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Kamal S, Kamaralzaman S, Sharma S, Jaafar NH, Chern PM, Hassan NI, Toran H, Ismail NAS, Yusri G, Hamzaid NH. A Review of Food Texture Modification among Individuals with Cerebral Palsy: The Challenges among Cerebral Palsy Families. Nutrients 2022; 14:nu14245241. [PMID: 36558401 PMCID: PMC9782059 DOI: 10.3390/nu14245241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/03/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022] Open
Abstract
Individuals with cerebral palsy (CP) frequently present with multiple feeding problems, which may require food texture modification to ensure safe feeding. This review aims to explore the challenges individuals with CP and their caregiver's face and recommend modified food textures to ensure safety and improve the quality of life and nutritional status. A systematic search was carried out through four databases (i.e., EBSCO (Medline), PubMed, Science Direct, and Web of Science) between January 2011 and May 2022. Out of 86 articles retrieved, seven were selected based on keywords and seven other studies through manual search-five cross-sectional studies, two qualitative studies, one correlational study, one mixed method study, one case-control study, two sections of books, and two educational materials. The findings suggest that preparation and intake of food with modified texture play a necessary role in the safety of swallowing in addition to physical, social, and environmental aspects. Safety was found to be the crucial part of the food texture modification provision besides considering the stress of the caregivers and the nutritional status of individuals with CP. Currently, there are no standard guidelines available pertaining to food texture modification. This led to uncertainties in the dietary provision among caregivers, which may lead to undernourishment. Hence, standard guidelines relating to food texture modification that focuses on food preparation and menus with calorie and nutrient information are timely to be developed.
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Affiliation(s)
- Sakinah Kamal
- Center for Rehabilitation and Special Needs Studies (iCaRehab), Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM), Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
- Dietetics Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM), Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
| | - Sazlina Kamaralzaman
- Center for Rehabilitation and Special Needs Studies (iCaRehab), Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM), Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
| | - Shobha Sharma
- Center for Healthy Aging and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM), Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
| | - Nurul Hazirah Jaafar
- Department of Nutrition Sciences, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia (IIUM), Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, Kuantan 25200, Malaysia
| | - Phei Ming Chern
- Department of Rehabilitation Medicine (Paediatric Rehabilitation), Hospital Rehabilitasi Cheras, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia
| | - Nurul Izzaty Hassan
- Department of Chemical Sciences, Faculty of Science & Technology, Universiti Kebangsaan Malaysia (UKM), Bandar Baru Bangi 43600, Malaysia
| | - Hasnah Toran
- Faculty of Education, Universiti Kebangsaan Malaysia (UKM), Bandar Baru Bangi 43600, Malaysia
| | - Noor Akmal Shareela Ismail
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia
| | - Ghazali Yusri
- Akademi Pengajian Bahasa, Universiti Teknologi Mara (UiTM), Shah Alam 40450, Malaysia
- Malaysian Advocates for Cerebral Palsy (MyCP), No 4., USJ3/4X, USJ3, Subang Jaya 47600, Malaysia
| | - Nur Hana Hamzaid
- Center for Rehabilitation and Special Needs Studies (iCaRehab), Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM), Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
- Dietetics Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM), Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
- Correspondence:
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Alani SS, Stierwalt J, LaPointe LL, Morris RJ, Jeong AC, Filson Moses J, Upton TD. An Investigation of Pulse Oximetry Levels during Swallowing in Healthy Adults and in Individuals with Severe and Very Severe Chronic Obstructive Pulmonary Disease. Semin Speech Lang 2022; 43:361-377. [PMID: 35276735 DOI: 10.1055/s-0042-1743486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To compare pulse oximetry (PO) levels during swallowing in healthy adults and adults with severe chronic obstructive pulmonary disease (COPD). Participants included two groups of 60 healthy adults, balanced for gender. The young group ranged from 18 to 38 years, and the older group from 60 to 87 years. In addition, there were 11 participants with COPD aged 43 to 82 years. PO levels were collected as each participant swallowed 10 mL of water, 10 mL of applesauce, and a piece of diced pear (three trials each). Analyses for the healthy groups revealed neither statistically significant main effects for bolus type nor interactions between gender and age. For between-subject effects, there was no main effect for gender, but there was a large main effect for age, and a gender and age interaction. In the group with COPD, there were no significant differences across bolus types; however, PO measures were consistently lower than the healthy groups for all bolus types. Healthy adults exhibited stable PO levels across bolus types. Adults with COPD, although exhibiting significantly lower PO levels, also remained stable. For clinicians who monitor PO measures, these results offer a more comprehensive understanding of the nature of these measures during swallowing in these groups.
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Affiliation(s)
- Salim S Alani
- Department of Speech-Language Pathology, College of Health and Human Services, California State University, Long Beach, Long Beach, California
| | - Julie Stierwalt
- Division of Speech Pathology, Department of Neurology, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Leonard L LaPointe
- School of Communication Science and Disorders, Program in Neuroscience, Florida State University, Tallahassee, Florida
| | - Richard J Morris
- School of Communication Science and Disorders, Florida State University, Tallahassee, Florida
| | - Allan C Jeong
- Department of Educational Psychology and Learning Systems, Instructional Systems and Learning Technologies Program, Florida State University, Tallahassee, Florida
| | - Jennifer Filson Moses
- Department of Psychology and Statistics, Los Angeles Pierce College, Woodland Hills, California
| | - Thomas D Upton
- Rehabilitation Education Training Program, School of Health Sciences, Applied Sciences and Arts, Southern Illinois University, Carbondale, Illinois
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Prendeville N, Sell D. Tongue Reduction Surgery and Feeding Difficulties in Infants With Beckwith Wiedemann Syndrome: A Case Series. Cleft Palate Craniofac J 2018; 56:679-689. [DOI: 10.1177/1055665618794070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To profile the pre- and post-operative feeding difficulties in infants with macroglossia in Beckwith Wiedemann Syndrome (m-BWS) who have had tongue reduction surgery (TRS) and to pilot a bespoke feeding rating scale. Design: Retrospective consecutive case series designed with two pre-operative and one 3-month post-operative feeding assessments. A 4-point Likert-type scale was developed and applied retrospectively to describe the feeding behaviors for liquids, purées, and solids. Descriptive and non-parametric statistics were used. Setting: National service for children with m-BWS at a pediatric hospital. Patients: Twenty-five infants, age range 4 to 12 months at initial assessment, underwent TRS (median age = 16 months). Intervention: Tongue reduction surgery. Outcome Measure: Oral and selected pharyngeal stage feeding behaviors on liquids, purées, and solids. Results: Pre-operative profile: Most feeding difficulties arose at the oral stage due to the macroglossia impacting important lingual movements. Difficulties were found with lip seal formation, biting, bolus manipulation and tongue lateralization. Aspiration risk was found in >75%. Texture modification was indicated for purées and solids. Post-operative profile: There were statistically significant differences for each consistency pre- and post-operatively. Eighty-four percent of infants had age-appropriate drinking and eating skills. Mild residual difficulties with biting, tongue lateralization, and bolus manipulation remained for solids in four infants. Conclusions: Feeding difficulties are common pre-operatively in m-BWS, putting infants at risk of aspiration if left unmanaged. TRS was effective in reducing or eliminating them. This is the first systematic report of infant feeding in m-BWS pre- and post-TRS.
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Affiliation(s)
- Nicole Prendeville
- Speech and Language Therapy Department, Great Ormond Street Hospital, London, United Kingdom
| | - Debbie Sell
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability (ORCHID), Great Ormond Street Hospital, London, United Kingdom
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Lee KM, Seo YT. Development of a Dysphagia Screening Test for Preterm Infants (DST-PI). Ann Rehabil Med 2017; 41:434-440. [PMID: 28758081 PMCID: PMC5532349 DOI: 10.5535/arm.2017.41.3.434] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 10/10/2016] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To explore both the early prediction and diagnosis of dysphagia in preterm infants as an important developmental aspect as well as the prevention of respiratory complications, we developed the simple and-easy-to-apply Dysphagia Screening Test for Preterm Infants (DST-PI) to predict supraglottic penetration and subglottic aspiration. METHODS Fifty-two infants were enrolled in a videofluoroscopic swallowing study (VFSS) due to clinical suspicions of dysphagia. Thirteen items related to supraglottic penetration or subglottic aspiration were initially selected from previous studies for the DST-PI. Finally, 7 items were determined by linear logistic regression analysis. Cutoff values, sensitivity, specificity, and the area under the ROC curve (AUC) of the DST-PI for predicting supraglottic penetration or subglottic aspiration were calculated using a ROC curve. For inter-rater reliability, the kappa coefficient was calculated. RESULTS Seven items were selected: 'gestational age,' 'history of apnea,' 'history of cyanosis during feeding,' 'swallowing pattern,' 'coughs during or after feeding,' 'decreased oxygen saturation within 3 minutes of feeding,' and 'voice change after feeding.' The Spearman correlation coefficient between the DST-PI and the penetration-aspiration scale (PAS) was 0.807 (p<0.001). The sensitivity and specificity at different cutoff values for detecting supraglottic penetration and subglottic aspiration were 96.6% and 76.9% at 3.25, and 88.9% and 75.8% at 6.25, respectively. CONCLUSION The DST-PI is a valid and reliable dysphagia screening test for supraglottic penetration or subglottic aspiration in preterm infants that is easy to apply in a clinical context.
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Affiliation(s)
- Kyoung Moo Lee
- Department of Rehabilitation Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Young Tak Seo
- Department of Rehabilitation Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
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Calvo I, Conway A, Henriques F, Walshe M. Diagnostic accuracy of the clinical feeding evaluation in detecting aspiration in children: a systematic review. Dev Med Child Neurol 2016; 58:541-53. [PMID: 26862075 DOI: 10.1111/dmcn.13058] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2015] [Indexed: 11/28/2022]
Abstract
The aim of this systematic review is to determine the diagnostic accuracy of clinical feeding evaluation (CFE) compared to instrumental assessments in detecting oropharyngeal aspiration (OPA) in children. This is important to support clinical decision-making and to provide safe, cost-effective, higher quality care. All published and unpublished studies in all languages assessing the diagnostic accuracy of CFE compared to videofluoroscopic swallowing study (VFSS) and/or fibre-optic endoscopic examination of swallowing (FEES) in detecting OPA in paediatric populations were sought. Databases were searched from inception to April 2015. Grey literature, citations, and references were also searched. Two independent reviewers extracted and analysed data. Accuracy estimates were calculated. Research reports were translated into English as required. Six studies examining the diagnostic accuracy of CFE using VFSS and/or FEES were eligible for inclusion. Sample sizes, populations studied, and CFE characteristics varied widely. The overall methodological quality of the studies, assessed with QUADAS-2, was considered 'low'. Results suggested that CFEs trialling liquid consistencies might provide better accuracy estimates than CFEs trialling solids exclusively. This systematic review highlights the critical lack of evidence on the accuracy of CFE in detecting OPA in children. Larger well-designed primary diagnostic test accuracy studies in this area are needed to inform dysphagia assessment in paediatrics.
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Affiliation(s)
- Irene Calvo
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland.,Department of Neurorehabilitation Sciences, Casa Cura Policlinico, Milano, Italy
| | - Aifric Conway
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland
| | - Filipa Henriques
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland
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Barbosa LDR, Gomes E, Fischer GB. [Clinical signs of dysphagia in infants with acute viral bronchiolitis]. REVISTA PAULISTA DE PEDIATRIA 2014; 32:157-63. [PMID: 25479843 PMCID: PMC4227334 DOI: 10.1590/0103-0582201432302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 03/24/2014] [Indexed: 12/29/2022]
Abstract
Objective: To determine the occurrence of clinical signs of dysphagia in infants with acute
viral bronchiolitis, to compare the respiratory parameters during deglutition, and
to ensure the intra- and inter- examiners agreement, as well as to accomplish
intra and interexaminators concordance of the clinical evaluation of the
deglutition. Methods: This was a cross-sectional study of 42 infants aged 0-12 months. The clinical
evaluation was accompanied by measurements of respiratory rate and pulse oximetry.
A score of swallowing disorders was designed to establish associations with other
studied variables and to ensure the intra- and interrater agreement of clinical
feeding assessments. Caregivers also completed a questionnaire about feeding
difficulties. Significance was set at p<0.05. Results: Changes in the oral phase (prolonged pauses) and pharyngeal phase (wheezing,
coughing and gagging) of swallowing were found. A significant increase in
respiratory rate between pre- and post-feeding times was found, and it was
determined that almost half of the infants had tachypnea. An association was
observed between the swallowing disorder scores and a decrease in oxygen
saturation. Infants whose caregivers reported feeding difficulties during
hospitalization stated a significantly greater number of changes in the swallowing
evaluation. The intra-rater agreement was considered to be very good. Conclusions: Infants with acute viral bronchiolitis displayed swallowing disorders in addition
to changes in respiratory rate and measures of oxygen saturation. It is suggested,
therefore, that infants displaying these risk factors have a higher probability of
dysphagia.
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Affiliation(s)
- Lisiane De Rosa Barbosa
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brasil.
| | - Erissandra Gomes
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
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Heggie AAC, Vujcich NJ, Portnof JE, Morgan AT. Tongue reduction for macroglossia in Beckwith Wiedemann syndrome: review and application of new technique. Int J Oral Maxillofac Surg 2012; 42:185-91. [PMID: 23041202 DOI: 10.1016/j.ijom.2012.09.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 07/31/2012] [Accepted: 09/05/2012] [Indexed: 10/27/2022]
Abstract
Beckwith Wiedemann syndrome (BWS) is a rare, congenital overgrowth disorder that is characterized by macroglossia, anterior abdominal wall defects, visceromegaly, gigantism, and neonatal hypoglycaemia. Macroglossia may contribute to anterior open bite malocclusion with prognathism, speech articulation disturbances, drooling and the perception of intellectual disability. It was the purpose of this study to review a series of BWS patients who underwent surgical reduction of the tongue by a modified technique with respect to aesthetic and functional outcomes. Seven BWS patients, age 6 months to 21 months, had a 'stellate/anterior wedge' reduction with an anterior rotation flap and were followed up from 4 months to 9 years postoperatively. Assessment of aesthetics together with tongue morphology and mobility were recorded and a postoperative speech evaluation was performed. Minor contour deformities were present in two patients during function but all parents were satisfied with the results. The speech pathology assessment results indicated positive outcomes for speech, oral structure and function, and feeding for all children assessed. This modified technique allows for an adequate reduction of tongue volume with conservation of motor and sensory function as well as preservation of anatomical contour.
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Affiliation(s)
- A A C Heggie
- Department of Plastic and Maxillofacial Surgery, Royal Children's Hospital, Melbourne, Australia.
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