a confirmed diagnosis of CP, 18 to 36 months corrected age, born in Queensland between 2006 and 2009, participated. Children with neurodegenerative conditions were excluded. This was a cross-sectional population-based study. Children were assessed by using 2 direct OPD measures (Schedule for Oral Motor Assessment; Dysphagia Disorders Survey), and observations of signs suggestive of pharyngeal phase impairment and impaired saliva control. Gross motor skills were described by using the Gross Motor Function Measure, Gross Motor Function Classification System (GMFCS), Manual Ability Classification System, and motor type/ distribution. OPD was prevalent in 85% of children with CP, and there was a stepwise relationship between OPD and GMFCS level. There was a significant increase in odds of having OPD, or a subtype, for children who were nonambulant (GMFCS V) compared with those who were ambulant (GMFCS I) (odds ratio = 17.9, P = .036). OPD was present across all levels of gross motor severity using direct assessments. This highlights the need for proactive screening of all young children with CP, even those with mild impairments, to improve growth and nutritional outcomes and respiratory health.

Clinimetrics of measures of oropharyngeal dysphagia for preschool children with cerebral palsy and neurodevelopmental disabilities: a systematic review

The aim of this study was to determine the psychometric properties and clinical utility of objective measures of oropharyngeal dysphagia (OPD) in children with cerebral palsy or neurodevelopmental disabilities aged 12 months to 5 years. Five electronic databases were searched to identify measures of OPD. The Consensus-based Standards for the Selection of Measurement Instruments (COSMIN) Checklist was used to assess psychometric properties and a Modified CanChild Outcome Rating Form was used for clinical utility. Nine measures of OPD from 27 papers were assessed: the Brief Assessment of Motor Function - Oral Motor Deglutition Scale; the Behavioral Assessment Scale of Oral Functions in Feeding; the Dysphagia Disorders Survey; the Feeding Behaviour Scale; the Functional Feeding Assessment, modified; the Gisel Video Assessment; the Oral Motor Assessment Scale; the Pre-Speech Assessment Scale; and the Schedule for Oral Motor Assessment. The Schedule for Oral Motor Assessment and the Functional Feeding Assessment, modified, proved to be the strongest measures based on published psychometric properties of validity and reliability. The Schedule for Oral Motor Assessment and the Dysphagia Disorders Survey were found to have the strongest clinical utility. Further studies to test the psychometric properties of existing measures, in particular predictive validity, responsiveness, and test-retest reliability, would be beneficial for selecting an appropriate measure for both clinical and research contexts.

Longitudinal cohort protocol study of oropharyngeal dysphagia: relationships to gross motor attainment, growth and nutritional status in preschool children with cerebral palsy

IntroductionThe prevalence of oropharyngeal dysphagia (OPD) in children with cerebral palsy (CP) is estimated to be between 19% and 99%. OPD can impact on children's growth, nutrition and overall health....

Clinical Usefulness of Schedule for Oral-Motor Assessment (SOMA) in Children with Dysphagia

ObjectiveTo investigate the clinical usefulness of the Schedule for Oral-Motor Assessment (SOMA) in children with dysphagia by comparing findings of SOMA with those of the videofluoroscopic swallowing study (VFSS).MethodBoth SOMA and VFSS were performed in 33 children with dysphagia (21 boys and 12 girls; mean age 17.3±12.1 months) who were referred for oropharyngeal evaluation. Ratings of oral-motor functions indicated by SOMA were based upon the cutting score of each specific texture of food (puree, semi-solids, solids, cracker, liquid-bottle, and liquid-cup). Abnormalities of either the oral phase, or the pharyngeal phase as indicated by VFSS were assessed by a physician and a speech-language pathologist.ResultsThere was significant consistency between the findings of SOMA and the oral phase evaluation by VFSS (Kappa=0.419, p=0.023). SOMA reached 87.5% sensitivity, 66.6% specificity, and 95.4% positive predictive value when compared with the oral phase of the VFSS. We were able to evaluate oral-motor function by using SOMA in 6 children who were unable to complete the oral phase evaluation by VFSS, due to fear and crying during the study. The findings of SOMA failed to show any consistency with the pharyngeal phase evaluation by VFSS (Kappa=-0.105, p=0.509).ConclusionThese results suggest that SOMA is a reliable method for evaluation of oral-motor function in children with dysphagia. In particular, SOMA is recommended for children that were unable to complete the oral phase evaluation by VFSS due to poor cooperation.

Oral-motor Dysfunction at 10 Months Corrected Gestational Age in Infants Born Less Than 37 Weeks Preterm

Feeding difficulties are common in preterm infants. These may be associated with inadequate dietary intake, poor growth, and parental anxiety. Oral-motor dysfunction has been observed in preterm infants during sucking and the early stages of weaning but has not been rigorously studied in later infancy when eating a range of food consistencies. We aimed to establish if oral-motor dysfunction during feeding occurs in preterm infants in later infancy and to explore the relationships with specific neonatal risk factors: gestational age at birth, prolonged supplementary oxygen requirement, and delay in establishing full oral feeding. Infants born less than 37 weeks gestational age were evaluated once at 10 months corrected gestational age using a validated feeding assessment (Schedule for Oral Motor Assessment). Fifteen infants were enrolled (9 males, 6 females; median gestational age at birth = 33 weeks, range = 25-36 weeks; median birth weight = 1890 g, range = 710-2950 g). Oral-motor dysfunction was observed in three infants all born after 31 weeks gestation. No relationship was found with the neonatal risk factors. This study indicates that oral-motor dysfunction may occur in later infancy and is not easily predicted from specific neonatal risk factors. Further study is required to evaluate the true prevalence and the health implications of oral-motor dysfunction in this population in later infancy.

Clinical progression and outcome of dysphagia following paediatric traumatic brain injury: a prospective study

Objectives: To provide a preliminary clinical profile of the resolution and outcomes of oral-motor impairment and swallowing function in a group of paediatric dysphagia patients post-traumatic brain injury (TBI). To document the level of cognitive impairment parallel to the return to oral intake, and to investigate the correlation between the resolution of impaired swallow function versus the resolution of oral-motor impairment and cognitive impairment.Participants: Thirteen children admitted to an acute care setting for TBI.Main outcome measures: A series of oral-motor (Verbal Motor Production Assessment for Children, Frenchay Dysarthria Assessment, Schedule for Oral Motor Assessment) and swallowing (Paramatta Hospital’s Assessment for Dysphagia) assessments, an outcome measure for swallowing (Royal Brisbane Hospital’s Outcome Measure for Swallowing), and a cognitive rating scale (Rancho Level of Cognitive Functioning Scale).Results: Across the patient group, oral-motor deficits resolved to normal status between 3 and 11 weeks post-referral (and at an average of 12 weeks post-injury) and swallowing function and resolution to normal diet status were achieved by 3–11 weeks post-referral (and at an average of 12 weeks post-injury). The resolution of dysphagia and the resolution of oral-motor impairment and cognitive impairment were all highly correlated.Conclusion: The provision of a preliminary profile of oral-motor functioning and dysphagia resolution, and data on the linear relationship between swallowing impairment and cognition, will provide baseline information on the course of rehabilitation of dysphagia in the paediatric population post-TBI. Such data will contribute to more informed service provision and rehabilitation planning for paediatric patients post-TBI.

Oral‐motor dysfunction in children who are failing to thrive

ABSTRACT A whole population prospective survey of inner‐city infants (N=2510), aged from birth to 15 months, found the prevalence of failure to thrive (FTT), unassociated with any medical aetiology, to be 3.3%. A speech therapist, blind to case status, used the Schedule for Oral Motor Assessment (SOMA) to rate abilities across a range of food textures and fluids. One in four FTT cases, but only 11% of comparisons, obtained dysfunction scores outside the normal range. Most difficulty was observed with purees, least with liquids. Oral‐motor dysfunction did not simply reflect developmental delay. SOMA scores did not correlate with either the mental or psychomotor index of the Bayley Scales of Infant Development (BSID), but did correlate negatively with birth weight (r=−0.3, p&lt;0.01); weight at 3 months (r=−0.28, p&lt;0.003); 6 months (r=−0.3, p&lt;0.01); and 9 months (r=−0.28, p&lt;0.02), but not with weight at follow up. Children with the highest dysfunction scores weighed least at all ages and had smaller head circumferences. High oral‐motor dysfunction scores were not linked to overt feeding difficulties, by maternal report. It was hypothesised that the disorder reflects the influence of early post‐natal growth failure (presumably due to undernutrition) upon developing brain structures, rather than a congenital abnormality.

Schedule for oral-motor assessment (SOMA): methods of validation.

The Schedule for Oral Motor Assessment (SOMA) was developed for the purpose of objectively rating the oral-motor skills of preverbal children, with a view to identifying areas of deficient abilities that could have clinical significance. The instrument can be administered without special equipment, by a trained observer. Oral-motor function is assessed across a range of food textures and fluids. Ratings of oral-motor skills are largely made post hoc by analysis of a videorecording of the test administration. The test-retest and interrater reliability of the instrument have been shown to be excellent. Criterion validity was investigated by means of a novel 'seeded cluster analysis' procedure in which 127 young children were assessed, most of whom were between 8 and 24 months of age. Ten percent of the sample had known abnormal oral-motor function in association with cerebral palsy (ages between 12 and 42 months). Not only was criterion validity satisfactorily established by the analysis but an abbreviated version of the SOMA--suitable for screening purposes--was developed. This has been shown to have a positive predictive validity greater than 90% and sensitivity greater than 85% for the detection of infants with clinically significant oral-motor dysfunction.

The objective rating of oral-motor functions during feeding

The Schedule for Oral Motor Assessment (SOMA) was developed to record oral-motor skills objectively in infants between ages 8 and 24 months postnatal. Its aim is to identify areas of dysfunction that could contribute to feeding difficulties. The procedure takes approximately 20 min to administer, and is intended to be rated largely from a videorecording of a structured feeding session. A series of foodstuffs of varying textures, including liquids, is presented to the child in a standardized manner. Oral-motor skills are evaluated in terms of discrete oral-motor movements. The schedule distinguishes these from skills at more aggregated levels of functioning such as jaw, lip, and tongue control. A total of 127 children have been studied with the instrument, including normal healthy infants and samples with nonorganic failure to thrive, and cerebral palsy. Interrater and test-retest reliabilities were determined on a subset of 10 infants who each took part in three trials rated by 2 therapists. Excellent levels of interrater reliability (kappa > 0.75) were obtained for the presence/absence of 69% of discrete oral-motor behaviors. Test-retest reliability was similarly excellent for 85% of ratable behaviors. For the first time an assessment of oral-motor functioning has been shown to have adequate reliability for children aged 8-24 months. The validation of the SOMA on a large sample of normally developing infants and its application to clinical groups is presented in an accompanying paper [1].