Oral and non-oral sensorimotor interventions enhance oral feeding performance in preterm infants.

AIM: The aim of this study was to determine whether oral, tactile/kinaesthetic (T/K), or combined (oral+T/K) interventions enhance oral feeding performance and whether combined interventions have an additive/synergistic effect. METHOD: Seventy-five preterm infants (mean gestational age 29 wk; standard error of the mean [SEM] 0.3 wk; mean birthweight 1340.3g; SEM 52.5 g; 49 males and 26 females) were randomly assigned to one of three intervention groups or a control group. The oral group received sensorimotor input to the oral structures, the T/K group received sensorimotor input to the trunk and limbs, and the combined group received both. The outcomes were time from introduction of nipple feeding to independent oral feeding (d), proficiency (intake in the first 5 min, %), volume transfer (%), rate of transfer (mL/min), volume loss (%), and length of hospital stay (d). RESULTS: Infants in the three intervention groups achieved independent oral feeding 9-10 days earlier than those in the control group (p<0.001; effect size 1.9-2.1). Proficiency (p ≤ 0.002; effect size 0.7-1.4) at the time of one to two and three to five oral feedings per day, volume transfer (p ≤ 0.001; effect size 0.8-1.1) at one to two, three to five, and six to eight oral feedings per day, and overall rate of transfer (p ≤ 0.018; effect size 0.8-1.1) were greater, and overall volume losses were less (p ≤ 0.007; effect size 0.9-1.1), than in the control group (p ≤ 0.042). The combined group attained independent oral feeding at a significantly younger postmenstrual age than controls (p=0.020) and had clinically greater proficiency than the T/K group (p=0.020; effect size 0.7) and oral group (p=0.109; effect size 0.5). Length of hospital stay was not significantly different between groups (p=0.792; effect size 0.02-0.3). INTERPRETATION: Oral and T/K interventions accelerated the transition from introduction to independent oral feeding and enhanced oral feeding skills. T/K has beneficial effects beyond the specific targeted system. The combined sensorimotor intervention led to an additive/synergistic effect for proficiency, further benefiting this population.

Sensorimotor interventions improve growth and motor function in preterm infants.

PURPOSE: To assess the effect of an oral (O+O), a tactile/kinesthetic (T/K+T/K), and a combined (O+T/K) intervention on preterm infants' weight gain and motor function and to determine whether the combined O+T/K intervention has an additive/synergistic effect on outcomes. DESIGN/SAMPLE: Seventy-five preterm infants were randomized into an O+O intervention consisting of oral stimulation, a T/K+T/K intervention involving whole body stimulation, an O+T/K intervention, and a control group. Interventions were administered for 15 minutes, twice a day, for ten days. OUTCOMES: Weight gain, motor function. RESULTS: The O+O and T/K+T/K groups had greater weight gain during the intervention period than did controls (p ≤.025). The T/K+T/K and O+T/K groups had better motor function than did controls (p ≤.017). CONCLUSION: Single and combined interventions improved growth and motor function. The combined intervention, because of the shorter duration of each modality, did not lead to additive/synergistic effects, suggesting that the duration of the sensorimotor input is as important as its target in achieving defined outcomes.

Psychometric testing of the McGill Ingestive Skills Assessment.

The goal of this study was to determine the psychometric properties of the McGill Ingestive Skills Assessment. Interrater and intrarater reliability and score stability were tested using repeated administration of this test. The Functional Independence Measure and Modified Mini-Mental State Examination, as well as patient characteristics, were used to determine the validity of the assessment. One hundred and two persons with ingestive skill loss of neurologic origin were evaluated. Intraclass correlations for interrater, intrarater reliability and stability reached or surpassed 0.80 for most subscales. In validity testing, significant relationships were found between McGill Ingestive scores and Functional Independence Measure and Mini-Mental scores, as well as with patient characteristics. It is concluded that the McGill Ingestive Skills Assessment approaches or meets levels of reliability necessary for assessing patients and is valid for adults with neurogenic feeding difficulties residing in tertiary care facilities.

Assessment of feeding performance in patients with cerebral palsy.

Patients with cerebral palsy (CP) frequently manifest oral-ingestive problems ranging from mild to severe. Drooling, rejection of solid foods, choking, coughing and spillage during eating may contribute to these problems. The aim of this study was to assess functional feeding skills of patients with CP, aged 4-25 years. They were assessed with the Modified Functional Feeding Assessment Scale (FFAm). Mothers had expressed concern regarding drooling and reluctance in accepting solid foods. None of the mothers thought that there was a major problem with adequate ingestion. However, the study revealed that patients had disabilities in spoon feeding, biting, chewing, cup drinking, straw drinking, swallowing and clearing.

Association of occlusion with eating efficiency in children with cerebral palsy and moderate eating impairment.

PURPOSE: This study focused on the contribution ofthe dental occlusion to chewing efficiency in a group of children with cerebral palsy (CP). METHODS: Twenty children aged 8.3 +/- 0.9 years participated in this study. Chewing efficiency was measured and biting and drinking skills were noted. Occlusion was determined from extra- and intra-oral photographs and from orthodontic plaster models. RESULTS: Significant correlatons were found between chewing efficiency and age (r:0.6, P=.006) and the total number of posterior teeth (r:0.7, P<.001). A marginally significant negative correlation was found between the total number of teeth and chewing time for the viscous texture (r:-0.4, P=.06). CONCLUSIONS: A possible association between chewing efficiency and occlusal wear may exist, but will need further examination. There was also a higher frequency of drooling (23%) in children who had an open bite compared to those with a normal bite. These results suggested that occlusal problems affected the efficiency of ingestion in children with CP.

Compliance with administration procedures of tests for children with pervasive developmental disorders: does it exist?

BACKGROUND: There are no specific tools to evaluate functional performance that accommodate the special needs of children with pervasive developmental disorders (PDD). METHOD: Pediatric occupational therapists in Quebec were surveyed to identify assessments that are currently being used, the modifications made, and the use of results for treatment planning and service recommendations. RESULTS: Results from 59 therapists treating children with PDD indicated that 52 different assessments, both standardized and non-standardized, were used. Standardized tests were used infrequently and were rarely administered without modifications. Equal weight is attributed to the results from standardized and non-standardized tests and clinical observations for the purpose of treatment planning and services. PRACTICE IMPLICATIONS: This study highlights the need for practice parameters that would guide the assessment process and create a consensus among therapists and practice centres.

Oral and nonoral sensorimotor interventions facilitate suck-swallow-respiration functions and their coordination in preterm infants.

BACKGROUND: Preterm infants are at high risk of encountering oral feeding difficulties. Early sensorimotor interventions may improve oral feeding skills in preterm infants. AIM: To further explore the effects of an oral (O), tactile/kinesthetic (T/K), and combined (O+T/K) sensorimotor intervention on preterm infants' nutritive sucking, swallowing and their coordination with respiration. STUDY DESIGN: Seventy-five infants (29 [0.3, standard error of mean, SEM] weeks gestation, 49 males/26 females) were randomly assigned to an O group involving sensorimotor input to the oral structures; a T/K group involving sensorimotor input to the trunk and limbs; a combined (O+T/K) group; and a control group. OUTCOME MEASURES: Stage of sucking, suction and expression amplitudes (mmHg), suck-swallow ratio, stability of suck-swallow interval, and swallow-respiration patterns. RESULTS: The O group had significantly more advanced sucking stages, and greater suction and expression amplitudes than controls [p≤0.035, effect size (ES) >0.6]. The suck-swallow ratio and stability of suck-swallow intervals did not significantly differ among groups (p≥0.181, ES≤0.3). The three interventions led to fewer swallows bracketed by prolonged respiratory pauses compared to controls (pause-swallow-pause, p≤0.044, ES≥0.7). The T/K and combined (O+T/K) groups had greater occurrence of swallows bracketed by expiration than the control and O groups (expiration-swallow-expiration, p≤0.039, ES≥0.3). CONCLUSION: The O intervention enhanced specific components of nutritive sucking. All three interventions resulted in improved swallow-respiration coordination. Sensorimotor interventions have distributed beneficial effects that go beyond the specific target of input.

The McGill ingestive skills assessment predicts time to death in an elderly population with neurogenic dysphagia: preliminary evidence.

The McGill Ingestive Skills Assessment (MISA) is a new assessment tool which quantifies the ingestive process by scoring a meal observation. The reliability and the construct validity of the MISA have been documented. However, establishment of the ability of the MISA to predict health outcomes related to feeding difficulties would support its applicability in research and in clinical settings. Seventy-three participants of a large-scale reliability and validity study were followed for up to 563 days following evaluation with the MISA. The date of the first pulmonary infection and the date and cause of death where applicable were obtained from medical records. Individuals with no incident of pulmonary infection and who were not deceased were "censored" at the date of followup. Survival analyses revealed that the MISA scores are predictive of death using a Cox proportional hazards model, and of time to pulmonary infection using a flexible model. Scores on the Solid Ingestion and Self-feeding scales are predictive of death using the Cox model, and the Texture Management scale is predictive of death using the flexible model. This effect remains statistically significant even when MISA scores are adjusted for the participant's age. These findings support the validity of the MISA for use with elderly individuals with neurogenic ingestive skill loss residing in long-term care facilities.

McGill Ingestive Skills Assessment (MISA): development and first field test of an evaluation of functional ingestive skills of elderly persons.

There is a lack of reliable and valid clinical assessment tools for individuals with loss of ingestive skills. The McGill Ingestive Skills Assessment (MISA) was developed to facilitate the reliable and valid bedside assessment of elderly persons with feeding difficulties. Items were generated by a literature review and selected with the collaboration of a multidisciplinary team. The first version of the MISA comprised 190 items in 7 scales, covering the domains of medical history, mealtime environment, physical characteristics of the patient, food textures consumed, solid ingestion, liquid ingestion, and behaviors related to self-feeding. The first field test for item selection included 50 individuals, aged 60 years and older, living in the community, supervised housing, and long-term care centers. After field testing, 134 items were eliminated due to poor face validity, redundancy, or poor psychometric performance. The remaining 56 items were provided with 4 response categories and were reorganized into 5 scales. The revised version was field tested to determine its preliminary psychometric properties on 33 individuals, 60 years of age and older, residing in a long-term care center. Six items were eliminated due to redundancy after the second field test. Analyses of the revised version resulted in the elimination of another 6 items that were redundant or that demonstrated poor reliability. Internal consistency of all scales is > or = 0.86 and interrater agreement is > or = 0.92. These analyses suggest that the psychometric properties of the MISA are adequate for diagnosis and treatment planning. This supports its readiness for clinical use following further reliability and validity testing with a larger sample.

Feeding management of children with severe cerebral palsy and eating impairment: an exploratory study.

Some children with cerebral palsy and severe feeding impairment experience pulmonary complications from aspiration and gastroesophageal reflux. This exploratory study examined whether pulmonary function would improve following one year of intervention with optimal positioning for feeding, control of gastroesophageal reflux and use of food textures that would minimize aspiration from swallowing. Two children showed a 28% and 45% improvement, respectively, in functional residual capacity. One child experienced a 37% improvement in total respiratory resistance and a 284% improvement in respiratory compliance. All children gained sufficient weight to maintain their growth trajectories but only one who was changed from oral to tube feeding due to aspiration showed catch-up growth in length. One child showed pathological gastroesophageal reflux that was controlled medically throughout the study period. Although all children experienced pulmonary illnesses during the one year of follow up, control of aspiration permitted a clinically significant improvement of their pulmonary obstructive syndrome Further study is needed to more fully determine the effect of this treatment approach on pulmonary function.

Infant sucking ability, non-organic failure to thrive, maternal characteristics, and feeding practices: a prospective cohort study.

This prospective study examined the relation of neonatal sucking to later feeding, postnatal growth, maternal postpartum depression, and feeding practices. Healthy infants of at least 37 weeks gestational age were recruited. At 1 week of age, a strain-gage device was attached to the infant's cheeks during sucking to identify sucking efficiency. Two-hundred and two infants (100 males, 102 females; mean age 39.6 weeks, SD 1.1 weeks) with efficient sucking and 207 (101 males, 106 females; mean gestational age 39.4 weeks, SD 1.2 weeks) with inefficient sucking were identified. Growth was measured at 2, 6, 10, and 14 months. Mothers completed a feeding questionnaire and the Edinburgh Postnatal Depression Scale at the same testing points. While 18 infants (5%) showed a downward shift in growth, their clinical picture did not present as non-organic failure to thrive (NFTT). Inefficient neonatal sucking did not predict postnatal growth, later feeding difficulties, nor maternal feeding practices, but concurrent inefficient feeding did. Maternal depression did not affect feeding practices, infant feeding abilities, nor growth, suggesting that the importance of maternal postpartum depression in association with feeding may be less than previously assumed. The term NFTT, therefore, merits reexamination and a more focused definition.