Oral Motor Therapy and feeding Critically Appraised Topic Does Oral Sensorimotor Therapy Improve Oral Skills in Feeding in Children with a Disability?

Oral Motor Oral Motor Therapy Therapy

and feedingand feeding Critically Appraised

Topic Does Oral Sensorimotor Therapy Improve Oral Skills in Feeding in Children with a Disability?

method usedmethod used1. Defined our questions2. Refined our questions - PICO

Population - the client groupPopulation - the client group InterventionIntervention Comparison interventionComparison intervention OutcomeOutcome

3. Completed searches + hand searched additional references

4. Selected articles from title, abstract information and ordered them

5. Reviewed the articles re: level of evidence, points of interest to allied health professionals

6. Developed a clinical bottom line

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answerable answerable questionquestion

Population

Intervention

Comparison

Outcome

Children with a disability

Oral motor/ Sensorimotor therapy

None Improve oral motor skills in feeding

PubMED, CINAHL, OVID, MedlineThe Spastic Centre 2006

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ObjectiveObjective

The Paediatric Feeding Interest Group (PFIG) members who worked in disability were interested in determining the efficacy of oral motor therapy in this population, as it is a widely used therapy.

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resultsresults7Level of Evidence # Source of

Evidence Level 1 evidence Level 2 evidence 2 Level 3 evidence 3

Medline, PubMED, OVID, CINAHL

Level 4 evidence 1

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Gisel (1994) Gisel (1994)

Limited (but not significant) improvements in the eating domains (spoon feeding, biting, chewing) but not in drinking.

As a group children maintained their weight but did not have catch up growth.

Most improvements seen over a 20 week periodNo significant treatment difference between

chewing only therapy vs sensorimotor therapyType of sensorimotor therapy was tailored to the

individual – therefore not consistent approach.

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Gisel (1996)Gisel (1996)

No significant changes in feeding times or mealtime duration across the group – no significant difference in any group because of large variations within each group.

All children maintained weight but no catch-up growth.

Many confounding variables noted eg. Health status, degree of disability and ambulatory status

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Level 2

Ottenbacher Ottenbacher (1983)(1983)

Mixed results – 4 subjects: 2 subjects improved their oral motor evaluation score, 2 subjects declined slightly. 2 subjects increased their weight and 2 subjects showed decreased weight.

Lack of homogeneity between subjects (in regards to age / weight) – several variables.

Results are mixed and the study is unclear about which changes are statistically significant

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Level 3

Gisel et al (1995)Gisel et al (1995)

No significant changes in eating efficiency (eating time) in response to treatment. Children maintained their weight: age and skinfold:age measurements but there was no catch up growth.

Articles suggested that increased texture may not improve eating time or growth but may improve oral skills (as occurred in a small number of subjects).

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Level 3

Gisel et al (1996)Gisel et al (1996)

Some significant improvements noted in spoon feeding, normal chewing and swallowing but no control group to compare results (cohort study). Non-aspiration group did better than aspiration group.

No significant improvements in weight gain.

Study had too many variables, large age range. Compliance with daily treatment was 68%.

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Level 3

Davies (2003)Davies (2003)

Articles reviewed varied. Limited evidence to suggest that children with moderate feeding difficulties improved oral motor skills with oromotor treatment.

No significant evidence to suggest that oral motor therapy results in decreased mealtime duration or increased weight gain.

No evidence to support that oral motor treatment results in improved clearance from the pharynx.

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Level 4 –

Topic: clinical Topic: clinical bottom linebottom line

The search results gave insufficient high quality evidence available to suggest that oral motor treatment improves eating skills / weight gain – growth / time taken to eat a meal / oral motor skills.

Studies showed small but not significant changes across these domains and factors such as health status, disability and ambulatory status may have influenced treatment outcomes.

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Clinical Practice Clinical Practice

In clinical practice, clinicians need to be In clinical practice, clinicians need to be aware that the evidence for oral motor aware that the evidence for oral motor treatment is limited however it may be treatment is limited however it may be used in conjunction with other treatment used in conjunction with other treatment programs and in conjunction with programs and in conjunction with feeding. feeding.

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acknowledgmentsacknowledgments

Jenny Wood Dorothea Gray Sudi

Veerabangsa Lenore Scali Liora Ballin Helen McLaren

Harriet Korner Hayley

Smithers- Sheedy

Alison Wu Lisa Hanley Jenny Lee

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referencesreferences1. Gisel, E.G. (1994) “Oral Motor Skills Following Sensorimotor Intervention in the

Moderately Eating Impaired Child with Cerebral Palsy” Dysphagia 9: 180-192.

2. Gisel, E.G. (1996) “Effect of Oral Sensorimotor Treatment on measures of Growth and Efficiency of Eating in the Moderately Eating Impaired Child with Cerebral Palsy. Dysphagia 11: 48-58.

3. Ottenbacher, K., Hicks, J., Roark, A. & Swinea, J. (1983) “Oral Sensorimotor Therapy in the Developmentally Disabled: A Multiple baseline study.” The American Journal of Occupational Therapy 37:8, 541-547.

4. Gisel, EG., Applegate-Ferrante, T., Benson, JE. & Bosma, JF. (1995) “Effect of Oral Sensorimotor Trreatment on Measures of Growth, Eating Efficiency and Aspiration in the Dysphagic Child with Cerebral Palsy”. Developmental Medicine and Child Neurology 37, 528-543.

5. Gisel, EG., Applegate-Ferrante, T., Benson, JE. & Bosma, JF. (1996) “Oral-motor skills following Sensorimotor Therapy in two groups of moderately Dysphagic Children with Cerebral Palsy: Aspiration vs Nonaspiration.” Dysphagia11, 59-71.

6. Davies, F. (2003) “Does the end justify the means? A critique of oromotor treatment in children with cerebral palsy.” Asia Pacific Journal of Speech, Language and Hearing 8,146-152

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PFIG EBP LeadersPFIG EBP Leaders

Alana Lum [email protected]

Anna Bechabech@tscnsw

.org.auThe Spastic Centre 2006

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