Prelinguistic intersubjective and socio-communicative skills in infants with neurodevelopmental disabilities aged 0-36 months: A new assessment and parent support tool.

Background: Although children with neurodevelopmental disability (NDD) present with several deficits, they partially share developmental impairments in prelinguistic intersubjective and socio-communicative skills, which are not easily assessed by conventional tests during the first years of life. Aim: The current paper presents a new procedure to assess the prelinguistic intersubjective and socio-communicative skills of NDD children aged 0-36 months. A specific observation form template, called the Observation of Prelinguistic Intersubjective and Socio-Communicative Skills (OPISCoS) form, has been designed to systematically detect infant skills during daily routines (e.g., mealtime, playtime, desk activities). The OPISCoS form helps speech therapists to provide parents support to better perceive and understand early communicative signals from their children, avoiding the risk of excessive or reduced social stimulation. Methods: The OPISCoS form is composed of three sections, namely, "Pragmatics and Communication," "Decoding," and "Expression," which are useful to delineate the communication abilities of children with NDD and are not tapped by traditional batteries. Vignettes from clinical practice illustrate and provide exemplifications for using the OPISCoS form with NDD infants and their parents. Results: The OPISCoS form was reported for two children and showed potential in detecting disrupted communicative behaviors and planning specific early interventions. Further, we observed an improvement not only in children's communicative abilities improve but also in their interactions with parents. From a clinical point of view, the OPISCoS form (1) offers an observational perspective of prelinguistic intersubjective and socio-communicative skills in infants with NDD and (2) may be useful to practitioners to enhance parents' sensitivity to their infants' communicative behavior. Conclusion: The OPISCoS form was developed in clinical practice and is based on a very preliminary description of a new observational procedure as integration for the assessment of NDD children. The OPISCoS form appears to be a useful tool for the clinical assessment of prelinguistic intersubjective and socio-communicative skills in NDD infants as well as for promoting the quality of early parenting.

Functional Evaluation of Eating Difficulties Scale to predict oral motor skills in infants with neurodevelopmental disorders: a longitudinal study.

AIM: To assess the predictive validity of the Functional Evaluation of Eating Difficulties Scale (FEEDS) on long-term eating developmental outcomes in infants with neurodevelopmental disorders. METHOD: In total, 144 infants (69 females, 75 males) aged 0 to 12 months (mean [SD] 5.34mo [3.42]) with neurodevelopmental disorders and requiring enteral nutrition support, hospitalized between January 2004 and December 2017, were included. The FEEDS was administered at the onset of hospitalization. Follow-up evaluations of feeding modalities occurred at discharge and at 6 months, 12 months, and 24 months after discharge. FEEDS score was tested as a predictor of infants' feeding modality (percutaneous endoscopic gastrostomy, nasogastric tube, mixed, oral feeding) and time to autonomous oral feeding. Percentages of false-positive and negative cases were checked. RESULTS: Lower FEEDS scores significantly predicted infants' feeding modality (0.40≤R2 ≤0.61). A 1-point increase in FEEDS score was associated with increased risk (6%-14%; p<0.05) of being non-autonomous feeders at the different follow-up points in infants who had a FEEDS score above the clinical cut-off. INTERPRETATION: The FEEDS appears to be a clinically valid assessment to predict the presence of eating difficulties in infants with neurodevelopmental disabilities. WHAT THIS PAPER ADDS: Functional Evaluation of Eating Difficulties Scale (FEEDS) significantly predicted eating difficulties in infants with neurodevelopmental disabilities. Lower FEEDS score is significantly associated with autonomous feeding at the 24-month follow-up. FEEDS cut-off identified infants at low-risk and high-risk for eating disorder.

EVALUACIÓN FUNCIONAL DE LA ESCALA DE DIFICULTADES EN LA ALIMENTACIÓN (FEEDS) PARA PREDECIR LAS HABILIDADES MOTORAS ORALES EN BEBÉS CON TRASTORNOS DEL DESARROLLO NEUROLÓGICO: UN ESTUDIO LONGITUDINAL: OBJETIVO: Evaluar la validez predictiva de la Escala de Evaluación Funcional de Dificultades de la Alimentación (FEEDS) en los resultados del desarrollo alimentario a largo plazo en lactantes con trastornos del desarrollo neurológico. MÉTODO: En total, se incluyeron 144 bebés (69 femeninos y 75 masculinos) de 0 a 12 meses (media [DE] 5.34 meses [3.42]) con trastornos del desarrollo neurológico y que requieren apoyo nutricional enteral, hospitalizados entre enero del 2.004 y diciembre de 2.017. El FEEDS se administró al inicio de la hospitalización. Las evaluaciones de seguimiento de las modalidades de alimentación ocurrieron al alta y a los 6 meses, 12 meses y 24 meses después del alta. La puntuación FEEDS se probó como un factor predictivo de la modalidad de alimentación de los bebés (gastrostomía endoscópica percutánea, sonda nasogástrica, alimentación mixta, oral) y el tiempo hasta la alimentación oral autónoma. Se verificaron los porcentajes de falsos positivos y negativos. RESULTADOS: Las puntuaciones FEEDS más bajas predijeron significativamente la modalidad de alimentación de los bebés (0.40 ≤R2 ≤0.61). Un aumento de 1 punto en la puntuación FEEDS se asoció con un mayor riesgo (6% -14%; p <0,05) de tener un patrón de alimentación no autónomos en los diferentes puntos de seguimiento en los lactantes que tuvieron una puntuación FEEDS por encima del límite clínico. INTERPRETACIÓN: Las FEEDS parecen ser una evaluación clínicamente válida para predecir la presencia de dificultades para comer en bebés con alteraciones del desarrollo neurológico.

ESCALA DE AVALIAÇÃO FUNCIONAL DE DIFICULDADES DE ALIMENTAÇÃO ( FEEDS) PARA PREDIZER HABILIDADES MOTORAS ORAIS EM LACTENTES COM TRANSTORNOS DO DESENVOLVIMENTO: UM ESTUDO LONGITUDINAL: OBJETIVO: Avaliar o valor preditivo da Escala de Avaliação Funcional de Dificuldades de Alimentacão (FEEDS) nos resultados desenvolvimentais de alimentação de longo prazo em lactentes com transtornos do desenvolvimento. MÉTODO: No total, 144 lactentes (69 do sexo feminino, 75 do sexo masculino) com idades de 0 a 12 meses (média [DP] 5,34m [3,42]) com transtornos neurodesenvolvimentais e que requeriam suporte nutricional enteral, hospitalizados entre Janeiro de 2004 e Dezembro de 2017, foram incluídos. A FEEDS foi administrada no início da hospitalização. Avaliações de acompanhamento das modalidades de alimentação ocorreram no momento da alta e com 6, 12 e 24 meses após a alta. Os escores da FEEDS foram testados como preditores da modalidade de alimentação da criança (gastrostomia percutânea endoscópica, tubo nasogástrico, mista, alimentação oral) e o tempo para a alimentação oral autônoma. Porcentagens de casos falsos positivos e falsos negativos foram checadas. RESULTADOS: Menores escores na FEEDS predizeram significativamente a modalidade de alimentação dos lacentes (0,40≤R2 ≤0,61). Um aumento de 1 ponto no escore da FEEDS foi associado com risco aumentado (6%-14%; p<0,05) de não ter alimentacão autônoma em diferentes pontos do acompanhamento em lactentes que tiveram escore FEEDS acima do ponto de corte clínico. INTERPRETAÇÃO: A FEEDS parece ser uma avaliação clinicamente válida para predizer a presença de dificuldades de alimentação em crianças com deficiências neurodesenvolvimentais.

Predictors and outcomes of the Neonatal Oral Motor Assessment Scale (NOMAS) performance: a systematic review.

The NOMAS is by far the most used tool to screen early oral-motor skills in newborns. Here we provide an updated review of scientific literature on the use of the Neonatal Oral Motor Assessment Scale (NOMAS) to screen early oral-motor skills in newborns. An integrative review has been carried out consistent with PRISMA guidelines and standardized qualitative appraisal. Data abstracting and synthesis were executed by two independent co-authors who solved disagreement in conference. Twenty records have been included and reviewed. The efficacy of the NOMAS in screening and identifying precocious oral-motor skills received inconsistent support. Moderate validity and low reliability emerged. Moreover, despite the NOMAS' adequately screen efficient and inefficient feeders, limited evidence emerged for predictive value of NOMAS score on feeding and psychomotor developmental trajectories during the first 2 years of age. CONCLUSION: The present review highlights benefits and limitations of the NOMAS. Future research is needed to develop observational and clinically-relevant tools to better identify newborns which are at lower- and higher-risk of developing less-than-optimal feeding behaviors and to guide with greater precision the diagnostic and therapeutic journey of these newborns. What is Known: • The assessment of oral-motor skills in newborns and infants is critical for early intervention • The NOMAS is the most adopted tool to assess oral-motor skills in newborns and infants What is New: • The ability of the NOMAS to target newborn at risk for feeding disorders is confirmed • Nonetheless, the capacity to predict long-term developmental outcomes is limited.

The Functional Evaluation of Eating Difficulties Scale: Study Protocol and Validation in Infants with Neurodevelopmental Impairments and Disabilities.

INTRODUCTION: A reliable and accurate evaluation of oral-motor skills in newborns at risk for swallowing and feeding disorders is key to set the goals of effective early interventions. Although many tools are available to assess oral-motor skills in newborns, limited evidence exists for what pertains their reliability and their effectivity in predicting short- and long-term developmental outcomes in at-risk infants. The aim of the present study is to develop and provide a preliminary validation of a new clinically grounded tool [i.e., the Functional Evaluation of Eating Difficulties Scale (FEEDS)] specifically designed to be used with at-risk newborns and infants. The paper describes the steps of tool development and information on the reliability of the tool are provided. METHODS/ANALYSIS: The FEEDS has been developed according to clinical evidence and expertise by a multidisciplinary team of professionals dealing with feeding problems in at-risk infants diagnosed with neurodevelopmental impairments and disabilities. The steps of FEEDS development are reported, together with a detailed description of items, scoring procedure, and clinical cutoff. The FEEDS has been applied to a relatively large sample of 0- to 12-month-old infants (N = 136) with neurodevelopmental disability, enrolled consecutively between 2004 and 2016 at the Scientific Institute IRCCS Eugenio Medea (Bosisio Parini, Italy), which is the main rehabilitation hospital for children with neurodevelopmental disabilities in Italy. Internal consistency (Cronbach's alpha) and reliability (inter-rater agreement) have been assessed. ETHICS AND DISSEMINATION: All the procedures are consistent with the World Medical Association Declaration of Helsinki (2013) and the FEEDS has been approved by the clinical committee of the Scientific Institute IRCCS Eugenio Medea. Further psychometric characteristics and evidence of the predictive validity of the FEEDS will be obtained on a larger sample and they will be reported in future publications from this group.

Cognitive-behavioural stimulation protocol for severely brain-damaged patients in the post-acute stage in developmental age.

PURPOSE: To present a cognitive-behavioural stimulation (CBS) protocol designed to help severely damaged patients in the early post-acute stage by describing the underlying methodology and assessing its efficacy compared to traditional rehabilitation methods. This protocol combines multisensory stimulation and cognitive-behavioural techniques to elicit and intensify the occurrence of adaptive responses and reduce maladaptive behavioural patterns. METHODS: A control group and an experimental group--both evaluated with the Levels of Cognitive Functioning Assessment Scale (LOCFAS)--were compared at the beginning of the rehabilitation programme and at the end of it. The control group consisting of patients assessed and treated before receiving the CBS protocol was enrolled in a traditional rehabilitation programme (only physical therapy and speech therapy). Besides the traditional therapy, the experimental group also received the CBS protocol. RESULTS: Patients on the CBS protocol show a greater improvement and are therefore more responsive than the control group after the 16-week remediation programme. The mean LOCFAS improvement of the experimental group is more marked during the first month of rehabilitation and is associated to the entry LOCFAS level, while in the control group the improvement on LOCFAS is considered to be 'spontaneous' and is associated to the aetiology of the brain damage. CONCLUSIONS: Our results show a better initial outcome for patients receiving the CBS protocol.