Retrospective clinical investigation of the impact of early treatment of children with Down's syndrome according to Castillo-Morales

Effectiveness of oral motor appliances on oral motor function and speech in children: a systematic review

BACKGROUND

Different oral motor appliances have been used in connection with speech therapy to improve oral motor function and speech development, but no consensus has been reached on the effectiveness of the appliances. The objective was to systematically review the effectiveness of oral motor appliances on oral motor function and speech in children with speech sound disorders (SSDs) or oral motor dysfunctions.

METHODS

A systematic search was conducted up to February 2023 in the PubMed, Scopus, and Cochrane databases. Inclusion criteria were prospective randomized or case-control clinical trials investigating the effect of intraoral appliances on orofacial function and/or speech. The risk of bias was evaluated by the Cochrane Collaboration's Robins-I tool.

RESULTS

Nine publications of three individual studies met the inclusion and search criteria. Six of the publications were conducted in children with Down Syndrome (DS) and three publications were conducted in children with Cerebral Palsy (CP). No meta-analysis was made due to the limitations of the publications. Selected studies reported some beneficial effects of intraoral appliances on oral motor function in children with DS and CP, although the evidence is low. Due to the study design in selected studies and confounding factors, the overall risk of bias was categorized as moderate or high.

DISCUSSION

Intraoral appliances may improve oral motor function in children with DS and CP. Due to lack of studies this review limited to children with DS and CP. The initial question concerning SSDs was not answered. Well-designed RCTs with larger sample sizes are needed, especially among non-syndromic children with SSDs. The level of evidence was considered very low.

Orofacial myofunctional therapy associated with the use of the stimulating palatal plate in children with trisomy 21: case studies

Individuals with trisomy 21 may have muscle hypotonia of the speech articulation organs, an enlarged protruding tongue positioned on the floor of the mouth, and a lack of lip closure. The stimulating palatal plate is an intraoral appliance that, associated with myofunctional therapy, aims to improve these children's habitual lip and tongue posture. This study aimed to present the cases of four male children with trisomy 21, with a mean age of 6.7 and a standard deviation of 7.8 months, who used the stimulating palatal plate in association with myofunctional therapy. The children used the plate for 6 months and did exercises based on the orofacial regulation therapy, and their parents received instructions on feeding them and removing deleterious oral habits. In the first session and at the end of the treatment, each child's face was video-recorded for 5 minutes at rest, and two researchers analyzed independently their habitual tongue and lip posture. Participants who began the treatment earlier and had the most severe postural changes had greater tongue and lip posture improvement.

Effects of using the stimulating palatal plate in combination with orofacial stimulation on the habitual tongue and lip posture in children with trisomy 21: an integrative literature review

ABSTRACT Purpose: to verify, in the literature, the effects of using the stimulating palatal plate on lip and tongue posture in children with trisomy 21. Methods: a search was conducted in Medline, LILACS, CINAHL, EMBASE, Scopus, Web of Science, and Cochrane. Original articles designed as clinical trials, longitudinal studies, or case-control studies, approaching stimulating palatal plate in the treatment of children with trisomy 21 and assessing habitual lip and tongue posture as an outcome, were included. Literature Review: a total of 376 studies were found, of which 10 met the selection criteria. They were published between 1996 and 2007 and carried out mostly in Europe, with small samples. The age when they began wearing the plate ranged from 1 month to 5 years, and intervention lasted from 4 to 58 months; in most cases, it was combined with orofacial muscle stimulation. Use frequency ranged from two to four times a day, each period lasting from 30 minutes to 2 hours. The children’s tongue and lip posture improved in most pieces of research. Conclusion: studies suggest that using the stimulating palatal plate in combination with orofacial muscle stimulation brings benefits to tongue and lip posture in children presented with trisomy 21.

Efeitos da placa palatina de memória associada à estimulação orofacial na postura habitual de língua e de lábios de crianças com Trissomia do 21: revisão integrativa da literatura

RESUMO Objetivo: verificar na literatura os efeitos da placa palatina de memória na postura de lábios e língua de crianças com Trissomia do 21. Métodos: foi realizada busca nas bases de dados Medline, Lilacs, CINAHL, Embase, Scopus, Web of Science e Cochrane, com inclusão de artigos originais com delineamentos dos tipos ensaios clínicos, estudos longitudinais ou caso-controle, que abordaram a placa palatina de memória no tratamento de crianças com Trissomia do 21 e avaliaram, como desfechos, a postura habitual de língua e de lábios. Revisão da Literatura: foram encontrados 376 estudos, dos quais dez contemplaram os critérios de seleção. Estes foram publicados entre 1996 e 2007, conduzidos principalmente na Europa, com amostras reduzidas. A idade de instalação da placa variou de um mês a cinco anos e a duração da intervenção de quatro a 58 meses, estando, na maioria, associada à estimulação da musculatura orofacial. A frequência de uso variou de dois a quatro períodos diários de 30 minutos a duas horas. Houve melhora na postura de língua e lábios das crianças na maioria das pesquisas. Conclusão: os estudos sugerem que a placa palatina de memória, associada à estimulação da musculatura orofacial, proporciona benefícios para postura de lábios e língua de crianças com Trissomia do 21.

Tonguing behaviours in persons with Down syndrome: moderator of the effects of negative mood on behaviour problems

BACKGROUND

There is concern that tongue protrusion may be maladaptive in individuals with Down syndrome (DS). However, tonguing and other self-manipulatory behaviours have been shown to contribute to emotion regulation in children without disabilities.

METHOD

Sixty individuals with intellectual disability (40 with DS, 20 of mixed aetiology) and their parents were videotaped during a puzzle-book task. Empirical relationships between observed tongue protrusion, other observed nonverbal behaviours, and reported negative mood, maladaptive behaviours, and stress-inducing characteristics were assessed.

RESULTS

Individuals with DS and reported negative mood who did not engage in tonguing were more likely to display internalising and externalising behaviours and stress-inducing characteristics, whereas those who did engage in tonguing were not more likely to display these characteristics.

CONCLUSION

These findings are consistent with the possibility that tongue protrusion serves an emotion regulation function for individuals with DS.

Cephalometric Evaluation of Children with Down Syndrome After Early Intervention with the Stimulating Plate

The aim of stimulating plate therapy in patients with trisomy 21 is to correct orofacial dysfunctions and prevent the establishment of subsequent morphological characteristics such as protrusion of the incisors and pseudoprognathia. This study investigated the effectiveness of this type of therapy in improving skeletal traits of patients with Down syndrome. The lateral cephalograms of 22 consecutive juveniles with Down syndrome, whose orofacial dysfunctions had been successfully treated with a stimulating plate according to Castillo Morales in infancy (17 months +/- 24 months), were examined 136 months on average (minimum of 78 months, maximum of 231 months) after initiation of treatment. In 16 of the 22 patients, the anomaly-typical bialveolar protrusion of the anterior teeth was diagnosed. The cephalometric results indicated larger values of cephalometric parameters concerning cranial base and maxilla, and markedly larger mandibular cephalometric values when compared to untreated children with Down syndrome. These results show that a stimulating plate may not always be indicated in patients with Down syndrome with a skeletal Class III pattern and minor orofacial findings.