How can the childs functional abilities be maximized? See ASHAs resources on interprofessional education/interprofessional practice (IPE/IPP), and person- and family-centered care. Sensory stimulation techniques vary and may include thermaltactile stimulation (e.g., using an iced lemon glycerin swab) or tactile stimulation (e.g., using a NUK brush) applied to the tongue or around the mouth. When treatment incorporates accommodations, modifications, and supports in everyday settings, SLPs often provide training and education in how to use strategies to facilitate safe swallowing. However, relatively few studies have examined the effects of non-noxious thermal stimulation on tactile discriminative capacity. Alex F. Johnson and Celia Hooper served as monitoring officers (vice presidents for speech-language pathology practices, 20002002 and 20032005, respectively). In the school setting a physicians order or prescription is not required to perform clinical evaluations, modify diets, or to provide intervention. Use: The Swallowing Activator is used for Tactile-Thermal Stimulation (TTS) to enhance bilateral cortical and brainstem activation of the swallow. Additional medical and rehabilitation specialists may be included, depending on the type of facility, the professional expertise needed, and the specific population being served. Information from the referral, parent interview/case history, and clinical evaluation of the student is used to develop IEP goals and objectives for improved feeding and swallowing, if appropriate. SLPs may collaborate with occupational therapists, considering that motor control for the use of this adaptive equipment is critical. A. https://doi.org/10.1542/peds.110.3.517, Snyder, R., Herdt, A., Mejias-Cepeda, N., Ladino, J., Crowley, K., & Levy, P. (2017). 0000090522 00000 n Journal of Adolescent Health, 55(1), 4952. 0000001861 00000 n Rates increase with greater severity of cognitive impairment and decline in gross motor function (Benfer et al., 2014, 2017; Calis et al., 2008; Erkin et al., 2010; Speyer et al., 2019). Speech-language pathologists (SLPs) play a central role in the assessment, diagnosis, and treatment of infants and children with swallowing and feeding disorders. Long-term follow-up of oropharyngeal dysphagia in children without apparent risk factors. 0000088878 00000 n Oralmotor treatments are intended to influence the physiologic underpinnings of the oropharyngeal mechanism to improve its functions. The plan should be reviewed annually along with the IEP goals and objectives or as needed if significant changes occur or if it is found to be ineffective. screening of willingness to accept liquids and a variety of foods in multiple food groups to determine risk factors for avoidant/restrictive food intake disorder. Some of these interventions can also incorporate sensory stimulation. The SLP providing and facilitating oral experiences with NNS must take great care to ensure that the experiences are positive and do not elicit stress or other negative consequences. data from monitoring devices (e.g., for patients in the neonatal intensive care unit [NICU]); nonverbal forms of communication (e.g., behavioral cues signaling feeding or swallowing problems); and. This method . The plan includes a protocol for response in the event of a student health emergency (Homer, 2008). discuss the process of establishing a safe feeding plan for the student at school; gather information about the students medical, health, feeding, and swallowing history; identify the current mealtime habits and diet at home; and. Intraoral appliances are not commonly used. Pediatric swallowing and feeding: Assessment and management. Reading the feeding. Singular. 0000051615 00000 n Moreno-Villares, J. M. (2014). In these instances, the swallowing and feeding team will. This might involve decisions about whether the individual can safely eat an oral diet that meets nutritional needs, whether that diet needs to be modified in any way, and whether the individual needs compensatory strategies to eat the diet. Behavioral interventions include such techniques as antecedent manipulation, shaping, prompting, modeling, stimulus fading, and differential reinforcement of alternate behavior, as well as implementation of basic mealtime principles (e.g., scheduled mealtimes in a neutral atmosphere with no food rewards). https://sites.ed.gov/idea/, Jaffal, H., Isaac, A., Johannsen, W., Campbell, S., & El-Hakim, H. G. (2020). Therefore, management of dysphagia may require input of multiple specialists serving on an interprofessional team. Retrieved month, day, year, from www.asha.org/practice-portal/clinical-topics/pediatric-dysphagia/. Postural and positioning techniques involve adjusting the childs posture or position to establish central alignment and stability for safe feeding. In turn, the caregiver can use these cues to optimize feeding by responding to the infants needs in a dynamic fashion at any given moment (Shaker, 2013b). Using this treatment, clinicians deliver electrical current through electrodes to stimulate peripheral nerves and evoke a muscle contraction. Members of the dysphagia team may vary across settings. Key words: swallowing, dysphagia, stroke, neuromuscular elec-trical stimulation. Such beliefs and holistic healing practices may not be consistent with recommendations made. Members of the team include, but are not limited to, the following: If the school team determines that a medical assessment, such as a videofluoroscopic swallowing study (VFSS), flexible endoscopic evaluation of swallowing (FEES), sometimes also called fiber-optic endoscopic evaluation of swallowing, or other medical assessment, is required during the students program, the team works with the family to seek medical consultation or referral. The data below reflect this variability. All rights reserved. In the thermo-tactile . hb``b````c` B,@. https://doi.org/10.1097/JPN.0000000000000082, Seiverling, L., Towle, P., Hendy, H. M., & Pantelides, J. 0000027867 00000 n Pediatric feeding disorder (PFD) is impaired oral intake that is not age-appropriate and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction (Goday et al., 2019). Little is known about the possible mechanisms by which this interventional therapy may work. Silent aspiration is estimated at 41% of children with laryngeal cleft, 41%49% of children with laryngomalacia, and 54% of children with unilateral vocal fold paralysis (Jaffal et al., 2020; Velayutham et al., 2018). (Justus-Liebig University, protocol number 149/16 . .22 The study protocol had a prior approval by the . Assessment of pediatric dysphagia and feeding disorders: Clinical and instrumental approaches. According to the Centers for Disease Control and Prevention (CDC), survey interviews indicated that within the past 12 months, 0.9% of children (approximately 569,000) ages 317 years are reported to have swallowing problems (Bhattacharyya, 2015; Black et al., 2015). Adaptive equipment and utensils may be used with children who have feeding problems to foster independence with eating and increase swallow safety by controlling bolus size or achieving the optimal flow rate of liquids. Interdisciplinary feeding team: A medical, motor, behavioral approach to complex pediatric feeding problems. The clinical evaluation of infants typically involves. https://doi.org/10.1111/j.1469-8749.2008.03047.x, Caron, C. J. J. M., Pluijmers, B. I., Joosten, K. F. M., Mathijssen, I. M. J., van der Schroeff, M. P., Dunaway, D. J., Wolvius, E. B., & Koudstaal, M. J. (1998). Arvedson, J. C., & Lefton-Greif, M. A. Arvedson, J. C., & Brodsky, L. (2002). Members of the Ad Hoc Committee on Speech-Language Pathology Practice in the Neonatal Intensive Care Unit included Justine J. Sheppard (chair), Joan C. Arvedson, Alexandra Heinsen-Combs, Lemmietta G. McNeilly, Susan M. Moore, Meri S. Rosenzweig Ziev, and Diane R. Paul (ex officio). Children who demonstrate aversive responses to stimulation may need approaches that reduce the level of sensory input initially, with incremental increases as the child demonstrates tolerance. McComish, C., Brackett, K., Kelly, M., Hall, C., Wallace, S., & Powell, V. (2016). Characteristics of avoidant/restrictive food intake disorder in children and adolescents: A new disorder in DSM-5. National Center for Health Statistics. Diet modifications should consider the nutritional needs of the child to avoid undernutrition and malnutrition. SLPs should be sensitive to family values, beliefs, and access regarding bottle-feeding and breastfeeding and should consult with parents and collaborate with nurses, lactation consultants, and other medical professionals to help identify parent preferences. This study is aimed to investigate whether thermal oral (tongue) stimulation can modulate the cortico-pharyngeal neural motor pathway in humans. (2001). The NICU is considered an advanced practice area, and inexperienced SLPs should be aware that additional training and competencies may be necessary. The hyoid bone and the larynx are positioned higher than in adults, and the larynx elevates less than in adults during the pharyngeal phase of the swallow. https://doi.org/10.1002/ppul.20488, Lefton-Greif, M. A., McGrattan, K. E., Carson, K. A., Pinto, J. M., Wright, J. M., & Martin-Harris, B. Methodology: Fifty patients with dysphagia due to stroke were included. 0000090877 00000 n Is a sensory motorbased intervention for behavioral issues indicated? an assessment of sucking/swallowing problems and a determination of abnormal anatomy and/or physiology that might be associated with these findings (e.g., Francis et al., 2015; Webb et al., 2013); a determination of oral feeding readiness; an assessment of the infants ability to engage in non-nutritive sucking (NNS); developmentally appropriate clinical assessments of feeding and swallowing behavior (nutritive sucking [NS]), as appropriate; an identification of additional disorders that may have an impact on feeding and swallowing; a determination of the optimal feeding method; an assessment of the duration of mealtime experience, including potential effects on oxygenation (SLP may refer to the medical team, as necessary); an assessment of issues related to fatigue and volume limitations; an assessment of the effectiveness of parent/caregiver and infant interactions for feeding and communication; and. Intraoral prosthetics (e.g., palatal obturator, palatal lift prosthesis) can be used to normalize the intraoral cavity by providing compensation or physical support for children with congenital abnormalities (e.g., cleft palate) or damage to the oropharyngeal mechanism. Haptic displays aim at artificially creating tactile sensations by applying tactile features to the user's skin. Prevalence of feeding problems in young children with and without autism spectrum disorder: A chart review study. Congenital abnormalities and/or chronic conditions can affect feeding and swallowing function. Although thermal tactile oral stimulation is a common method to treat dysphagic patients to improve swallowing movement, little is known about the possible mechanisms. Pediatric Videofluroscopic Swallow Studies: A Professional Manual With Caregiver Guidelines. The effect of tongue-tie division on breastfeeding and speech articulation: A systematic review. The infants ability to turn the head and open the mouth (rooting) when stimulated on the lips or cheeks and to accept a pacifier into the mouth. %PDF-1.7 % https://doi.org/10.5014/ajot.42.1.40, Homer, E. (2008). If choosing to use electrical stimulation in the pediatric population, the primary focus should be on careful patient selection to ensure that electrical stimulation is being used only in situations where there is no possibility of inducing untoward effects. https://doi.org/10.1097/MRR.0b013e3283375e10, Fisher, M. M., Rosen, D. S., Ornstein, R. M., Mammel, K. A., Katzman, D. K., Rome, E. S., Callahan, S. T., Malizio, J., Kearney, S., & Walsh, B. T. (2014). Lateral views of infant head, toddler head, and older child head showing structures involved in swallowing. -Group II (thermal tactile stimulation treatment program): Comprised 25 patients who received thermal tactile stimulation daily three times, each of 20 minutes Three groups A, B and C were made, patients were taken through purposive sample technique and groups were . Does the child have the potential to improve swallowing function with direct treatment? (2016a). Behavior patterns associated with institutional deprivation: A study of children adopted from Romania. Typical modifications may include thickening thin liquids, softening, cutting/chopping, or pureeing solid foods. 0000055191 00000 n The tactile and thermal sensitivity, and 2-point . The pharyngeal muscles are stimulated through neural pathways. 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