Children with cerebral palsy (CP) are at risk for aspiration with oral feeding with potential pulmonary consequences, and commonly have reduced nutrition/hydration status and prolonged stressful meal times. There is considerable variability in the nature and severity of swallowing problems in these children whose needs change over time. Children with generalized severe motor impairment (for example, spastic quadriplegia) are likely to experience greater swallowing deficits than those with diplegia, but oropharyngeal dysphagia is prevalent even in children with mild CP. This review is focused on dysphagia in children with CP: types of deficits, clinical and instrumental evaluation, management decision making and evidence of effectiveness of interventions.

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Feeding children with cerebral palsy and swallowing difficulties.

This manuscript describes an instructional strategy, system of least prompts, and reviews the use of the procedure in the applied research literature. The literature is analyzed in terms of the populations for which the procedure has been used, the type of skills that have been taught with the procedure, and the results when the procedure was employed. The literature also is described in terms of previously identified parameters of the system of least prompts including (a) the number and type of prompts included in the least-to-most assistance prompt hierarchies, (b) the presentation of the target stimulus at each prompt level, (c) use of a fixed response interval, and (d) the delivery of reinforcement following correct prompted and unprompted responses. Summary statements and recommendations about future use and research are included.

System of Least Prompts: A Literature Review of Procedural Parameters

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.

Effects of Adaptive Seating Devices on the Eating and Drinking of Children With Multiple Handicaps

Aim: To examine the evidence of the effectiveness of different feeding interventions for children with cerebral palsy. Methods: A search of 12 electronic databases identified all relevant studies. For each study, the quality of the methods was assessed according to the study design. A total of 33 articles were retrieved, and 21 studies were included in the final analysis. Results: Feeding interventions were separated into five main categories: oral sensorimotor facilitation, food consistency, positioning, oral appliances, and adaptive equipment. Five studies were randomized controlled trials. Outcomes were mainly reported on feeding safety and efficiency. One study documented positive results in height and weight change. Nineteen of the 21 studies presented positive outcomes in eating efficiency and/or safety. Interpretation: Feeding interventions demonstrate potential benefits for children with cerebral palsy. However, the current level of evidence is poor, and empirical data are lacking. Methodo...

Feeding Interventions for Children With Cerebral Palsy: A Review of the Evidence

Recent legislature actions have focused attention on the need to provide comprehensive educational and habilitative services to persons who are severely and profoundly handicapped. One important area of programming, directed to meeting the needs of this population, is the development and training of feeding skills. The social functions of eating in our culture and the importance of establishing and empirically validating intervention strategies designed to remediate oral-motor dysfunction are discussed. The evolution of therapies based on neuro-developmental and sensorimotor facilitation procedures and the efficacy of these therapies in remediating feeding disorders are reviewed. The implications of severe feeding dysfunction for the health of the severely and profoundly handicapped are highlighted, and the need for continued research in this area is emphasized.

The development and treatment of oral-motor dysfunction: A review of clinical Research

The purposes of this study were to examine the effects of proper positioning and prosthetic equipment on the acquisition of selected self-feeding skills with a young cerebral palsy child and to develop evaluation strategies and procedures that could be easily employed by a teacher or parent in a classroom or home setting. The normal developing sequence of feeding skills was used as a guide in designing the training program. Results indicated that, through proper positioning and the use of adaptive equipment, the child was able to move his arms in a manner that allowed him to begin self-feeding with minimal assistance from the staff.

Barbara Banerdt

Papers

A Training Program for Selected Self-Feeding Skills for the Motorically Impaired: