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El Nagar R, AL-Nemr A, Abdelazeim F. Effect of oromotor exercises on feeding in children with cerebral palsy: systematic review. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2021. [DOI: 10.1186/s43161-021-00054-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Feeding problems are prevalent in children with cerebral palsy (CP). Oromotor exercises (OME) should be started as soon as possible to enhance chewing and drooling. Oromotor exercises consist of active exercises, passive exercises, and sensory stimulation. The purpose of this review is to evaluate the effectiveness of oromotor exercises on feeding, chewing, and drooling in children with CP.
Body
The American Academy for Cerebral Palsy and Developmental Medicine and Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology were used to conduct a systematic review. Four databases (PubMed, Cochrane Library, PEDro, and Google Scholar) were searched; this review includes seven articles, participants were 173 participants ranging in age from 18 months to 18 years. Articles were assessed according to their level of evidence and quality assessment was done by AACPDM, PEDro scale, and JBI scale. Due to the heterogeneity across included studies, descriptive analysis was performed on all of them. Primary outcomes were chewing and drooling. Results showed the effectiveness of OME in improving drooling, but with weak evidence while not effective in improving chewing.
Conclusion
High-quality studies are required to develop a firm judgment on the influence of oromotor exercises on feeding. The current level of evidence to support the effectiveness of oromotor exercises in children with CP is currently insufficient.
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Riva A, Federici C, Piccolo G, Amadori E, Verrotti A, Striano P. Exploring treatments for drooling in children with neurological disorders. Expert Rev Neurother 2020; 21:179-187. [PMID: 33222543 DOI: 10.1080/14737175.2021.1855146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Introduction: Drooling represents a major problem in the every-day life of pediatric patients with neurological disorders. The significant burden, both physical and socio-psychological, of the disorder requires adequate clinical evaluation and proper management. However, treating drooling remains a challenge for clinicians. This is a review of the most up-to-date therapeutic options for the treatment of drooling in the pediatric population, hence both conservative, pharmacological, and surgical approaches are discussed. Areas covered: Randomized clinical trials (RCTs), structured reviews, and case reports are included. Special focus is paid on the methods used to evaluate the efficacy and safety outcomes in the selected RCTs, trying to promote the use of more validated scales to assess drooling in the future. Expert opinion: The lack of reliable metrics to assess efficacy and safety outcomes in drooling limits researchers from identifying the best patient-suitable treatment. The relatively small number of clinical trials carried out over the last two decades is also due to the difficulty in assessing drooling using subjective scales. A key enabler for new efficient therapies stands in the introduction of accurate and robust metrics to measure treatment effectiveness on drooling.
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Affiliation(s)
- Antonella Riva
- Pediatric Neurology and Muscular Diseases Unit, IRRCS Istituto Giannina Gaslini , Genova, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Università Degli Studi di Genova , Genova, Italy
| | - Camilla Federici
- Pediatric Neurology and Muscular Diseases Unit, IRRCS Istituto Giannina Gaslini , Genova, Italy
| | - Gianluca Piccolo
- Pediatric Neurology and Muscular Diseases Unit, IRRCS Istituto Giannina Gaslini , Genova, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Università Degli Studi di Genova , Genova, Italy
| | - Elisabetta Amadori
- Pediatric Neurology and Muscular Diseases Unit, IRRCS Istituto Giannina Gaslini , Genova, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Università Degli Studi di Genova , Genova, Italy
| | - Alberto Verrotti
- Department of Pediatrics, Università Degli Studi dell'Aquila , University of Perugia, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, IRRCS Istituto Giannina Gaslini , Genova, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Università Degli Studi di Genova , Genova, Italy
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Mikami DLY, Furia CLB, Welker AF. Addition of Kinesio Taping of the orbicularis oris muscles to speech therapy rapidly improves drooling in children with neurological disorders. Dev Neurorehabil 2019; 22:13-18. [PMID: 28933983 DOI: 10.1080/17518423.2017.1368729] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the effects of Kinesio Taping (KT) of the orbicularis oris muscles as an adjunct to standard therapy for drooling. METHODS Fifteen children with neurological disorders and drooling received speech therapy and twice-weekly KT of the orbicularis muscles over a 30-day period. Drooling was assessed by six parameters: impact on the life of the child and caregiver; severity of drooling; frequency of drooling; drooling volume (estimated by number of bibs used); salivary leak; and interlabial gap. Seven markers of oral motor skills were also assessed. RESULTS KT of the orbicularis oris region reduced the interlabial gap. All oral motor skills and almost all markers of drooling improved after 15 days of treatment. CONCLUSION In this sample of children with neurological disorders, adding KT of the orbicularis oris muscles to speech therapy caused rapid improvement in oral motor skills and drooling.
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Affiliation(s)
- Denise Lica Yoshimura Mikami
- a Departamento de Pós-Graduação em Ciência e Tecnologia em Saúde , Universidade de Brasília (UNB) , Campus Ceilândia, Brasília, Brazil
| | - Cristina Lemos Barbosa Furia
- a Departamento de Pós-Graduação em Ciência e Tecnologia em Saúde , Universidade de Brasília (UNB) , Campus Ceilândia, Brasília, Brazil
| | - Alexis Fonseca Welker
- a Departamento de Pós-Graduação em Ciência e Tecnologia em Saúde , Universidade de Brasília (UNB) , Campus Ceilândia, Brasília, Brazil
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Martín-Ruiz ML, Máximo-Bocanegra N, Luna-Oliva L. A Virtual Environment to Improve the Detection of Oral-Facial Malfunction in Children with Cerebral Palsy. SENSORS 2016; 16:444. [PMID: 27023561 PMCID: PMC4850958 DOI: 10.3390/s16040444] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 03/17/2016] [Accepted: 03/21/2016] [Indexed: 11/16/2022]
Abstract
The importance of an early rehabilitation process in children with cerebral palsy (CP) is widely recognized. On the one hand, new and useful treatment tools such as rehabilitation systems based on interactive technologies have appeared for rehabilitation of gross motor movements. On the other hand, from the therapeutic point of view, performing rehabilitation exercises with the facial muscles can improve the swallowing process, the facial expression through the management of muscles in the face, and even the speech of children with cerebral palsy. However, it is difficult to find interactive games to improve the detection and evaluation of oral-facial musculature dysfunctions in children with CP. This paper describes a framework based on strategies developed for interactive serious games that is created both for typically developed children and children with disabilities. Four interactive games are the core of a Virtual Environment called SONRIE. This paper demonstrates the benefits of SONRIE to monitor children’s oral-facial difficulties. The next steps will focus on the validation of SONRIE to carry out the rehabilitation process of oral-facial musculature in children with cerebral palsy.
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Affiliation(s)
- María-Luisa Martín-Ruiz
- Department of Telematic and Electronic Engineering, Technical University of Madrid, Madrid 28031, Spain.
| | - Nuria Máximo-Bocanegra
- Department of Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences Rey Juan Carlos University, Alcorcón, Madrid 28922, Spain.
| | - Laura Luna-Oliva
- Department of Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences Rey Juan Carlos University, Alcorcón, Madrid 28922, Spain.
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Controversies in the Management of Pediatric Sialorrhea. CURRENT OTORHINOLARYNGOLOGY REPORTS 2015. [DOI: 10.1007/s40136-014-0073-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sığan SN, Uzunhan TA, Aydınlı N, Eraslan E, Ekici B, Calışkan M. Effects of oral motor therapy in children with cerebral palsy. Ann Indian Acad Neurol 2013; 16:342-6. [PMID: 24101813 PMCID: PMC3788277 DOI: 10.4103/0972-2327.116923] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 12/09/2012] [Accepted: 01/28/2013] [Indexed: 11/04/2022] Open
Abstract
AIM Oral motor dysfunction is a common issue in children with cerebral palsy (CP). Drooling, difficulties with sucking, swallowing, and chewing are some of the problems often seen. In this study, we aimed to research the effect of oral motor therapy on pediatric CP patients with feeding problems. MATERIALS AND METHODS Included in this single centered, randomized, prospective study were 81 children aged 12-42 months who had been diagnosed with CP, had oral motor dysfunction and were observed at the Pediatric Neurology outpatient clinic of the Children's Health and Diseases Department, Istanbul Medical Faculty, Istanbul University. Patients were randomized into two groups: The training group and the control group. One patient from the training group dropped out of the study because of not participating regularly. Following initial evaluation of all patients by a blinded physiotherapist and pedagogue, patients in the training group participated in 1 h oral motor training sessions with a different physiotherapist once a week for 6 months. All patients kept on routine physiotherapy by their own physiotherapists. Oral motor assessment form, functional feeding assessment (FFA) subscale of the multidisciplinary feeding profile (MFP) and the Bayley scales of infant development (BSID-II) were used to evaluate oral motor function, swallowing, chewing, the gag reflex, the asymmetrical tonic neck reflex, tongue, jaw, and mouth function, severity of drooling, aspiration, choking, independent feeding and tolerated food texture during the initial examination and 6 months later. RESULTS When the initial and post-therapy FFA and BSID-II scores received by patients in the training and the study group were compared, the training group showed a statistically significant improvement (P < 0.05). CONCLUSION Oral motor therapy has a beneficial effect on feeding problems in children with CP.
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Affiliation(s)
- Seray Nural Sığan
- Department of Pediatric Neurology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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Secondary Effects of Botulinum Toxin Injections Into Salivary Glands for the Management of Pediatric Drooling. J Craniofac Surg 2013; 24:28-33. [DOI: 10.1097/scs.0b013e31827102a0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Arvedson J, Clark H, Lazarus C, Schooling T, Frymark T. The effects of oral-motor exercises on swallowing in children: an evidence-based systematic review. Dev Med Child Neurol 2010; 52:1000-13. [PMID: 20497451 DOI: 10.1111/j.1469-8749.2010.03707.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of this unregistered evidence-based systematic review was to determine the state and quality of evidence on the effects of oral motor exercises (OME) on swallowing physiology, pulmonary health, functional swallowing outcomes, and drooling management in children with swallowing disorders. METHOD A systematic search of 20 electronic databases was completed to identify relevant peer-reviewed literature published in English between 1960 and 2007. Experimental or quasi-experimental design studies examining OME as a treatment for children with swallowing disorders were appraised for methodological quality by two assessors and reviewed by a third. RESULTS Sixteen studies of varying methodological quality were included. No study examining the effects of OME on pulmonary health in children was identified. The included studies incorporated a wide variety of OME, and mixed findings were noted across all of the outcomes targeted in this review. INTERPRETATION Based on the results of this evidence-based systematic review, there is insufficient evidence to determine the effects of OME on children with oral sensorimotor deficits and swallowing problems. Well-designed studies are needed to provide clinicians with evidence that can be incorporated into the preferences of the client and the clinicians' knowledge of anatomy, physiology, and neurodevelopment in the management of this group of children.
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Affiliation(s)
- Joan Arvedson
- Children's Hospital of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Alrefai AH, Aburahma SK, Khader YS. Treatment of sialorrhea in children with Cerebral Palsy: A double-blind placebo controlled trial. Clin Neurol Neurosurg 2009; 111:79-82. [DOI: 10.1016/j.clineuro.2008.09.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2007] [Revised: 09/08/2008] [Accepted: 09/12/2008] [Indexed: 10/21/2022]
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Shama L, Connor NP, Ciucci MR, McCulloch TM. Surgical treatment of dysphagia. Phys Med Rehabil Clin N Am 2008; 19:817-35, ix. [PMID: 18940643 DOI: 10.1016/j.pmr.2008.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The role of surgery in the management of dysphagia is clear in some areas and controversial in others. Evaluation for the causes of dysphagia can elucidate conditions in which surgery can improve safety, quality of life, or both. Surgical therapy, when indicated, is safe and effective for many causes of dysphagia. This article includes a general overview of the causes of dysphagia that can be addressed successfully with surgery as well as a discussion of why surgery may be less appropriate for other conditions associated with dysphagia.
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Affiliation(s)
- Liat Shama
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792-7373, USA
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Abstract
Cerebral palsy describes a wide spectrum of motor problems caused by a nonprogressive lesion of the developing brain. It is variably associated with a variety of other developmental and medical problems that present challenges to parents and care providers alike. This article provides an overview of etiology and diagnosis, with a system-based discussion of management.
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Lamey PJ, Clifford TJ, El-Karim IA, Cooper C. Personality analysis of patients complaining of sialorrhoea. J Oral Pathol Med 2006; 35:307-10. [PMID: 16630295 DOI: 10.1111/j.1600-0714.2006.00417.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sialorrhoea, the symptom of apparent excessive secretion of saliva is a relatively uncommon complaint. Some authors consider that in the absence of clinical findings, then these patients have a psychiatric disorder masquerading as a physical illness. However, there is little evidence in the literature to support this conclusion and a detailed psychological assessment of this population has not previously been reported. METHODS In total, 18 patients and 18 age- and sex-matched controls were studied. All had a history of a complaint of excess salivation in the absence of any oral mucosal or systemic abnormality. All patients completed an Eysenck Personality Questionnaire. RESULTS There were no differences in the extroversion of psychoticism scores between the study and control group. However, the result showed significant increases in the neuroticism and Lie Scale score in the patient group. CONCLUSIONS The overall results of this study indicate that the complaint of sialorrhoea in otherwise healthy individuals does not have an organic basis and suggest that sialorrhoea is associated with high levels of neuroticism and a tendency to dissimulate.
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Affiliation(s)
- P-J Lamey
- Oral Science Research Centre, School of Dentistry, Queen's University Belfast, Belfast, Northern Ireland, UK.
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Bothwell JE, Clarke K, Dooley JM, Gordon KE, Anderson R, Wood EP, Camfield CS, Camfield PR. Botulinum toxin A as a treatment for excessive drooling in children. Pediatr Neurol 2002; 27:18-22. [PMID: 12160968 DOI: 10.1016/s0887-8994(02)00381-8] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Drooling is problematic for some neurologically impaired children. Botulinum toxin A injection to salivary glands has effectively reduced drooling in adults but has only recently been used to treat children. This was a preliminary study to determine the efficacy and safety of botulinum toxin in children. Children identified as having severe daily drooling were enrolled. The preinjection assessment included measurement of the amount and frequency of drool. Each parotid gland was injected with 5 U of botulinum toxin A. Follow-up was for a minimum of 16 weeks. Nine children were enrolled, 4-17 years of age. All children had moderate or severe mental retardation. At week 4, all patients had a reduced drooling frequency and eight of nine patients had a reduction in the weight of saliva. Overall, five of nine parents (55%) deemed the treatment successful. This preliminary study demonstrates that botulinum toxin A is a relatively effective treatment for some children with significant drooling without serious side effects.
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Affiliation(s)
- J E Bothwell
- Department of Pediatrics, Division of Pediatric Neurology, IWK Health Centre, Halifax, Nova Scotia, Canada
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Abstract
OBJECTIVE To study the outcome of 21 typically developing children who had been referred to the Saliva Control Clinic at the Royal Children's Hospital, Melbourne. METHOD Information was collected on various aspects of the child's health, oromotor function and severity of drooling. A follow-up telephone survey was completed by the parents of these children after a mean period of 3.4 years. Information was gathered regarding their child's drooling, current health, oromotor status and the usefulness of the clinic. RESULTS There was a statistically significant improvement (P < 0.01) in the saliva control measures analysed on follow-up. Thirteen children ceased to drool, three still drooled occasionally, and five continued to drool. The recommendations, mainly advice and referrals to other health professionals, were generally reported to be helpful by the parents. CONCLUSIONS This cohort of children was established retrospectively, and the study is therefore limited in both numbers and design. The results indicate that some typically developing children may be delayed in the development of saliva control. Parents and professionals can be reassured that this problem is likely to resolve.
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Affiliation(s)
- H Johnson
- SCIOP, Spastic Society of Victoria, St Kilda, Victoria, Australia.
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Asher RS, Winquist H. Appliance therapy for chronic drooling in a patient with mental retardation. SPECIAL CARE IN DENTISTRY 1994; 14:30-2. [PMID: 8042139 DOI: 10.1111/j.1754-4505.1994.tb01093.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Multiple physical impairments are associated with chronic drooling. This case illustrates the use of a simple appliance to align the patient's lip to provide opportunity for a lip seal when swallowing or at rest in a patient with a Class II malocclusion. The appliance resulted in a significant decrease in drooling in this patient.
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Affiliation(s)
- R S Asher
- Special Care Clinic, University of Colorado School of Dentistry
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